Do you ever bolus without testing?

I really hate to even bring this up, as lots of members here always seem to do the right thing and have A1c's under 7!! However, my son is almost 14 and very self concious about his D. He is knowledgable and responsible but hates dealing with his D amoungst his peers. Afew times for dances and parties we have told him he can bolus without testing and low ball the carb count to be safe. he had been successful with this approach, i don't love that i am condoning this but feel like maybe we are meeting in the middle. we would rather him run higher in these situations. If we really put the pressure on him to test every time ( which he always does for meals and at home) i fear he would rebel and eat whatever or worse yet be depressed and overly burdened by his D and not even want to be involved socially. Just getting him out there doing what he is doing is a step in the right direction and stressful for myself and my husband letting him go solo. So, honestly any thoughts or experiences? thanks! amy

Yup, Pretty much all the time. In fact I rarely test. I was diagnosed in 75 and there was no testing back then. I basically had to wing everything and somehow I am still in one piece. I just don't get the obsession testing 10-12 times a day. They would have to pay me to do that. I will admit I go low often but know the symptoms pretty well. Today I took one test and was 93. I do on occasion run high for longer then I would if I constantly tested but to me it isn't worth it for the percentage I have that problem. In the end my A1c's average in the low to mid 6's but as good as this all sounds I just don't feel well and am irritable, have anxiety and in a bad mood from it often.

Having been a teenager with diabetes myself ( I was dx at age 11, and am now 30), I can tell you that you have to pick your battles. :) While it's not the best thing to do, at least he's actually bolusing, which I would imagine a lot of kids don't do (as I certainly skipped it occasionally when i was out with my peers). Maybe ask him to test as soon as he can after he leaves the party/event? Is a CGM a possibility for him? Even though they're not always perfect, having an estimate of where his blood sugar without having to test at a party or something would be better than nothing? Either way, I'm in support of you. The teenage years are hard, for both parents and kids, and I think it's great that you are meeting him in the middle with this. Keep up the good work!

One thing I never did in my nearly four decades of diabetes is ever skip a shot. I was on two shots of NPH for many years but that therapy among not understanding how insulin and carbs work together eventually took its toll on me real bad. To this day I wouldn't even think of missing a shot under any circumstance. High sugar to me is far worse then low. Even slightly elevated for me and I am besides myself.

No! Too dangerous.

I have to say NO , unless I see my Sensor readings stay very very stable around 5-7 ( x 18 ) ,OR poked finger about 1/2 hour earler before needing to bolus for food/drink and result acceptable ..I am not a teenager , however I am an oldie at almost 72 it could be a possibility of " forgetting to ..." ? I am very insulin sensitive ...too much and I am in trouble ; too little I am in trouble ..for everyone this is different and I respect , what you as a parent have to deal with .

Dear Jacobs Mom,

WOW! you are an amazing mom! You have some how tried to understand a diabetic mind, Parents always get angry when they see their child doesn't test and mentions that they don't want to test. However, you have found a way to get it! and try to work with your son. ALL TYPE 1 DIABETICS HAVE THIS PROBLEM AT SOME POINT IN THEIR LIVES. I find it so cool that you are trying to understand him (us) and realize how this condition can be a burden and embarrassing. points for you mom!

There are risks to this idea and you obviously understand them, so does your son, I like that you tell him to under bolus at times. However, always remind him that if he has a chance to test without feeling uncomfortable he should. Eventually he will need to learn how to tune people out and not care what they think so he can take care of himself, it takes time to get there but he will get there ;-)

This is a tough one. Yes, I will admit that I do bolus sometimes (maybe once a day or so) without testing. I generally try to only do this if I really can't escape to test or I am just feeling really, really lazy.

I think it's ok to do this sometimes. Successfully living with T1D means trying to find some balance, and sometimes that means not being perfect.

Now, one caveat - I think it's ok to give him permission to do this on occasion. However, he has to understand that bolusing without testing is dangerous, has it's own risks, and CANNOT become a regular habit.

Your son may need to think/plan ahead a bit if he's really self-conscious about testing in front of other people. Like him, I do not like testing in front of others. It's awkward and sometimes I just don't feel like fielding the questions. So, if I am going out to lunch with coworkers, I think ahead and test BEFORE we leave our office building. Then, I know approximately where my BG is when we get to the restaurant and bolus accordingly.

thanks for the suppot desi, I am trying! i hate making him feel accountable always for his actions. i usually handle alot of his decisions when he is home so he can just be a kid but his skills are there. he knows this is something that really isnt ok and only somewhat acceptable when he is with his peers and there is no way around it. best wishes! amy

I missed this the first time around. Very occasionally I'll use the CGM number instead of bothering to test, particularly if my BG seems relatively stable and if the CGM is accurate. I think that if it's a regular habit, you might benefit from recalculating your calculation and putting the "extra unit", or whatever, into the bolus before, figuring out a new ratio and seeing how that works? If I feel like I'm doing a lot of corrections, I'll upload the data, see if the "pie charts" (Medtronic Carelink) have changed with more out of range readings.

I don't always "recalculate" like I described but, if my breakfast ratio isn't getting it done, I'll move it a little bit to put out some more insulin (and I've mixed this up and done it backwards which will result in more off readings, rather than less!) and see how it works. A lot of times, I'll see an improvement pretty quickly and will feel good that I figured something out.

Sometimes it's hard to differentiate between "basals in need of adjustment" and "bolus ratios in need of adjustment" but I usually use before meal readings to figure basals and 2 hour post-meal readings to recalculate bolus ratios.

Understand your dilemma & respect your reasoning, but it's a slippery slope. Not testing before bolusing is risky. Not something I do. Of course, as a parent you can't force your son to test while he's away from home anyway. One concern is that he's developing habits that will continue & one that's not good for the long haul.

I hesitated to reply because I think children have different issues. But as an adult I would no sooner bolus without testing than put a gun to my head without checking to see if there was a bullet in the chamber. Well, ok...that was a bit of an exaggeration but it was the first simile that came to mind early in the morning. No, I would never bolus without testing - I could be 50 and put myself in danger of a severe hypo, or I could be 150 and in need of correction so I don't end up on an endless mountain climb.

Having said that I think it is great that you are trying not to be too controlling as I've heard many adults talk about rebelling against their D in their teen years. On the other paw..I do think you as mom should be firm in your stance that testing before bolusing is necessary (and why). I don't think this means that he always will, but I think condoning not testing is too far in the opposite direction. Perhaps you can casually make some suggestions for alternative testing, such as, as MBP mentioned on the way somewhere, and even, yes, in the dreaded bathroom.

I hope too that Jacob gets the opportunity to hang out with some other Type 1 teens through a camp or a JDRF sponsored group because that will increase his confidence regarding his D.

No testing on caveman machine fingerprick - no dosing; no exception.

My life is exciting enough without adding unecessary riots.

My view of process is as follows:

a) how long does that insulin I am about to inject last.(humalog lispro u100)

b) In evening I want to ensure insulin I inject wears out/exhausted before sleep time.

c) bolus for breakfast and lunch can be a little over as always on a 4 hour lasting insulin, there will be time to add snacks - correct,

d) evening bolus I do not size for the max peak read value but I down size such that over the 4 hour operating run, glucose doed not burn out early from gut - IE carbs in meal under estimated one gets low at end of period. I do not like adding snacks that take time to digest late at night and use candy/glucose tablets instead.

What I am doing - may not be necessary for most folks who have properly running liver/fifo buffer that does not overblast glucose on underrun of gut intestine generated glucose.

good luck.

Yes I bolus without doing a finger stick and also do corrections based on my CGMS/BG trend. But I test on a regular

schedule and if something is unusual I will burn lots of test strips.

I used to. Really, it was more indicative about how bad my control was more than anything else. Consequently, I test religiously now because I don't want to slip again. Whatever works for your son to keep him in control without risking too much.

I completely agree with Desi! I think you are doing a wonderful job! The fact that you are talking to your son about this is excellent. I am also raising a teenage daughter with diabetes and they will feel like they don't want to bother even trying to care for themselves if all they get is negative feedback. Let him know how proud of him you are whenever he does test before bolusing and when he doesn't, let it go. Making him aware of the healthiest ways of doing things is important but then it is up to him. At least he is bolusing and taking care of himself. You would be amazed at how many teens have trouble with this! Keeping the lines of communication open is very important but understanding that he is not going to do everything perfectly is also important. He is a teenager and is concerned with more "important" things. Your excellent teaching and communication will stay with him forever and as he gets older he will remember your advice and use it. If it makes you feel any better, my daughter was very self concsious about anything d related from the time she was 4yrs old until she was about 16. Now that she is 17 she doesn't shout it from the roof tops but she does not let what other people think stop her from doing what she needs to do to care for herself.


I usually won't skip testing for a meal. but If my sugar was decent at mealtime and I didn't have anything "unpredictable" to eat I'll skip testing until the next meal. If I get hungry again I'll sometimes just skip testing and bolus for whatever else I eat.

I do. I wish I didn't, but sometimes I need to save on strips as I'm still paying for them myself. I know my basal is set right, so unless there is an issue of exercise, I know I won't go low. It is not ideal, I know.

I would say yes, as long as it is done with wisdom. I was 10 when I got diabetes in 1961. It was an entirely different world--there was no way, except in a lab, to test blood glucose. But insulin was also different--you kept 1 vial of "regular" in the fridge, in case your tes tape reading began to shoe you were 4+. Do I sound like I am speaking Martian? It should, as it was totaly out there then.

With the pump, and CGM, I have done this occassionally. But only in an emergency. It is hard to be his age and need to deal with this--I know. But I also know that when hormones begin to kick in, diabetes becomes a different monstor. Use this trick with widom, rarely.