Do You Pre-Bolus/Bolus for a Meal/Snack When Your CGM Shows an Up or Down Direction Arrow

Just wondering, if lunch (for example) is approaching, and your cgm is showing a downward/upward direction arrow (or you are trending up or down), and yet your BG fingerstick reading is in range, do you bolus for your meal based on your finger stick? do you wait/correct, or just go along with your business and pre-bolus and eat your meal?

please help

Pre-bolus regardless.

if you are getting close to meal-time, and you have been trending down for a couple of hours, and you get on the low side, BG at 80, do you take a glucose tab and wait a little while before your BG starts to come up a little? then pre-bolus?

and, do you find that when your BG is on the low side, do you pre-bolus for less time before eating your meal than when your BGs are in a safer range?

If I’m 85 or less right before I eat, I bolus 5-10 minutes after (per guidance in Think Like a Pancreas). The CGM confirms that this works well for me. If dinner is a ways out, e.g., 30-45 minutes, I’ll eat 5 g of quick carbs, then do a fingerstick 10 or 15 minutes before dinner and bolus accordingly.

Breakfast is the one meal for which I often have to pre-bolus 30 minutes to an hour. I’ve learned from my CGM that just getting up and moving about (make tea, feed cats, get paper) raises my BG some 10-20 points! Makes sense when you think about it but…I didn’t “know” until now!

Have you read Sugar Surfing? I downloaded it via Kindle and think Ponder’s guidance will be very helpful.

1 Like

do you mean that you don’t pre-bolus, but bolus after you eat? a little confused about your method. but it sounds very logical.

just got off the phone with my endo, and we made a few minor changes in my basals and basal times to try and accommodate the regular and consistent after breakfast lows.

Yep, but only when I’m low and eating low-medium glycemic food. If I was going to have something carby, I’d bolus at the same time or maybe 5 minutes before. The CGM trend information in combination with fingersticks show me that it takes longer than I think it should for high GI food to start working. I am still tinkering with this!

I don’t pre-bolus. When I do, my food seems to last longer than my insulin. I usually bolus as I’m preparing my food, or as I’m sitting down to eat it. This is something that just works for me. I do, however, pre-correct. If my blood sugar is running higher than 130 before meal time, I will do a correction bolus, wait until my BG is in range, then bolus for my meal and eat. (When I’m being good, that is. Obviously this does not happen all the time. If I’m low with a down arrow, I will bolus and then immediately start eating.

don’t you worry about insulin stacking? also, what are your high low ranges? 130 seems like an excellent BG #.

I don’t worry about insulin stacking.My pump keeps track of my IOB and the whole point is to only do 1 correction anyways. I correct before I eat, then, when I’m in pre-meal range, I bolus for my food and eat. I don’t have to do a second correction.

I have different ranges for different times of the day. Before I eat I want to between 70 and 100, two hours post meal I want to be between 120 and 140, and four hours post meal I want to be back around 100.

well i really have 2 questions; 1) when you bolus for your meal (after you have done your correction) do you just bolus for the entire carb count or do you consider your BG # ?) for example, you’ve made your correction bolus, then when you decide to eat, you don’t use your “wizard” again to put in the right amount of insulin while there is insulin on board? why don’t you just make your correction at the same time you are bolusing for your meal? doesn’t your pump make the correction for you when you bolus all at once? and 2) is your body comfortable at such a low range of BGs? if i am 70, i start to shake.

While I believe that pumps across the board adjust for IOB for corrections, I’m not really sure which if any pumps actually correct for IOB for mealtime boluses. Has anyone checked lately to see which pumps adjust for IOB for mealtime boluses?

I always thought that my pump adjusted insulin corrections for mealtime boluses, but you definitely have a good point. i am going to call Medtronic right now and ask them if my pump does a correction when i bolus for meals. then i’ll report back.

The real question is whether the pump takes into account any IOB from a recent correction when computing the proper meal time basal dose.

Brian (and all others),

just got off the phone with Medtronic regarding bolusing and IOB. the support tech informed me that when i bolus for meals, the pump’s “wizard” feature accounts for any necessary corrections when you enter your current BG and the carbs you plan to eat. your pump should already be programed for your BG range, so the “wizard” knows how much insulin you need to get back into your designated range. so, for example, if you’re BG reading is 140, but your target BG is 120, and you enter the carbs you plan to eat at your upcoming meal, your pumps will account for BOTH the carbs and the correction in one bolus and it takes into account your IOB. there is no need to bolus twice.

i don’t know which pump you are using, but this is the feature on the Medtronic Paradigm and how it works.

hope this helps

I believe the Omnipod adjusts for IOB when making a bolus recommendation based on BG and anticipated carb intake.

If my BG is low before a meal, as confirmed by a fingerstick & Dexcom, I take the usual amount of glucose tablets to bring me up to my target, straight away. Then when I am ready to eat, I add the glucose carbs to the meal carbs & enter that amount into the pump, I use the low BG value I had previously tested & let the pump sort out how much insulin I need. It usually comes out at the dose I expected for the meal bolus. I have an Animas Ping pump & the EZCarb calculation takes into account any IOB if the BG is outside my normal range.

  1. My set goal on my pump is 100. If I check my blood and it’s 95 before my meal, then I just bolus for the carbs and say “no” when the pump asks if I want to lower my insulin based on my BG. If I’m say, 65, then I adjust my insulin to bring my BG closer to 100. I play it by ear, though, nothing is set is stone.

  2. I don’t make my correction at the same time because I don’t like to eat if my blood sugar is too high. If I’m 200 and I eat 15 carbs, I’m going to spike before I come down, causing me to be high for even longer. If I correct and bolus for my food then wait my BG to come down, and then eat, I end up with horribly high numbers around the four hour mark. It seems as though the insulin is no longer working but the food still is.

For example (and remember I work 2nd shift so my schedule is wonky at best): I set my alarm for 7AM. If I check my blood sugar and it’s 160, I do a correction. I get out of bed at 8AM, but I wait until my blood sugar to have dropped into range to eat breakfast. I do this by keeping an eye on my CGM. So, then I will check my blood sugar again. If it’s in range, I put that number into my pump, enter in my carbs, decide if I need to adjust based on my carbs. I won’t need to do a correction with my breakfast since I am in range.
While at work, if I know my lunch break is about 2 hours away, I check my blood sugar. If it’s a little high, I will do a correction. Now, at work, it’s a little different. If I’m still out of range at lunch break time, I have to decide if I’m going to eat then or not eat until much later. Let’s say my BG is 130 (with IOB) and I decide to eat. First, I type my BG into my pump and it will ask me one of 3 things (1) to add more insulin because my IOB is not enough to lower my BG into range (2) it will tell me I don’t need to do a correction beucase my IOB is right on or (3) it will tell my that I have too much IOB and I may go low. So, pretend that I get option 2. I don’t need a correction nor do I have too much IOB. I put in my carb count then eat.

I can’t believe that I’m the only one doing corrections while it’s not meal time. I just see it a different way. I know that it is best if I am in range before meal time and that is what I’m aiming for, so when meal time is approaching, I start making sure that my BG are good enough to eat. I always try to think about the future and plan ahead.

Oh, and yes, I am fully functioning down to 60, usually.

1 Like

My Medtronic pump will not allow me to bolus if my BG is under 70. what do you consider your low to be before you treat?

what do you consider your low to be before you treat?

RE doing corrections when it’s not meal time, I suspect many, if not the majority, of PWDs correct outside of meal time. Me? I’m what many would call “correction-happy”. While I’m still plowing through Stephen Ponder’s Sugar Surfing in order to fine-tune it to a Zen Art, I’ve always stood by micro-bolusing, micro-carbing, and temp basaling to flatten that line.