I am looking for some help with how to handle a bolus when one is low as you sit down for the meal. this has happened to me twice in the last two months and both times it has been frustrating. My CDE told me that I should take some fast acting carbs and wait until I'm above 4.0 to bolus and then eat my meal but in these instances I've been in a rush and had to eat right then because I wouldn't have any chance for a long time after that. Basically I had some fast acting sugar but my BG still wasn't up so I ate my meal anyway and checked soon after and bolused then for the food I ate I think I went low again soon after and was screwed up for the rest of the day. This just happened to me again about half an hour ago so I will see what my BG does but I just wanted to know if anyone had experienced this before and what are some strategies to handle this situation?
If it is time to eat, and I'm not dangerously low but say in the 50s, I'll just go ahead and eat without bolusing. Then I bolus after I start to eat or after I've finished.If I'm lower, in the 40s I'll treat with glucose tablets. I gain weight very easily so I don't believe in treating if I'm ok and just going to eat anyway. It's interesting you went low again soon after. When you had the initial low before you ate did you still have any insulin on board? If you did, that could have contributed to the problem.
What I'll do is if I'm say at 50-ish, I'll have maybe 8-10G of fast carbs, jelly beans or something and run the bolus through at 70, where the carbs "should" get me, and just eat away. This is somewhat fraught with peril, requiring additional testing, etc. to make sure that everything does what it's supposed to, but it usually will work out ok?
I have a pump and CGM. I input the BG and it will correct the dose to counteract the low. I have tried the "no bolus and eat," and it is a mess for me. Even with 15 carbs, I will skyrocket without some bolus. My husband gets irritated, but he would like my average BG to be 180 ot higher. Ain't gonna happen!
I eat enough glucose to bring my BG up to about 90 mg/dl (my target), then when I eat (usually 5 to 10 minutes later) I add the extra glucose carbs to my meal carbs, enter the low BG number & let the pump do the numbers, usually if I've got the glucose carbs correct, it recommends the meal carb dose I would have taken. Usually I am fine after that,
Zoe has a really good point. If you still had Insulin On Board (IOB), that could mess things up just like you describe. Your Animas One Touch Ping has a feature to track and subtract IOB from any corrections or carb boluses. The bad news is that if you don't have this feature turned on, it won't work. You may want to check with your CDE that this feature is turned on and that you have the duration of action set properly for the insulin you are using.
Mine calculates IOB and makes correction for low. Like right now my BG was 66 and pump was saying to treat...but I was also going to eat right away so I went ahead based my bolus with what the bolus wizard recommended taking into count my IOB and how much I was eating.
Just one more way we're all different. I've tried correcting my bolus to counteract the low and I always go high. I find I need to always take the full bolus for the carbs I eat, but what I can play with is the timing, so that I don't crash before the food kicks in.
Just follow the 15/15 rule .. 15 carbs, wait 15 min.
each carb can raise BG's on ave of 5 pts, thus 15 x 5 = 75 pts
If have to eat rightaway? Go ahead, eat as usual, but wait to take your Bolus for those Carbs until after you eat , but take Normal Bolus..
Wait 1 hour and test.. you should be fine..
If possible? Drink OJ or Any sugar Juice. ave 2 carbs per Oz.. thus 7 Oz's should be fine.
I sometimes have the same problem and have been told that in a hurry and if I can not do the 15-15 rule to go ahead and eat the meal but only bolus for half of what I have eaten, it's not the best thing to do because sometimes you go out of your target range but usually it won't happen if you know your carb counting :) ... hope this helps
With the CGM on my paradigm pump, I can scroll back and see how fast it's crashing, if at all.
If it's a stable low, I can square bolus, setting it to deliver over the course of 30 minutes or so (essentially slowing down the delivery), only just a little shy of what I'm eating, carb-wise.
If it's continuously dropping, then I would treat it as a low and then wait a few to start the ascent again :) before delivering the normal amount.
It's a sliding scale kind of situation where your mileage may vary, but I can be fairly sure nothing horrific will occur.
I would eat glucose tabs to compensate the low - around 15g of cabs - and then I would eat. Afterwards I would bolus for the carbs I have eaten - likely I will test my BG before this injection. I would not recommend to just trust on the carbs in the meal to treat the low. The problem is that the digestion process itself does consume carbs before it can deliver carbs. In addition to that the carbs from the meal will be to complex to increase the BG quickly. It would violate the first rule of low treatment: get out as fast as possible.
To me, it seems like you are dealing with two separate "curves" and if you are low before or even at mealtime, it makes more sense to deal with the curves separately? If you are low w/ the meal, I think that in the long run (i.e. the rest of the evening/ morning, afternoon, maybe not "long run" as much as "intermediate run"?) it works better to figure "ok, the "at" number is off, I will fix that and then consider the meal a separate "event" that will have its own curve, that would likely be better off to be dealt with by bolusing at the mealtime, even if you are on the low side, because that bolus is intended to "cover" the meal curve?
There's probably millions of little variables to practice with but other things I do with this perhaps more risky approach are to load in some faster acting carbs at the start of the meal, milk, high-carb beer, fruit all seem to hit a bit faster than meat/ starch/ veggies? If you don't bolus until afterwards, the food gets a "head start" on the food bolus that I would project into a higher than expected (for the bolus and food combo...) BG later and then a low when the bolus hits later than expected? Which is exactly the sort of event I try to avoid. Less carbs and less bolus would probably also be a clever way to approach that but I still have all these leftover mashed potatoes to get rid of. I deal with this situation a lot as I'm the cook probably 80-90% of the time and also like to get a run in in between work and cooking.
Thanks for all the suggestions. I will definitely refer back to this page when the situation arises again. I am new to Tu and its so amazing its like I have hundreds of diabetics sitting in my closet I can just open it up any time I have a question its really great.
It depends. For the most part I try to do things the way the CDE said but I’ll make up the calories to treat the low over the course of the day. I do it that way coz it’s quicker to bring up the low. If the low is a mild one (above 60) and the meal isn’t high fat then I might just let the pump calculate the dose.
My advice: Eat the meal. Let the bg come up a little bit (maybe half an hour). And then take a reduced bolus.
That won't solve all the problems - there will be the days when you or me are particularly insulin sensitive and are going to have a hypo anyway.
I agree with Tim. When I am low b/f a meal, I will start eating and when I am almost finished the meal, I will bolus. It usually works for me.
Say your bg is 56 and you have to eat, this is the method I use and it works well.
1. eat 15-30 g/cho of your meal
3. once the bg has risen, bolous for the rest of your meal
4. This way, you are treating the low with your meal and you are bolousing after wards.
let us know how it works.
Actually the Ping will only take out insulin for carb boluses if you are below your target. If you are below your target it will not tell you to take any insulin at all unless the insulin dose needed for carbs is larger than the current IOB. AT your target it will tell you to dose for ALL the carbs but even one point below it and it will tell you to bolus for NONE unless the above is true.
In her situation it may have worked but it is not a good assumption ithe Ping will do that for you at or above your target. I actually disagree with the way Animas handles these situations the more I look at it.........
Wow, thanks, I didn't know that! Now that I do, I realize I've just been working around it and bolusing anyway when it says not to - maybe reducing a bit - or increasing a bolus that looks too small. Doesn't make much sense.