Monday, February 10, 2014

The Sushi Bolus.

Aaron and I have very different sushi strategies and preferences. When I say I love "sushi", what I really mean is that I love the rice rolls that involve cooked fish. I can't handle the slimy uncooked stuff that Aaron orders (I just shivered thinking about it). On the other hand, I will eat the wasabi that comes with my rolls, whereas Aaron will not even look at it, much less eat it. He's not a spicy food kind of dude.

Sushi Night (it's not really an official event, but more of an "Ooooh, you know what sounds really good?" spontaneous sort of thing) happens about once a month, so I've gotten some degree of practice with the art of the Sushi Bolus. And it really is an art, not a science - who knows what is in those sauces? Whatever it is, it's delicious, and when in doubt on carb counts I go with my stand-by strategy* of:

Throw a bucket of insulin at it and stalk your blood sugar for the next several hours.

A pain? Yes. Worth it? Also yes.

Every situation and PWD are going to be different, but here's what worked for me in the instance above: I ordered two "cooked rolls" (think California or Philadelphia rolls) and ate 14 pieces, plus some soy sauce, wasabi, and ginger. 6 of those were also covered in some sort of sweet sauce and I have no idea what it was made of. I set up an extended bolus on my pump to cover 85g of carbs over 3 hours, with a 65/35 split, and ended up with the results above.

If you've never programmed an extended bolus on your pump before, 1. consult with your CDE/endo (and also, this DiabetesMine article from 2011 does a nice job of explaining what this type of bolus is all about), and 2. here's what I mean by the above: what happens is that of the total amount of insulin I'm programming for this meal, 65% of it was administered up front as a normal bolus. The remaining 35% was spread out over a 3-hour period. This helps me because for whatever reason, sushi digests kind of slowly for me and using this technique helps me avoid a spike later. In fact, in this case I seem to have overdone it a bit, so I had to (at the end of that 3 hour bolus period) set a temp rate of 10% for an hour to even things out.

It takes some practice, but having the ability to bolus in more advanced ways like this is so valuable to me. It's one of the reasons I stick with using an insulin pump.

*As always, this is not medical advice. 


  1. Wow, that line is pretty remarkable - nicely done, Kim! As a sushi fan myself (all of the parts), I'm jealous as this never seems to work for me. Always end up in the 200s or higher. But then again, I'm lazy and haven't tried enough recently to fine-tune, so I have no right to complain. Totally agreed, overall, that sushi (or oysters, Chinese food, pizza...) are all big motivators in being on an insulin pump. I'd be lost without it during these occasional must-have meals. No, this does inspire me to fine-tune everything.. and go out for sushi. :)

  2. Great job and way to rock the Sushi-boat, Kim - Stellar numbers!
    I agree, it's totally a pain to do the sushi diabetes math bolus/ but totally worth it.
    For me, I've found that I can pretty much handle tuna & Philly rolls - especially if they are made with brown rice more so than white rice, same goes for eel, and use a temp basal rate.
    With that being said, Chinese food still throws me for a loop, so does Mexican - but I'll keep trying! :)

  3. I've had my pump for almost 2 years and I haven't gotten the sushi bolus right. You've inspired me to give it a whirl again. Mmm, sushi.

  4. If by sushi you mean cooked fish, I'm on board. If you mean the slimy stuff, there is NO WAY! We went to a Chinese food place for my birthday lunch and had a discussion about whether or not we'd eat octopus. I just can't get over the idea of all the suction cups!

  5. This is SO helpful - I've been trying to master this art for years and the rice and soy sauce just keep playing games with me...can't quite seem to nail down a strategy. Howeeeeeever, this advice is seriously cash money and I will be stashing it in my back pocket for the next time I happen to stumble upon a Rainbow Roll! Thank you, Kim!

  6. I admit that I do love my sushi- but it is a huge struggle to master this tricky combination.

    One thing I do is switch it up with spring rolls. It helps relieve my sushi cravings, but is much easier to work with (plus it doesn't have raw fish). We are actually having spring rolls tonight for dinner! I'll post the recipe and carb counts on my blog in case you are interested:

    Thanks for the great advice Kim :)


Note: Only a member of this blog may post a comment.