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How to Use an Insulin Pump to Bolus for Pizza

Written by: Kourtney Johnson

6 minute read

January 10, 2025

Mastering pizza nights: Bolusing with an insulin pump made simple

You’re out to dinner with friends, and could really go for a hot, cheesy slice of pizza. You have diabetes and wear an insulin pump, but you seriously doubt it can bolus effectively for such a high-carb meal.

An insulin pump can be used for dosing insulin for pizza because it allows for precise insulin delivery and autocorrections, which help manage the slower digestion of high-carb foods. This helps maintain better glucose control after a meal like pizza, which can cause delayed glucose spikes.

What are Insulin Pumps?

Diabetes technology has come a long way in recent years.

Insulin pumps are part of an automated insulin delivery (AID) system, which also includes a continuous glucose monitor (CGM) and an algorithm. These are medical devices that deliver and suspend insulin and are designed to make your life with diabetes easier.

AIDs can:

What is an Insulin Pump Bolus?

A bolus is a dose of insulin delivered by the AID system to manage sugar levels when food is eaten so you stay within a safe range.

A meal bolus is typically taken before meals or to correct high blood glucose levels. A correction bolus can be used to adjust insulin doses based on blood glucose readings. The correction can be used when more than an hour has passed since eating, or if high glucose and low active insulin are detected.

The biggest advantage of a bolus is that it provides you with energy by allowing the glucose in your blood to enter your cells.

Bolus doses change with each meal, and some foods—like pizza—require different insulin regimens than others.

What Are Insulin Needs for Pizza?

A typical pizza contains fat, protein, and carbohydrates. Carbs raise blood sugar levels when digested, but fat and protein can affect them as well.

Both protein and fat are digested more slowly than carbs, which means there will often be a delayed spike in blood-sugar levels—usually several hours after eating.

Caroline Thomason, RD, CDCES, is based in Washington, D.C. Thomason explains that pizza presents a challenge for those with diabetes because of its high fat and carb content, which makes it hard to accurately forecast and control blood sugar levels. A standard bolus dose of insulin might not be enough to manage the delayed spike in blood sugar levels.

When giving a bolus for pizza with an insulin pump, Thomason says one common approach is to split the bolus dose into two parts: A portion is given immediately before eating, and the remainder is delivered over a few hours to match the slower digestion of fat and protein.

“For example, one might take 50 to 60 percent of the insulin up front and the remaining 40 to 60 percent over two to four hours, depending on your insulin sensitivity and the specific type of pizza,” says Thomason.

On a pump, Thomason adds that you might have an extended bolus, dual-wave, or square-wave bolus setting that is pre-programmed and makes this easier with just a click of a button. These settings are designed to extend bolus delivery over time so that insulin will be more readily available as needed–ideal when eating high-fat meals like pizza where you might experience delayed spikes in your glucose levels.

“These recommendations can vary depending on your pump settings and general blood sugars, so we recommend working with a healthcare provider to tailor this approach to you,” says Thomason.

How to Use an Insulin Pump to Bolus for Pizza

Step 1: Prepare to Eat Your Pizza

Determining the exact amount of carbs in your pizza can be difficult, but if you’re eating from a chain restaurant, you can find nutrition information on their website.

For a mom-and-pop type of pizza place, you can estimate nutritional information by looking up the details for similar thin-crust or thick-crust pizzas.

Step 2: Double-check Your Insulin Pump

Before digging into your pizza, it’s important to make sure your pump is set up for success.

Check to see how much insulin is in your reservoir and ensure there aren’t any problems with delivery (such as a malfunctioning infusion set).

Step 3: Give a Bolus

Now is the time to enter the amount of carbohydrates you’ll be eating.

If you want to deliver the bolus in two parts, you can do so using your pump’s technology.

However, the MiniMed™ 780G system from Medtronic features Meal Detection™ technology*, which is designed to detect rapid rises of sugar levels and then deliver auto-correction doses every 5 minutes to keep levels in range.†

If glucose levels rise, your pump will give automatic correction doses up to every five minutes until levels are back in range.

Step 4: Monitor Blood Sugar Levels Post-bolus

Keep an eye on your blood sugar levels for several hours after eating and give a correction dose if needed.

Tips for Successful Bolusing with an Insulin Pump

There are a few tips to keep in mind in order to optimize the benefits of your pump.

Talk to Your Doctor About Your Basal Rate

Basal insulin—the “background” insulin that maintains blood sugar between meals—accounts for about half of your daily insulin. If you notice unfavorable blood sugar trends, consult your doctor about adjusting your basal rate target.

Administer Insulin Before Eating

Remember to administer insulin before eating, as current rapid-acting insulin isn’t as fast as the body’s own. To effectively manage blood sugar when you start eating, it should be given 15-20 minutes prior to meals.

Know Your Insulin on Board

Another benefit of insulin pumps is that they keep track of insulin on board. This is insulin that is still active in your body from a bolus dose, which can continue to bring glucose levels down.

If your glucose is high, it’s helpful to know if you have any insulin remaining from what you gave for your meal when deciding whether to give a correction dose or not.

Consider Food Sequencing

When eating high-carb foods like pizza, food-sequencing might be something you’d like to try.

“Food sequencing, such as eating a salad or other low-carb, high-fiber foods before the pizza, can be beneficial for managing your blood-sugar levels and may have other benefits like increasing fullness and preventing overeating,” Thomason explains. “Starting with a salad helps to slow the absorption of carbohydrates from the pizza from the fiber, potentially leading to a more gradual rise in blood-sugar levels after eating. The fiber and water content in the salad can also promote satiety, which might influence how much pizza you eat over your meal.”

How to Overcome Potential Challenges of Eating Pizza with Diabetes

As mentioned before, the slow digestion of pizza can impact blood sugar levels by causing them to spike several hours after eating.

Knowing this ahead of time is helpful so you are prepared to keep a close eye on your blood sugar levels and take action if they are high or low.

Slice Through the Myths: Bolusing for Pizza Made Easy

Pizza is a food most people love, but it requires more planning to manage
your blood sugar levels. For that reason, it can be helpful to:

  • Take time to prepare by determining the amount of carbs you’ll eat.
  • Double-check your insulin pump is correctly working.
  • Give a bolus and monitor your blood sugar levels after taking insulin.

Other ways to avoid high blood sugar levels when you eat pizza, include:

  • Giving insulin 15 to 20 minutes before eating.
  • Making adjustments to your basal rate, if needed, with your physician.
  • Paying attention to your insulin on board.
  • Pairing your pizza with a low-carb, high-fiber food like salad.

Additional Resources

If you’d like to learn more about general diabetes management, nutrition, and insulin pumps, you may find these resources useful:

*Taking a bolus 15 – 20 min before a meal helps to keep blood sugar levels under control after eating.

† Refers to SmartGuard™ feature. Individual results may vary.

The #MiniMed 780G system is for type 1 ages 7 and over. Prescription required. WARNING: Do not use SmartGuard™ feature for people who require less than 8 units or more than 250 units of insulin/day. See bit.ly/780gRisks.


This content was made possible by Medtronic, an active partner of Beyond Type 1. 

Beyond Type 1 maintains editorial control over its content.

Author

Kourtney Johnson

Kourtney is a registered dietitian living with type 1 diabetes. She was inspired to study nutrition after learning about the role food plays in managing this condition. When she's not writing about all things food and diabetes-related, she enjoys reading, cooking, traveling, going to the beach and spending time with loved ones.