Hi, I have a question in multiple daily injection technique. If we eat something that raises blood sugar within an hour from 100 to say 300, we can take fast acting insulin in appropriate amount to cover this spike. Can we do this often, like any time between two meals in a day of 24 hrs. For example, suppose some snacks result in higher sugar levels before sleep in night, can we take fast acting right before sleeping. Or we are limited to use insulin only at certain times in a day. I am sure pump users can adjust bolus to cover it. I have been recently into habit of taking snacks a lot right in between of regular meals. It rises sugar, and I take humalog 3-4 units. I also fear it may not be healthy to be flexible like this.
you can use fast acting insulin at any time, whenever you eat somehting with carbs in it. as long as you are counting your carbs and shooting up the right amount of insulin for your snack, youre doing what you should be doing. fast acting insulin can be used if you get up at 3am for a snack, for if you are hungry between meals, whenever you want. it would be unhealthy to eat carbs and not cover them with fast acting insulin.
if i am having a snack just before bed, i try to make it low carb so that i dont have to inject any long acting. i am a bit careful because i dont want to go low at night if i miscalculate the insulin dose.
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Thanks, This totally makes sense. And this is really I have been doing. Only I should have known carb amount correctly and right insulin dose for that so that blood sugar does not go high or low.
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Also, if you’ve done more physical activity during the day than usual, you may need to eat a snack before bedtime with little or no bolus to avoid going low while sleeping.
Are you pre-bolusing a certain amount of time between insulin dose and first bite? In an ideal world your insulin action curve would closely match your food action curve. Some people just use a fixed pre-bolus time like 15 minutes. For many people, including me, the time of when insulin starts lowering blood glucose significantly can be as long as one hour in the morning and is not usually less than 30 minutes at other times. These pre-bolus times are customized for me and may likely be different for you.
I use a continuous glucose monitor (CGM) and can watch my blood glucose level after I’ve taken my meal insulin and actually see when the glucose level starts to bend downward. Alternately, you could use a blood glucose meter to determine your best pre-bolus time. You would need to take your insulin and watch your blood glucose closely with a series of fingersticks 5-15 minutes apart. Always do experiments like this with emergency glucose nearby and when distractions can be kept to a minimum, like on a day off from work.
I realize I have not answered your original question but I’ve found using an optimal pre-bolus time can eliminate or moderate the amount of insulin correction taken after eating to bring down a high BG, like 300 (16.7).
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I’ve tried to do this; however, I find that higher protein/fat snacks before bed tend to cause a more prolonged rise in blood sugar and a tendency to go high overnight. More carb-y snacks (or something that has some carbs, some protein/fat) are actually easier, since I can cover with some Humalog and then it’s resolved early in the night. I have a CGM and tend to wake easily for lows though, so I’m not super concerned about the risks of overdoing the insulin.
The only thing you need to be careful about is stacking. Your insulin starts working in 10-30 minutes and peaks at a certain time and trails off until it stops working. If you’re not careful, you can end up going low.
A lot of this is taken care of for me by my pump, so someone on MDIs has to do it for themselves. I’m too time-change addled to do much math right now!
i usually do things like celery and cream cheese or a cup of chicken broth, so low carb, low everything. life is hard and sometimes not very tasty!
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The big problem here is how varied everyone’s diabetes is. What works for me might not work for you and I find many times what works for me today won’t work for me next week. The joys of diabetes!
That being said, everyone has great ideas and suggestions as usual. I will add my two cents worth, that pre-bolus is the key to most post meal rises. And it takes a lot of trial and error to get the timing right. What is current blood sugar, is arrow going up or down etc. Many like Terry just watch for the bend and that’s the time to start the meal. And I will also say that stacking your insulin can get some into a real bad spot, but I think if you use your CGM and watch the numbers, it can be done, but carefully. But most professionals will say that it is the timing of the insulin in relationship to eating your meal. Good luck with your experiments.
yes, physical activities can lower the insulin dose. I easily go to 50 mg/dl, if I dont take any snacks in day. But usually I end up taking lots of snacks without caring about amount and I go high. Then take correction dose an hour later.
Its a wonderful observation I never thought about. I just take insulin dose and 15 mins later starts meal (morning or evening). This observation is a crucial step to better control. I will try to find out this time period for each mealtime in my case.
Its really an experimental medical condition. Patient has to conduct lots of experiment on itself to find out a good prediction. These predictions ultimately help the patient. Unfortunately I am not using CGM so far. So only pricking fingers with needle find out levels.