I’ve read several discussions lately where people mention that when they started consistantly giving themselves insulin 20-30 min before eatting, they noticed a lower A1C and/or better post-eatting numbers.
I have 3 questions:
1-How far ahead of eatting do you bolus or give yourself an injection?
2-What type of insulin do you use?
3-How big of a difference has it made in your A1C?
I’m paying more attention to my post-pradnial (after eatting) numbers since joining this site and I’m really curious if just giving myself more time between bolusing and eatting would help even out those 2 hour spikes.
Hi Autumn! My favorite topic because I think this is what reduced my A1c!!
(1) I take my insulin at least 15 minutes before eating, I try to wait 25 minutes. If I am high, then I try to wait 1 hour. Here’s my rule of thumb:
<80mg/dl- Take insulin and eat right away
80-100 mg/dl- wait about 15 minutes
100-150- wait about 25 minutes
>150- wait 45-60 minutes
(of course, sometimes I’m not patient or don’t plan in advance and I don’t wait this long!! But I try to!)
(2) I use Humalog insulin
(3) I saw an A1c drop from 7.6 to 6.5 in a matter of months. It is not only due to early bolusing, but that was the most significant change that I made (I did not do low carb, start new exercise regime, etc.)
Dr. Bernstein recommends testing when your insulin starts dropping your blood sugar. Here’s how he suggested to do this:
when you are about to eat a meal and you have good, but not too low blood sugar (say between 100 and 140), take your bolus and start testing your blood sugar every 5 minutes. Start eating when you see your blood sugar drop more than 5 mg/dl (of course this assumes an accurate meter). I waited for a drop of 10 mg/dl and I was amazed that it only happened 25 minutes after I injected that insulin. As always, people and insulins vary, but this is a good way to figure when the insulin will start making your blood sugar drop.
I have experienced some uncomfortable lows with my method. So it should be approached only with caution. My most important tool is the kitchen timer. I take the bolus and set the kitchen timer, usually to 15 or 20 minutes. When the timer goes off, I drop everything and EAT. This method is much easier to do at home than when eating out. When I eat out, I bolus when the food arrives and try to eat the no carb food for the first 10 minutes (eating a salad) or just stirring the food around on my plate
Hope this helps! I will be curious about other people’s responses!
I take Humalog at least 30 min prior to eating, 45 min if I can. My A1C dropped from around 8 to the 5’s after one month of pumping and has stayed in the 5’s since April.
I take Novolog pre meal and I try and take it within 15 min of my meal
4 units for breakfast
5 units each for lunch and dinner
and I take 1 unit for every 40 over 120 on my meter which does not happen often any more
I try and leave 4 hours between meals
I also take 20 units of levemir before bed
I dont always get 4 hours between dinner and bedtime
November will be my first time back at the endo since my diagnosis but my averages have been between high 90’s to 100
I am very interested in what everyone has said. I’ve been trying to get my A1Cs into a normal range (last test was 8 in Oct down from 8.3 in july!)… I lead a very hectic lifestyle and many times can’t inject until JUST before I eat, but your stories are so inspiring I may try to be more aware and plan ahead.
I did a clinical trial several years ago for a “fast acting” bolus insulin and I LOVED IT… you actually injected immediately after your meal, but sadly I never saw the product come to market.
Hi Lisa,
I was very interested in seeing people respond. I know each of us is different. Shooting my inuslin before meals does not work for me. If i am very high for some reason before a meal it is okay for me to shoot before hand. But obvisously my metabolism or digestion is so crazy that if I normally shoot before eating I will go low before my food starts to digest. I have an obviously very slow transit time and cannot even eat at all between meals. I have kept track of different foods and faithfuly written down everything and times, etc. But the best my doc and i can come up with is just a very slow time for digestion. If it was something very liquid like a regular soda or a glucose shot then I can come up fast. Even trying to work with glucose tabs takes a longer time for me
I know this is a quirky problem, but the only thing we have been able to find is just a slow metabolism. When we schedule me for tests we have to give me at least 12 hours to make sure i am truly empty. So my answer for your question would be to say that i have to shoot immediately after and it catches me fine. My last A1C was 5.6 so I guess it is working okay. But I do shoot Lantus twice a day so maybe that has an effect too.
Saundra,
Is there any way to try to boost your metabolism a bit (via weight training/exercise?)… I suppose if it’s working for you… I WISH I had an A1C of 5.6
Everyone has given great suggestions. I’ve been able to give myself about a 15-20 min head way on eatting for dinner the past few nights and it seems to be helping. I haven’t tried it at lunch yet because I’ve been chasing highs made by bad breakfast choices. (Donuts and coffee. Which today really made me feel crappy, so they are the first entry on my “Foods that make me feel yucky” list.)
My next question is, what if you don’t know your exact carb count for your meals? Do you do a best guess bolus 20-30 minutes before and then add more once the meal is placed in front of you?
Just some food for thought too… Depending on when you insulin peaks or ramps up… 20 mins for Novolog and Humalog to start lowing BG… Apidra is different I have noticed too, I bit faster and has more insulin effect up frint then Humalod and Novolog…
But it depends on the food your are eating too… Matching insulin to peak when your food of choice does is tricky… Thats why combo boluses from an insulin pump are so great, but even under used by me and lots others out there.
The other thing to remember is when testing your BG there is a delay as well, that number might be 5 - 15 minutes behind what you really are depending on if you are testing your fingers, palm, arm, or leg.
I use Humalog and unless I’m high (over 130) I eat right away. I am sensitive to humalog so if I don’t eat pretty quickly I end up hitting a low. Well, seeing how my A1C came down from a 10 to a 6.5 in two months,I think it’s worked pretty well for me =) but its all “to each his own”! and i’ve definately learned that about many things!
I have a low insulin sensitivity factor, so it takes my body a little bit longer to start reacting to a bolus. I usually bolus about 30 - 45 minutes prior to eating a meal. But we all know that life doesn’t always allow for this… I’m on a pump and use Novolog. I haven’t really thought about my A1C’s in regards to it being affected by how close to a meal I’ve bolused… But it makes sense. At this point, I’m glad to have my a1c’s down to where they are compared to what they were before the pump! Before getting my pump, I could only get my a1c down to 8.2 unless I wanted to be in a constant hypoglycemic state… Once I got the pump, my personal best was 4.7. Now I stay pretty consistant between about a 5.5 and 6.5.
When I was taking Apidra, I had to take it as soon as I started eating, or no more than 5 minutes before. It worked very quickly for me & left my body just as quickly. I’d have great numbers 2 hours after eating, but 4 hours later or less BG was climbing up high. If I took higher doses of Lantus to compensate, I’d be too low.
I’m now on Humulin R. Works much better for me. My doctor thinks I have slow digestion, so I’ve been instructed to take it right before eating. If I’m eating something that’s super easy to digest like a protein shake or soup, than I take it 30 minutes before a meal. Most people are told to take Regular 45 minutes before a meal, which sure makes things more difficult.
I haven’t been on Humulin long enough to know yet how it will change by A1c.
I’m on apidra, and it seems to work very fast. I try to bolus 15 minutes before I eat, but sometimes I cheat (when I teach I only have an 18 minute dinner break, and I can’t inject during class). But if I bolus before I eat and save the carby things in my meal for last, everything works out great. Maybe I’m lucky, maybe it’s the apidra.
i have the same problem. They cannot figure it out. I have to eat right aways when i take bolus and if i am lower which is hardly ever lately i have to take it after i start eating. before i was on the pump i had to take lantus twice a day. and for a while they where going to make it three times a day. I have to take a lot of insulin through out the day. I take just novolog now in my pump
I bolus after I eat if my sugars are in the normal range. I take Symlin, so sometimes it is hard for me to tell how much I am going to be able to eat, and the glucose from the carbs in my meal is going to slowly trickle in over a few hours anyways. Of course, all of my boluses are square if my BG is normal at mealtime. If it is high, I move to dual wave, with the correction given up front and the insulin for the meal delivered over 90 minutes to two hours. I use Apidra in my pump (Minimed 722). The advantage with Symlin, especially if you have a CGMS, is that you can spot and reverse unhealthy movements in blood glucose before you are outside the normal range.
Using Symlin helped me drop my A1C by a full point in 3 months. If your biggest issue is post-meal spikes, this is the one issue Symlin addresses best. Give it a “shot”.
I wanted to re-test how early I should take my bolus because I’m on a trial with the Minimed CGMS. So I woke up around 5.9 mmol/L (106 mg/dl) – the meter and the CGMS agreed – I bolused for 60g of carbs. Thirty minutes later, both the meter and the CGMS read exactly the same (i.e. NO drop). Now after 40 minutes, I have dropped to 5.5 mmol/L (99 mg/dl) (according to my meter – my CGMS still reads 5.9 mmol/L).
So I will eat now (following Dr. Bernstein’s rule of eating when I see a 5 mg/dl or 0.25 mmol/L drop in my blood sugar).
I’m going to keep testing this, but it seems that Humalog takes 35 minutes to start dropping my blood sugar. I wonder how normal this is???
I inject NovoLog directly before I eat and even this can be a problem with food that turns out to be slower than expected. From my standpoint I think that 35 minutes is a long time. It is another great example that we are all different and we react differently to insulin. Have you ever tried to switch from NovoLog to Apidra?
Ok so here goes… I’ve been on MDI for almost 10 years now and my AiC is 5.6. I do not even take my insulin before i eat. The reason for this is that I do not eat a certain amount of carbs at any given meal except my snack at night so I chose to take my insulin asfter in case I want seconds or if I am not as hungry as I thought I was. That’s just how i do my insulin when i eat.
I also use Apidra and bolus 15 minutes before eating. If I eat very low carb, I’ll wait till Dex gives me an indication that my BG is rising before bolusing. I don’t know if it’s the Apidra, the pump, the Dexcom, or the timing (most likely a combination of all) that has lowered my A1C, but I’m in very good control.
because I think this is what reduced my A1c!!