Gastroparesis and prebolusing

i was just diagnosed with diabetic gastroparesis. i have for many years been able to pre-bolus about 10 minutes before eating my meals. it didn’t seem to matter how many carbs i was eating or how high the glycemic index was; my BGs were well controlled and my A1cs were good. but then, for some reason (coincidently, when i began on a Dexcom sensor), i was able to see patterns emerging that i had never noticed before, despite having used many BG testing post meals. i realized that i needed to pre-bolus for at least 15 minutes and that i had come to rely heavily on my pump’s dual bolusing feature. even for simple carbs such as oatmeal or yogurt and, basically, any kind of starch.

i tried extending my pre-bolus to 15 - 20 minutes before meals. this didn’t seem to do the trick either. now i am taking a drug (from Canada) called Domperidone before all meals and at bedtime. its helped relieve my nausea, but has not helped to relieve most of the other symptoms of the delayed gastric emptying. and i have come to notice that my BGs post meals are elevated from a starting BG of 80 - 120 to as high as 180 2 hours post meals

has anyone gone through this, and, if so, can you make any recommendations for how you have changed your bolusing before (and/or during) your meals??? i really need help. even with my D Ed and Endo, i haven’t found a solution yet. i am soooo frustrated and feel down and out with my lack of success.

thanks all, Daisy

Daisy, have you thought about giving Afrezza a shot? Given the variability that gastroparesis tosses in the mix, the ultra fast action and quick clearance may be just the ticket for reacting to high postprandial BG hours later.

In fact, with the uncertainty of when digestion is going to actually hit your bloodstream, Afrezza may be the ideal replacement for your bolus insulin.

Hi Daisy,
Suffer from a VERY bad case of GP and have used the domperidone. You have a difficult complication, and Dave is correct, you need fast acting insulin. I actually use Apedira (it starts to work for me in about 15 min) and I take it after eating …I watch my sugars and usually when I see the numbers start to go up 20-50 points I know I’m starting to digest and do my shot ( I do MDI because I need the control). I find I avoid the lows this way, everyone is different.

Nausea is the worst have some Gel based glucose on hand and keep some Ensure Clear or other liquids. I also throw up pretty regularly so if I do so after I’ve injected I know I need to take something liquid (because of the slow digestion) to avoid a low…

You didn’t ask, but I’ll tell you that diet goes a long way to helping with the nausea. The GP diet is NOT diabetic friendly, I just keep a clean low carb diet…watch the fat and fiber (both have to be low). Fat and Fiber both interact with digestion and can slow it down, causing your sugar to be more out of whack…

Sorry to know you have this, and don’t ever feel like it’s your fault. It will take time and trial to get the normal numbers back, but they are so important to keeping the GP from progressing and so worth the effort.


thanks for the info about yourself and your experiences w/ GP. i am on the pump for 16+ yrs and have had a great A1c of 5.8 (most recent 1 month ago) which i have worked very hard for; i eat right, i excersize, i don’t eat many carbs, mostly protein and fiber (big salads) cheese and fish. i have had to cut out a lot of these foods lately b/c they have just been making me sick when i look at them. (but, i confess, i am addicted to natural, sugar-free peanut butter; i eat it throughout the day by the spoonful, and i know that this is not good w/ the GP ) since the GP Dx, i have only been able to tolerate things like Cream of Wheat, Eggs, Yogurt, Applesauce (no sugar added), Soup…and the like. I test my BGs often. i don’t know if it has just been a rough few months for me and that is playing havoc on my BGs or not. my fasting BGs are excellent (70s to 120s). i haven’t made any major changes except that i am eating more carbs and less protein to combat the nausea. i use Novolog Insulin in my pump and use the Wizard function to insure that my I:C ratio is on target. sometimes my BGs respond nicely, and then when i use that same formula the next time, my BGs react differently, with seemingly no rhyme or reason. I do use the BOOST shakes for Ds to insure that i am getting my calories ( i am very skinny and weigh barely 100lbs). they are very low in carbs and have hardly any sugar in them. i react funny to them as well. i know that in the mornings i am very insulin resistant (always have been), so i try to just eat pure protein for Bfast, but lately, i am reacting to the morning protein as well. Just so frustrated. i want to cry all the time. my husband is a great support, and my family members are as well. their big fear is not only my discomfort, but my potential weight loss. i need to put on at least 5 or so lbs and it just seems impossible. have you had this problem due to your nausea?

everyones response and experiences encouraged !!!

Daisy, you have excellent control, so it doesn’t sound like a bit more variability and some higher, late postprandial spikes are anything to be concerned about. Maybe you need to adapt to this new situation by, in part, relaxing some of your D management expectations?

Like I said, your control is EXCELLENT. You have breathing room. Go ahead and breath a little more, you’ll be fine.

As you said, you’re very lean… So maybe bumping up the carbs, and concomitantly insulin, isn’t such a bad thing; you’ve got plenty of runway in the weight dept too.

Dave makes awesome points…you do have excellent control and this will help with the GP (numbers over 180 tend to also slow digestion and numbers higher consistently like 250 and above can in some folks, can progress the GP).

Keep the stress levels down and don’t worry about the GP, you have already climbed the mountain in treating diabetes, this is just one more little hill until you get back to the top again.

For me, I did see a nutritionist who does both diabetes and GP - she and I worked on some smoothies (including the powdered peanut butter) that give me great nutrition so when nausea gets really bad (for me I have it 24/7 but sometimes it is much, much stronger) I go to that standby for a day or two then add foods back in, starting with soft foods and moving up. I also do several small meals per day and try not to eat late as it raises my morning blood sugar (Dinner at 8 with 7 gm of carb will still be impacting me at 6 the next morning).

IMPORTANT note, there is guided imagery and other holistic type treatments that do help you get over the nausea. It really does help if you can access something like that.

I also do my fast acting after the main meal when my sugar starts to climb.


thanks for your generous support. I have been trying to put on weight for years now. i actually went on the Dex Sensor for about a year (a trial experiment) but couldn’t stay on it b/c i am too thin and i couldn’t ever find a sweet spot to insert the sensor. sometimes it worked well, but i couldn’t get more than 3 days out of it and it was a killer trying to put it on. but, when it worked, it worked well and i learned a lot about my blousing from it. but, i didn’t have the GP at the time. (or maybe i did but it was in the mild stages) i recognized that i needed to dual bolus for everything. and that was a pain in the butt, but it was a good formula for me and kept my BGs in check. still, at the time, i was on a high fat/lowcarb/high protein diet which slowed my digestion down.

anyway, this is where i am at today. frustrated and feeling out of control (despite my excellent A1c) i think i probably need to loosen up a bit and not be so hard on myself. but, the GP really is uncomfortable, and its hard to get my calories in; often, as i think i mentioned earlier, if i just look at food i want to throw up.

thx again, Daisy

[quote=“Daisy_Mae, post:7, topic:56542, full:true”]
anyway, this is where i am at today. frustrated and feeling out of control (despite my excellent A1c) i think i probably need to loosen up a bit and not be so hard on myself. but, the GP really is uncomfortable, and its hard to get my calories in; often, as i think i mentioned earlier, if i just look at food i want to throw up.
[/quote]Daisy, this is what I was getting at above – load up on carbs. You have plenty of “room” to do so, given your routine diet (LCHF), and your exceptional control.

This is a win-win-win in your situation: Will bias toward weight gain (carbs == more insulin == body will prefer to pack it on as fat if you take in more calories than you need), will digest much faster, aiding with the GP issues, you get to eat some yummy stuff you’ve probably been denying yourself for-evah!


i like the way you think w/ regards to including more carbs; my only problem w/ carbs is that i tend to spike (from 85 to 180 w/in an hour post meal). then i spend time chasing my tail to bring my BGs back into range. my fav foods are carbs and butter (lol) and peanut butter. i could eat them day or night or both. i could live on cream of wheat, english muffins, and pizza and grilled cheese sandwiches for the rest of my life if i had to, and i would have a huge smile on my face.after years of experimenting i have figured out how to dual bolus for the grilled cheese and the pizza, but it eludes me on how to bolus for the straight carbs. i think i have tried just about everything. (long pre-bolus, short pre-boluses, dual boluses of every possible combination) so, when i want carbs, i just accept that i am going to spike and i forgive myself. i have to remember: i am not defined by my BG number. i have friends who indulge on iced cream, cookies, smoothies, juices, bagels; they are also D1s. i watch them and have no interest and i remind myself that their A1cs are over 9%. i already live with the neuropathy in my feet, lower legs and hands (which comes and goes) i just get so frightened that if i tempt fate anymore, and i slack up on my diet, i will end up getting an amputation somewhere down the line. so, needless to say, i am very very hard on and very critical of myself. and i know that i am depriving myself of a lot of delicious yummy foods. i read about a lot of other on this TuD site and i am baffled how much others are able to indulge and enjoy their meals. OH! being D stinks.

do you have any suggestions for how to bolus better for carbs? my D Ed/nutritionist has been working with me for years. she is excellent, patient and willing to experiment beyond the lines of typical assumptions with diff foods. (i have to bolus even for simple things like eggs, turkey, fish) so i know that i am in good hands with her; but, i am and will always remain open-minded to other Ds who have trouble bolusing for their carbs. (i have long given up on my notion that i can eat carbs for Bfast as my morning resistance is so awful; my Bfasts are always protein and/or avocados) so, thats my story for today. any more of your suggestions are soooo welcome. please keep me in the loop. (my GI doc told me that once i get my BGs in line, i will probably feel better with the GP; but my BGs ARE in line. i don’t get this just the nature of being a D???)

Daisy, much depends on how long you linger up there about 140 or so. If it’s only an hour or two, it’s not nearly the concern you seem to be placing on it. Have faith in a1c – it’s been a pretty solid metric for correlating with the bad consequences of D.

As far as neuropathy and other complications of diabetes, while there is correlation between BG control and these problems, it is also true that there is a higher risk simply by having diabetes – no matter how good your control is.

With a a1c of 5.8, in my opinion you’ve got some room to maneuver. If it goes up to 6.2 because you shift calories to carbs and now have some bigger postprandial spikes into the high hundreds, I don’t think there’s really a significant increase in risk for complications. The charts have been posted around here before – the “knee” of the curve where risk starts to increase significantly is around 7 – that’s why that’s the magic a1c number in diabetes care.

As for controlling the spikes, maybe give Afrezza a try, if insurance will cover it.

My heart goes out to you, Daisy. I had a GI bug that basically gave me temporary GP last year, and it was horrible trying to manage my BG. You’re in my thoughts :hugging:

thanks again for your kind words and encouragement. last evening i tried bolusing for Cream of Wheat; my BGs before eating were 110 with a 20 minute pre bolus. 2/12 hours post meal my BGs were 108 and held steady. i tried the same formula this afternoon and got similar results. very pleased. i think part of the success was due to the time of day that i ate the simple carbs as opposed to a protein meal. perhaps i am on to something here. i certainly hope so; not only do i love Cream of Wheat, (and starches in general) but they are easy of the GP. my tummy seems to handle soft non-asidic foods well. no nausea or feelings of bloating or over-fullness.

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Time of the day might very well have something to do with it! I am far, far less “carb sensitive” in the evenings and after intense exercise. If I eat oatmeal or some other kind of cereal in the morning, even in modest quantities (~25g carbs or so), it will raise my BG by as many as 60-80 mg/dL in one hour (my spike). That’s not terrible for many people, but it’s higher than I want to go. The same meal at 8:00pm when I went on a bike ride or worked out heavy earlier in the day might raise my BG by only 5-10 mg/dL. I believe this is due to a combination of Dawn Phenomenon, higher (natural) insulin resistance in the AM, and the dampening effects of “hungry muscles” which want all the glycogen I can feed them after working out. That combination means I can load up on carbs later in the day. Since I’m not trying to lose weight, and since I’m more concerned with flatlining my BG rather than being in the “Keto club,” this works quite well for me.

*Edit: when I say “raise by 60-80 mg/dL,” I mean from whatever I was pre-meal. So that oatmeal breakfast (1/4 cup steel-cut oats with slivered almonds and salted butter) might take me from 85 mg/dL fasting to 145 mg/dL after an hour, which is outside my preferred range. This has led me to mostly eating low-carb, except for after exercise when I’m feeding depleted muscles. Then I eat “moderate” carb (40-50g gross per meal, usually dark green veggies, nuts, and fiber).

as a GP person, I miss the fiber of oatmeal…and almonds yummmmmmmmmmm these would slow my digestion up by days :slight_smile:

So does fiber cause the issues with GP in particular, or is it a combination or a range of foods? I don’t have GP, but I do have problems digesting fats (no idea why, but it’s always been so). It’s a real pain, especially since I’m now eating LC to help with the BG.

And yes, I miss good oatmeal as well, fiber included. I don’t eat it because, even of the evenings, I generally don’t want to the spike in BG. If I am going to get some quality carbs and fiber after working out, I usually choose broccoli, kale, spinach, or a protein bar (which is full of inulin).

fiber actually both fills you up and moves through slower. So when you have problems digesting slowly already…it adds that one more level of complexity as to ‘when you will digest’ and by filling you up allows for that much less food in the tummy…the more fiber I have the less I can eat and more erratic my sugars…

That makes sense. So is GP a general slowing of the digestion across the board, or does it an enzyme or hormone-mediated process that slows digestion at a certain point in the process?


i find i have similar problems; the more fiber i eat, the fuller i feel after eating; and this can mean as little as 2 fork fulls of food. i have now completely given up on my passion for veggies. even things like chicken or tuna have become off limits; they make me feel terribly bloated and nauseated, and that horrid feeling can last for hours after ingestion. the simple carbs are the most comfortable (cream of wheat, farina, etc) but then i tend to see a spike. what i have been trying to do to keep all my BGs stable is prebolusing for longer periods of time. i used to be on the dexcom and it made it easier to see when my insulin began working, and then i knew when it was a good time to eat (also, b/c i have found that different foods require different pre-bolusing times; i need longer pre-bolus for fast carbs…for reasons unknown to me) but i had to go off of the dexcom, so now i just have to test frequently and monitor everything i do carefully with notes/records.

Hi David,
I’m not a Dr. but I believe it is slowing of the process. It comes with terrible nausea, vomiting and it is very difficult to control sugars as you don’t know when you are digesting. Today was typical I was in the 70-110 range before and for four hours after lunch (10 gm of carbs and some fiber with 1/2 cup salad) … suddenly at five hours I started to digest and shot up to 290

Hi Daisy Mae
You have excellent control still from the numbers you posted earlier - you may want to see if you can get a CGM and some rapid acting insulin to help keep that control in check…I do measure hourly right now and as soon as I see that swing I hit it on the head :slight_smile:

I’ve been moving to more liquid type diet lots of nutrition packed into a smoothie helps me digest and keep my sugars stabilized as liquids pass through better…but you have watch the nutrition and work with a nutritionist to make sure you have recipes that contain all that you need…or you can cause other problems

I also find that cooked veggies and broiled, boiled protein does ok by me…you have to find what works for you

OMG, how do you manage to eat salad w/ the GP ? i just look at lettuce and i think i will vomit. i cant seem to digest it at all, no matter how long it may take.

on another note, i seem to have been (so far ) blessed with consistantly healthy BGs. nothing crazy or unmanageable. great over-night #s, fasting #s and right through the day. i do have spikes from simple carbs, but they dont last very long (Phew).