So, anyone on here who has read any part of my saga knows that I fear lows with every fiber of my being,
This fear has been a little easier to deal with since I went on the pump.
However, I still react very strongly to boluses. Rather immediately.
I eat a bagel and drink a black coffee almost every morning. It is the only carb-tastic part of my diet I have not been willing or able to consider changing. But I am OK with that, as I know, right down to where I get my bagel from, how many carbs it has. (research research research)
So that aside, I have developed some interesting bolusing tactics and wanted to see if anyone else has done this.
15 minutes before is too soon.
I take the carb bolus halfway through my meal and then take a little more at the end, and i've seen that my postprandials are WAY less spiky.
Ok 1,2,3 contribute! :)
I try and bolus 15-20 minutes before unless I'm already low. As long as your system ends you up in target most of the time, then it works for you; we're all different. If it ends you up high and you do it because you're afraid to bolus early, than it's not so good.
134 at time of this post.
Ate bagel, some OJ (was feeling on the downward slide, a little shaky and fuzzy)
Bolused 3.4 units for 40 carbs (was on the low side, I know it was more like 60 but with the shaky feeling i was erring on the side of caution)
So, I just retested and am at 234.
I took one more unit even though my pump said not to... because the "active insulin" really isn't an accurate depiction of what it's doing.
A couple comments, if that's ok. You don't say how long after eating the 134 was. You mentioned you really love your bagels, but they are one of the harder things to bolus for, and the addition of oj was a guaranteed high. Many of us only drink oj to treat lows. You say you were "feeling on the downward slide" before eating. Did you test? Going on "feelings" is not too reliable.
I know this is counterintuitive, especially if you're afraid of lows, but if I am on the "lowish side" (60ish) before my meal and bolus for less than the carbs warrant, I will inevitably go high.(And, in fact, my Ping recommends the full carb bolus even when I put in the lowish bg.) What I would do in that case is bolus right before eating or after I started eating and bolus for the full carbs. If you are really nervous about lows you can not bolus, eat, and keep testing to see when you start up, but you might still end up high that way.
Have you tested out your I:C ratios? 1:12 would be too little insulin for me at breakfast. My I:C ratios are 1:5, 1:10 and 1:21 for the three meals. Though I know we are all different, breakfast is the time most of us have some insulin resistance. (If I really craved a bagel I'd be better off eating it for lunch or even dinner!)
the 134 was before eating the meal.
i don't have a CGM so for trends, I have to go on how I feel.
because a 134 on a steady keel is great! but a 134 and heading down dramatically changes things.
my a1c has been 10+ for years now... and I am only now getting used to how it feels to sit at a "normal" bloodsugar and not feel like I'm dying.
I am considering a higher ratio for carbs in the AM... but in these beginning phases of majorly tighetning control, I am just trying to keep my bloodsugars in the 100s, not be in perfect control.
If you have been running high, a 134 might feel low. I think having a fear of lows means that you will have to draw a careful balance about pushing yourself towards bringing your numbers down and the feelings you have about running at lower numbers (and of course avoiding any real true lows). But I do hope that you will push yourself to move your numbers lower and get tighter control.
I think in this case, you were admittedly conservative in your bolus and then you corrected. I think your idea of using your pump to match the timing of your meal is a really good one, but in the case of a bagel it really acts almost like a simple sugar. I know some people, when they eat a high protein meal, or a meal with carbs which has a bunch of fat, they will use an extended bolus. Essentially taking half the insulin at the meal and the other half later. That can better match the blood sugar surge.
In the case of a bagel, I really think you will find it works well to bolus all at once. Your blood sugar will start to rise within minutes of the first bite, so many people bolus 15 minutes ahead of time. And a bagel is a huge surge, don't test at one hour and try to correct, test at 2-3 hours and then make a decision to correct. If you try to correct at 2 hrs, you may "stack" your insulin and get too much making you go low. You don't want that.
I hope that helps. And as Zoe says, a bagel is hard to bolus for, many of us have real trouble with carbs in the morning. They sell mini bagels, would you consider a mini bagel?
Ah. Starting at 134 and eating a bagel and oj, then under-bolusing because you felt low (I agree 134 may feel low if you're used to being in the 200s or more), is pretty much how you ended up at 234!
What I would do in those circumstances is eat something a bit less carby (at least not both the bagel and the oj), bolus for the full carbs and include a correction for the 134 to whatever your target is. Then test at the two hour mark and if high, correct. I usually do correct at two hours and if I still have enough IOB my pump will tell me not to correct at all.
I do appreciate Bsc's suggestion that you try and balance out your fear of lows and the need to get better control. Perhaps you can take one step at a time: Bolusing earlier, adding a correction with meal bolus, bolusing for full carbs, reducing your carb intake a bit (especially at breakfast) and correcting at two hours are all steps towards better control. So maybe you can pick one of those things and do it first, see the good results (lower, but not too low) and then try another thing later on.
I think if I was erring on side of caution I would not have had OJ but just the bagel and taken less insulin for it. I was having an episode like you described this past weekend as well. I don't run high but I was feeling like I was crashing and I was in the 130 range as well, but it stayed stable while I was snowboarding, maybe it was the rush or something. I have also found that it takes a lot less OJ than I thought to correct a low BG, literally only a few sips. When you get that frantic feeling though it's hard not to have a whole glass.
After 234 reading, hovered in that range through dinner time, didn't really snack today.
Dinner was indian spicy chickpeas w/ veggie burger and cheese and spinach chopped up.
191 before, 133 after. now like 4 hours later hanging at 166.
even with that after-breakfast snafu, still a really great day for me.
oh, I never mentioned that I got the OJ to start with because it was gray and icky out and I have a cold coming on. ooph.
I have to say, those are really improved numbers. I'm really proud of the progress you have made. Please post again and tell us how another "Bolus Blues" goes.
YEsterday - went to bed at 166... awake at 133. Drank coffee only until about 11 am. The little bit of sugar in the coffee brought me to 207.
Prepared indian food for lunch (basmati rice, cheese, spinach and a piece of parantha (which is like a crepe) and bolused 4 units for about 40 carbs.
189 after eating.
Also helps that I've been running around cleaning the house like a psycho all morning.
I'm happy with today so far.
A bagel and coffee always does me in when I have it in the morning, I go super-high, and if I bolus enough (it's tough to guess carbs on the bagel-shop bagels, and where I live we don't eat Lenders!) If it works for you, that's great!
Yes, the numbers are a little high, but it's explainable given what you've said. But with the A1C you described and the goals you're setting (realistically, it's not logical to go from an A1C of over 10 to under 6 all at once, and you're wisely taking smaller steps) I think you're on the right track.
I'd like to offer a tip.... if your insulin tends to work faster than the food, I suggest you try a 30-minute (maybe 60-minute) square/extended bolus, taken right before you eat. This way, the spikes should smooth out even more, and you're less likely to forget to do it (as I have) mid-meal.
Do you keep a record of what you eat and your blood sugar results? I had to look at cereal or granola for breakfast and the resultant highs (no matter how much insulin I took), for a couple weeks before I finally got that cereal just wasn't going to work for me, and switched to eggs. I now am consistently only 20 points up or down - at least Monday through Friday breakfast!
You're headed in the right direction, Sagwabetes! Keep up the good work!