Eating every few hours and overlapping boluses

So I have been eating about every 3-4 hours and taking my bolus 3-3.5 hours after my last bolus to prevent a spike before my next mini meal. Anyone else eat every few hours? How often is it “safe” to bolus and snack while on MDI? I never take more than 2 units at a time. Thanks in advance for the wonderful advice I know I will receive.
-Jenn

I eat every few hours. I generally only consciously try to clean out IOB if I’m going to run or bike a lot. Last night we went out boozing it up (only a little as I had to stop early in the evening to get home…still…) and just bolused …5-.8 for each of four drinks, like four over the course of a few hours. I kept an eye on the CGM and it was ok so I didn’t bother testing. Then we went to dinner around 8:00ish, I tested, was @ 85 so I bolused for about 75G of carb. We went to the scuzziest bar I have ever been to after that and I stopped drinking. By the time we were headed home, I was running a bit low as I hadn’t quite eaten enough and had a few jelly beans and some chips and was around 100 when I got home. No crashing out and decent all night, just kept up with everything. I have read that “extended boluses” are supposed to be handy for “party situations” but I prefer to do multiple, small boluses to extending them.

I don’t eat that often but you might need to experiment a bit to find out your Duration of Action - how long the insulin stays in your body. People find they have different durations - from 3 to 5 hours. If you are finding you go low, then you are probably “stacking” (taking more insulin when some is still active) and you have to start computing your Insulin on Board before determining dose. I’m not sure why you feel you will spike if you don’t eat that often. Is it a pregnancy thing? (about which I know less than nothing!). If you are spiking too high after meals, you do have other options such as altering your I:C ratio for a bit more insulin or taking a correction dose. But if it works for you to eat often and you don’t go low from stacking, then it works!

This is the problem of “stacking” insulin. When you bolus for a meal, only 20% of the insuliin is used in every hour (for Humalog/Novolog), so you will still have insulin “on board” up to 4-5 after your bolus. If you fail to account for this insulin, you may “stack” your bolus for a second snack/meal, adding on top of the existing insulin. This can lead to a nasty hypo and stories that your friends and family will tell for years, so avoid that.



If you are on a pump, your pump will make take this into account for correction (and I believe some also account for it in carb boluses), but if you manually inject like we do, then you have to figure it out directly. The two major ways of dealing with it are to wait 4-5 hours between feasts or to subtract off for insulin on board. Let’s say you want to eat 3 hours after your last meal where you took 2 units of humalog. You will still have 40% of 2 units as IOB, namly 0.8 units. If you eat a snack that is to be covered with 1 unit of humalog, then you need to inject 1 unit (the carb colus) - 0.8 units (IOB) = 0.2 units. In that case, you can eat without an actual bolus.



Does that make sense?

Ok well BSC scared me so I will no longer be bolusing and eating until right at the 3 hr 45 min-4 hour mark lol. Thanks for the feedback guys! Looks like if I want to eat more than every 4 hours I’d need a pump, oh well!

Not necessarily, LilMama. If there is some reason why it’s important to you to eat more often, (perhaps it’s better for your pregnancy?) you just need to do some math to keep track of your IOB. There is nothing magical about the pump that allows you to eat more often. It just figures out the IOB for you (from numbers you have programmed in yourself) rather than having to do the arithmetic each time. Learning to figure IOB is a good practice anyway for doing corrections. Especially if you want to catch spikes at the 2 hr PP test rather than stay high longer, you do need to take the IOB into account.

Oh jeez, my intent was not to scare you. I do think that once you bolus for what you eat, you need to take care to understand stacking, but it doesn’t have to be rocket science. I assume everyone does math stuff, and that is not true. Zoe is right, once you get a pump, it will keep track of stuff for you.

How do you calculate IOB? My insulin doesn’t even seem to kick in until 1.5 hours.

I simple rule of thumb from Using Insulin is that Humalog/Novolog is used up at a rate of 20% each hour after injection. After an hour, 20% has been used, leaving 80% as IOB. At 1.5 hours, 30% has been used, leaving 70% as IOB., and then at 2 hrs, 40% has been used and 60% remains as IOB. You can just remember 40/60 at two hours and be fine.



You may benefit by bolus 15-30 minutes before your meal. Ideally, your insulin peak action should align with the glucose surge from your meal. But if you bolus too early, you can go low, causing “Animal House” like behavior at the table, not a pretty sight.

This is pretty much exactly what I have been doing. My endo was worried about me “stacking” my insulin like this, but the CDE/dieticien I met with basically said this was a good thing, because I was creating my own basal rate and, therefore, keeping my bloodsugar relatively stable throughout the day.

Now that I’m on the pump, I find it much easier to keep track of how much remaining insulin I still have in my system (the “insulin on board” feature). Because I tend to eat frequent, small meals (especially meals that are low in carbs), the pump is really beneficial. Often on MDI, I didn’t need a whole unit of insulin for a snack, but needed something otherwise I would go high an hour or two later. Now, I can give myself a fraction of a dose.

Have you considered getting on the pump? I was initially concerned about all the possible negative aspects (being attached to something 24/7, bulk of wearing it under clothes, etc) but really love it!

When you need to take small doses on MDI, the 1/2 marking syringes make it easier. I use BD 1/2 markings, and I’ve read on TuD that there are other brands available as well, for instance at Walmart’s.

I mentioned this to my endo, and she said that even the 1/2 unit synringes are just not that accurate, and cannot deliver insulin as accurate as the pump can. She said that while these small synringes are good in a pinch (i.e., if my pump fails), the pump provides dosing on a much more accurate level.

Hi DogLady. I’m on a pump part time, and the pump is certainly more accurate and leads to better control for me. When I’m on MDI (most of the time), I try to achieve results that are as close to pumping as possible, and for this the 1/2 marking syringes are invaluable. MDI is a lot more work, for me at least, all those bolus/correction shots plus three shots of Levemir. The Levemir for me is tricky, I need exactly 1 1/2 units at 9:00 AM, another 1 1/2 units at 2:30 PM, 5 units at 9:00 PM.

Yeah, I hear ya. I had a lot of reservations about going on the pump, but thus far it is awesome. I am sure I will have some issues at some point, and may take a “pump vacation” but the accuracy with dosing is just so nice. I was never able to accurately account for things like IOB and correction factors when doing MDI. Always seemed to be too many variables at play. While the pump can’t take away all those variables (like exercise, weather, etc), it makes it easier to consider them, because all the other complicated calculations are done for you.

I usually wait 30 somtimes up to 45 minutes before a meal if I took a correction bolus to lower my bg with my mealtime bolus.
Thanks for the advice as always! :slight_smile:

The way I do it, LilMama is to know what my Duration of Action is (that is also how the pump computes it for you). I used 3 hours on MDI and 3.5 on the pump, I tend to have a shorter Duration than what BSC describes below. (I use Apidra) Some people use 4 or 5 hours (which is what BSC describes). You have to do a correction for example and see how long the insulin keeps on lowering your blood sugar. After you estimate your DOA it’s a pretty simple matter to do the math. When I used 3 hours for example, if I bolused 3 units for a meal and was high at 2 hours and wanted to figure a correction minus my IOB, I figured I had one unit left IOB and added that to what I used to correct.

I snack all the time. I don’t always check my BS before I snack either. I do know my insulin carb ratio, and my insulin usually peaks at the 2 hour mark. If I check my BS and it seems too high, and lets say I am at 1 1/2 hour post eating, I will not use a correction amount, unless the BS is WAY off the mark - like 100 points high, and I only ate enough food to raise me 50 points, then I would correct for the extra 50. As long as you are giving yourself the insulin for the amount of carbs eating, I wouldn’t worry about it. (Now, there is the whole bit about glycemic index, and if you are always eating foods that enter your bloodstream as glucose quickly, and the insulin takes 2-3 hours before it gets that glucose out of your bloodstream, only you have eaten again, adding more glucose to your bloodstream— it would be possible to end up with high A1C’s even if your 2 hour post eating numbers are all excellent. )

Thats awesome! I love how the pump keeps up with how much insulin is on board for you thats one of my main concerns so I refuse to correct a high bg or bolus to eat until the four hour mark. Sounds like the pump gives you a little more flexibility.