How far in advance to bolus? What kinds of carbs work for you?

Hi All,

My name is Denise, I am a type 1 diabetic and my husband and I are starting to plan for pregnancy. My A1C is currently 7.6 and I am trying to get more control of my sugars before getting pregnant. My doctor suggested pumping 20-30 minutes before I eat and he told me that I can’t limit carbs too much. I’ve been experimenting, sometimes I pump 20 minutes before eating, sometimes 30, sometimes 15, sometimes 10 minutes. I’m also experimenting with different types of carbs, granola, oatmeal, sprouted whole grain bread, quinoa, you name it. Nothing really seems to work, my sugar spikes considerably when I eat carbs, except for when I eat 1/2 cup of Near East brand couscous (and only that brand).

So my question is:

  1. How far in advance do you pump before eating?

  2. What kinds of carbs do you find don’t spike your blood sugar and in what quantity?

Thank you so much!!

Denise

I think you mean to say “bolus” before eating (to distinguish between this and delivering basal insulin per pump).

This presentation from Gary Schiener may be a good starting point for dealing with post-meal spikes (Start at Page 5)-

Here is the real takeaway -

Gary also does a great job in his book “Think Like a Pancreas” describing Bolusing in easy to read details. If you don’t have the book I highly recommend getting it and reading it.

Generally I pre-bolus anywhere between 45 minutes and 0 minutes based on what my blood sugar is and what food I am eating (i.e. if it is fast or slow to digest). Average is about 15 minutes. I often look at my CGM to see when the insulin action starts (when the number starts to drop) and then I eat.

I eat moderate carb (50-100g a day) and restrict foods that spike me too quickly based on experience. I find if I keep the carbs below 30g per meal the spikes are ok.

Other folks on this site go LCHF and have excellent control. I have to admit if I was pregnant (I am a man so very unlikely), I would probably go LCHF to nail down the control. There are a few pregnant ladies on the site who have excellent control and may be able to offer advice.

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Do you have a CGM? Seems like that would be the single most critical item to get your A1C down. If you do, then there are a ton of strategies you can employ.

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The first thing I’d do would be to get my A1c below 6.7 before attempting to get pregnant.

Good luck! I’m 7 weeks pregnant and less than a year ago never would have imagined myself here now.

First, I second another poster’s question: do you have a CGM? Using one consistently dropped my A1C in 3 months from 8.2 to 6.6. Prior to that, I wasn’t testing very regularly, either (3-4 times/day), so the increased knowledge was the first step for me. Second, I went LCHF and that made a HUGE difference. I love salads and vegetables, so it wasn’t a hard transition for me. That dropped my A1C into the 5s.

I still spike occasionally, but not nearly as high, and usually when I don’t pre-bolus. I try for at least 15 minutes, and that’s with the LCHF diet. With real carbs, I would advise waiting longer and making sure that your bg is below 100 before eating.

Good luck, good luck, good luck! You can do this. :slight_smile:

Thank you for posting : Timing of bolus insulin!

Does Fage plain greek yogurt 2% fat fall under the High GI category?

Congratulations on decreasing your A1C into the 5s! And good luck with your pregnancy.

@AE13, wow, I could have drawn that chart myself. That table from Schiener’s book is pretty much exactly what my protocol is, developed by trial and error.

@deniseinsandiego, one VERY important thing to keep in mind: All bets are off when you’re sick. Especially if you have a stomach bug. Since you can not rely with certainty on digestion to get sugar into your blood if you start going low, my advice is to always wait until BG starts to rise after eating when sick and then administer insulin.

Just live with the spike, and the struggle to bring BG back down. You can safely tolerate some higher BGs for a few days while sick far better than a low you can’t correct because nothing you eat and drink gets absorbed.

For me, full fat plain yogurt is low GI. I don’t eat 2% yogurt, but I assume it is similar.

I wish I can find FULL FAT Fage Yogurt! Trader Joe carries only the 2% and 0% Fage (yep, for all the folks who were misinformed and told to eat a low fat diet.) At my health food store, they carry, sometimes, full fat plain Greek yogurt. Most often, they sell the flavored ones and there is too much carb in those (30g per serving).