Can you skip a meal on MDI?

If I were to switch back to MDI, would I be able to eat low carb enough to be able to skip meal time injections? basically, could I live off my Lantus? ok, maybe not every meal, but say, lunch. Could I eat like nuts and meat and cheese and not have to give a pen shot? I’m thinking about switching back to pens once I lose 50 lbs and develop a strong discipline toward food.

Can you skip bolus while using a pump if you eat something like that? I suppose it’s something you’ll have to answer for yourself…

I am able to skip bolus when I eat close to zero carb-- I often just eat eggs and meat for breakfast and don’t bolus, but other people might have to bolus even for that…

Not sure pump vs mdi makes as much difference in this scenario as your individual condition…

I find that on MDI when my basal is set properly I can skip meals without a problem. On the other hand generally if I eat I still need to bolus even if the meal is very low carb. I find that even with very low carb, protein in the meal and the mere act of eating causes a blood sugar rise.

like sam, i also can skip the bolus a lot of the time if i eat zero carb or close to it, or if im doing exercise immediately after eating a meal with even some carbs. most days i have eggs and maybe 15 carbs for breakfast and then walk the dog for an hour. no bolus. i dont know if maybe my basal is taking care of some of my food. this will always be a mystery.
i have a low carb lunch and cycle 7km to work, no bolus.
i get home and have tea or broth and some cheese or salad for dinner. no bolus.

at weekends if im out with friends ill have more carbs and ill have to shoot up. if its the week before my period i have to shoot up no matter what i eat, my hormones go crazy even after i up my basal from 18 to twenty units.

i was diagnosed about 4 years ago and for the first two years i hardly touched my novorapid (LADA??) now ive got to be more careful. possible for me but your dmv. good luck!

Sure. I was on low carb when I was on MDI and frequently had meals for which I didn’t have to bolus (same goes now that I’m pumping for that matter). Endos have a rule about TDD being evenly split between basal/bolus but for me that never happens.

I’m LADA, and there was a brief window where I could eat small, low carb meals and not need to bolus. Now, I bolus for almost everything I put into my mouth. MDI or pump made no difference for me in this regard.

The YMMV rule definitely applies, but for me it can be done. Time of day can be a big factor if you’re like most people with a variable insulin requirement through the day (I can’t do this for breakfast or an early lunch, but a small, low-carb late lunch or dinner sometimes works for me without a bolus injection).

As I think the others have said above, you question does not seem to make sense. MDI versus pump has nothing to do with skipping meals. Rather it is about how well matched your source of basal insulin happens to be and how much bolus insulin is needed to cover the increase of BG from whatever your meal was.

Why people seem to think that MDI is a completely different creature from the pump is something I don’t grasp. The pump is the same approach as MDI except that the pump … in my opinion … if used correctly, offers more flexibility than MDI. But aside from that, one treatment should not be any more “enabling” than the other.

Why would you think this would be the case?

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I think these perceptions strongly reflect peoples’ experience–or lack thereof–of other treatment regimes. For me, MDI was life-changing and liberating, and the pump has been more of an improved, incrementally better version of MDI, as compared to R/NPH which imposes much harsher limits limits on your freedom, much greater unpredictability, much less control then either of them. If you never experienced R/NPH, the difference between MDI and the pump might seem much more significant, For me the change to MDI was life changing, revelatory, liberating, and the pump–since it operates on essentially the same principles–seemed more of an incremental improvement, a difference of degree rather than kind.

When I was on MDI, I never bloused for 5 carbs or less, simply because I couldn’t draw the needed amount of insulin into a syringe with any kind of accuracy. I would guess that your I:C ratio would have a lot to do with that.

I skipped meals while on MDI. I bolus the same whether on the pump or on syringe. I have read in a few different places people seeming to assume you can’t carb count on MDI, I don’t understand the thought process behind this. If your basal rates are good, then you shouldn’t have to eat, or not eat for that matter, at certain times of the day.

Wow, really? MDI was how I learned carb-counting. Joslin wouldn’t put me on it otherwise. But then someone on TUD recently said they never learned it and they were on a pump. [gobsmack] No end to the variations of how people are taught to manage this disease. Or aren’t taught.

Hi Cocheze. I received a little training for a pump, but not for MDI. the chronology: first I was on MDI without training, and life was a disaster–those were the days of Regular, NPH and frequent bouts of hypoglycemia. Then I was referred to an endo, who put me on a MM pump, and I finally received training from a CDE. When I went back on MDI, I tried/try to bolus and correct the way I did on the pump. The basal is just not as accurate on MDI as it is on the pump, although Levemir is quite good, so my A1c is not nearly as good as it was on the pump. In answer to your question, while on either MDI or a pump, no way could I skip meals and feel well.

So this is always a major point of confusion for me, because I just can’t think of R/NPH as MDI. NPH is just nohow a genuine (or even much of a pretend) basal insulin. For me there’s a huge bright line between R/NPH and using a genuinely flat, long-acting insulin like Lantus or Levemir, to the extent that I wouldn’t use the same name–they’re just not the same thing, as I experienced 'em anyway.

Not a criticism–I see other people not making the distinction. But for me it’s huge.

i am one of the ones who has to bolus for everything, including eggs and meat(s). i can’t get away w/ anything, even just looking at food raises my BGs. so, as Sam says, if you can get away with it, you can get away with it. whether you are on the pump or doing mdi (unless you plan on going back to something like NPH and R insulins) do you plan on using something like Lantis to cover your basals?
if you are not eating, then you wouldn’t need to bolus. we only bolus to cover the foods we are eating.

DrBB. no question, they’re different. I just think of those days as “early MDI”. I certainly took Multiple Daily Injections then–NPH 3 times daily in order to get 24 hour basal coverage; R with meals; corrections were pretty much nonexistent. Now I still take Multiple Daily Injections, Levemir twice daily, and Apidra for boluses and corrections. And by the way, MDI is so routine now that I don’t even think about it unless I’m reading or writing about Diabetes on TuD, blogs, etc.

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For me, the biggest difference is that, while Levemir and Lantus provide a reasonably flat response (one issues with the allegedly-non-existent “peaks” are resolved), MY basal needs tend to be quite curvy. I was never able to find a good balance on either Levemir or Lantus where my BG remained stables, say on basal testing – usually, I have two big drops during a 24-hr period (for me, 4am and 5pm), no matter how I tried adjusting doses. Unless, of course, I was taking too little basal insulin for me needs the rest of the day…)

So, for me, MDI meant that I had to eat something to avoid – or correct – hypo events twice a day. I have no such issue when using a pump – which was the reason I went to a pump in the first place!

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Yeah, I remember one article in particular (though I don’t remember where from) about beating diabetes burnout. It talked about just having a cheat day, saying that if you have an insulin pump just go ahead and eat whatever you want for a day and just let yourself go for a short period and those who were on MDI should eat what they want at their meal times since they didn’t have the same freedom. I have days like that now (I’m trying to forget the cereal I ate earlier), I had days like that when on MDI. On MDI I would just take extra injections.

I have read multiple other articles written for/by the diabetes community that, to me, imply carb counting doesn’t happen on MDI. I’d love it if people would just be able to wrap their heads around the fact that pumps and MDI do the same thing, the delivery system is just different (with bolus insulin, anyways, and I realize this is a general statement, disclaimers and all that jazz).

Yeah, I was the same way about it–one of the reasons I was a reluctant pump convert was that I was so automatic with what I was doing and changing meant having to think about it all the time. But then I just kinda casually asked my endo at Joslin about it and she said “well, we have an Intro to Pumping session I can sign you up for,” and, well, one thing led to another. But I am glad I made the transition even though it drove me a little nuts at first.

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Yes you can… regardless of MDI/pump.

The trick is always what is happening with your BG. Concerned things are going to drop, eating becomes useful. Dropping for whatever reason, exertion, absorption, or simply hungry, food is helpful.

But the short answer, you can skip a meal for all kinds of reasons. Just be careful, if/when you do, if there is a decent chance you’ll have a problem because your insulin will bite you in the butt skipping might be a bad idea, that particular day at least.

I’m on MDI and I both skip meals and occasionally eat meals so low in carbs that I don’t need to bolus for them. I have found that staying as low as possible on my carbs and taking as little insulin as possible is the best way to keep my BG stable and avoid hypos (which plagued me daily when I was trying to eat more like a “normal” person). Getting a CGM really helped me learn what was really going on with my BG after eating certain things, so if you don’t have one I would recommend it. I hated the tyranny of the “never skip a meal” instructions my endo gave me, because sometimes I just don’t feel like eating. After I started learning more about my diabetes, I began to suspect that they give those instructions to everyone because they don’t think we can be trusted to micromanage our disease. They underestimate how dedicated and disciplined many of us are about our own health. I’ve learned not to say too much to my endo about how I’ve taken charge of my own health, because she thinks I should be following her instructions to the letter. But her instructions are the ones that put me on a BG rollercoaster. So I just tell her I’m really disciplined about my diet and let her praise me for doing such a great job keeping my BG stable and my A1c down :wink:

Your mileage may vary!

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