I was also diagnosed in 1960s, and NEVER had to wait for hypo symptoms to eat. Was this how doctor prescribed your treatment? This was not common practice from the many doctors that treated me.
1 Like
I was diagnosed at age 15 in the 60s. After the first few months I ignored my diabetes and ate what I wanted. My BG must have been in the 300s routinely. Used to go to the Joslin Clinic in Boston, I think this was before they had the AIC test. I remember trying to get my urine green not orange before going to Joslin. Was I trying to fake them out or fake myself out? But that was the only thing I could thing of to continue all my athletics. I used to play 45 holes of golf at a time, run cross county, track and weightlift. Today I would be fortunate to last two holes of golf without a low BG. Today sure is different especially checking urine and not blood. I canât imagine a tolerating a low BG in order to eat. But back in the 30s and 40s people routinely died of T1D as they would basically starve to death to reduce their BG which they couldnât test.
2 Likes
As a child, I was always told to take my dose 30 min before eating. Itâs a habit Iâve had for over 30 yrs. It does help with post prandial spiking.
2 Likes
As an adult, visiting family, I would always ask for meal time estimate, so I could take my R insulin. My family was very bad at estimating, but I survived.
1 Like
That was a very wise thing to do back then and now. I have just started giving boluses before meals and what a difference. Was never told this during my 50 years of T1D. My spikes recently have really moderated. Worst case is I give a bolus as I start eating if I am under my target. Otherwise I also try 30 minutes earlier or more if I am higher than 200.
2 Likes
35 years ago, I started on insulin with the orders to take Rapid half an hour before mealtime. Since then an Endo repeated similar orders to take Rapid when you smell the food being cooked. I find 30 to 45 minutes to be an appropriate time frame and when I can, I wait for the bend (or if already high, when I drop within the upper levels of my target range). As mentioned, results will vary if: meal is delayed, cannot eat as much as anticipated or itâs too delicious to stop but I know that as long as I have glucose/sweets available I can correct a LOW faster than a HIGH.
2 Likes
I was monitored at the Joslinâs clinic in Boston, which was at the time considered the premier institution for diabetes management in the country, since the standard textbook on diabetes had been written by Dr. Joslin and was still regularly updated and re-issued. Each of the doctors at the clinic had his or her own idea of how the disease should be managed, however.
1 Like
I wonder if we attended at the same time? I went there from 1967-1990ish.
1 Like
I didnât know about pre-bolusing until I read about it through the DOC. When I shared my newfound knowledge with my CDE, they were very much opposed. It wasnât until I explained how great it was working out and that there was always something I could eat (bread, candy,âŚ) that could fill the gap if my meal didnât begin as planned. I love pre-bolusing! I must add though, now I rarely bolus (pre or correction) because of keto (low carb).
2 Likes
Surprised CDE was opposed to it. Several people on this topic said they were told from the beginning they should give meal insulin 30 minutes before a meal. I do now all the time. Unless I am too low. What a difference. Nice to see you have just heard about and it is working,like me.
1 Like
Pre-bolusing is a total game changer to me. I typically wait around 15 minutes. Thatâs when âthe bendâ usually happens, as @Terry4 described it. Yesterday I had a meal with about 65g of carbs. Thanks to pre-bolusing, the BG increased only by ~15 mg/dL. This was a food mixed with fats, however. If I eat bread for example, the BG increases more. But still, preprandial 89 mg/dL, postprandial peak 131 mg/dL, thatâs great too. With carb reduction and careful pre-bolusing, Iâve succeeded in having no peaks higher than 140 mg/dL over the past six weeks. Before I did pre-bolus, I regularly hit 150-160 mg/dL or higher, and that was when my honeymoon phase was fresh and new.
Also, with meals that peak very quickly and sharply, it is worth considering to mix in fats and protein, and to eat the carbs slowly. The idea behind this is that by eating the carbs slowly, bit by bit, the body doesnât absorb a lot of carbs at one, but multiple small amounts over time, resulting in a more gradual BG increase, which can be handled better by the bolus insulin. I do that with bread for example. To make the slow eating easier, I like to watch a TV series while eating the bread.
1 Like
Doesnât this contradict every post you keep writing about how you only started having hypos after the DCCT recommendations were implemented?
No peaks higher than 140 for six weeks and eating sometimes 65C is magnificent. A couple of weeks ago I would have not this was possible, It truly is a tool that is not well understood and not well implemented by some/many? I also make sure I really chew my food well. Seems a little silly at first but it helps the body absorb the food.
1 Like
No. The hypos became much more prevalent and severe after the DCCT results led to widespread insistence on strict control, but even before then, since there was nothing to treat diabetes except the clumsy NPH plus Clear dosing, hypos would often occur. We were actually forbidden to take additional insulin during the day since this was deemed just likely to cause confusion, and instead we were instructed to increase or decrease the dose by 2 units the next day depending on whether the urine sugar results had been high or low the previous day. This meant that the only way you could cover a meal was by timing the effects of the background dose, the NPH, which was given in the once-daily dose along with the Clear in the morning, to coincide with the meal. So you were counting on taking too much NPH so that it would culminate in hypoglycemia attacks at noon and dinner.
Thatâs a fascinating coincidence, rcarli! I was there starting in 1966, and I went to the required 5-year reviews, during which we had to go back to the clinic and spend a week living in the dormitory there, until I moved out of the area after my second follow-up in 1976.
Perhaps you remember how all the patients wanted Dr. Joslin as their physician, not realizing he was the son of the famous Dr. Joslin after whom the clinic was named. There was also just one female doctor there, Donna Younger, and I remember she was referred to as a âlady doctor,â and patients would be asked if they had any objections to a female doctor treating them. Obviously, this was a long time ago.
Seydlitz, I donât remember 5-year reviews and never spent a week there other than after being diagnosed and the local hospital had no idea how to get my BG regulated.
I do recall Dr. Joslin and I recall going to classes through the basement cellars. My doctor was Dr. Barnett. Youâre not from Worcester by a chance? My roommate in the hospital was from Worcester.
I think it is a tool that isnât taught often, probably because it has the potential to cause a hypo. For example, if you eat something that releases carbs very very slowly, a pre-bolus may not be necessary. However, many meals arenât like that, so for me, it usually works out well.
Also, it flies in the face of pharma marketing. They have been very busy trying to sell the fantasy tales about rapid acting insulin not requiring a pre-bolus. When I was diagnosed, I was told that these are super-insulins that can be administered right before eating, or even after I have begun eating!
That being said, some people indeed do not need to pre-bolus with Fiasp. Though, I am skeptical about that particular insulin after reading about many problems with it. The stinging has been reported a lot. And, for some people, the super fast onset decreased over time, devolving into that of regular Novorapid. In some cases, it eventually got even worse than a rapid acting insulin. So, Iâm not sold. Iâve heard that Lilly is working on an ultra rapid acting insulin, currently known as âURliâ (no, I didnât make this name up, it really is that silly). Letâs see what comes out of that.
Oh, and some people need no pre-bolus even with standard rapid acting insulin. I do envy them.
EDIT: I also agree with the chewing part. I think proper chewing helps to make the carb absorption more gradual, because instead of a few big chunks, there are many little chunks in the stomach, pre-digested by the mouthâs saliva.
No, rcarli, I lived at the time in Milton. My family had just emigrated from Germany and just as I was trying to adjust to a new country, new schools, and a new language, suddenly there was diabetes. I donât remember Dr. Barnett, but mine was Dr. B. Dan Ferguson.
What I most remember about the Joslinâs Clinic was how upbeat they were about the disease, first because it was certainly going to be cured in five to ten years, and second because, as I did not realize at the time, the standard response of the medical profession to incurable illness is to deluge the patient with irrational optimism and positive propaganda posing as âeducation.â Certainly the positive prospects they outlined were totally unjustified by the statistics and prognoses about the disease at the time.
I found my initial stay at the clinic and the five-year follow-ups quite depressing, since they were periods of my life which contained nothing but diabetes, and where all the patients I was living with were also caught up by the disease. Herman Boerhaave in the 17th century came up with the idea that all patients with the same disease should be put in the same section of the hospital to facilitate both teaching and treatment, but the downside is that younger, healthier patients are exposed to older, sicker patients, with all the depressive effects that that brings.
I will admit that I am guilty of not prebolusing, even though I sometimes should. Breakfast is the only time of day that I have a consistent spike that is significant enough that it shouldnât just be left alone. And even though it comes down, it would be nice to have it come down sooner. I once tried getting up to do my BG & bolus ½ hour earlier than usual (although I did still go back to bed for that ½ hour, so I didnât actually get up until my usual time), and it definitely helped. I should be doing this every day, but I guess Iâm too lazy, but if youâre not too lazy, breakfast probably is the time where prebolusing is most applicable.
1 Like
This is Caleb as well. And when he was wee, it was even more extreme. We found prebolusing a half an hour in the morning to be too difficult to manage. If we didnât time it just right, we risked a low, and getting three kids out of the house in the morning makes it easy to lose track of the 30 minute mark. We employed a superbolus and it worked wonders. He could bolus 10 minutes before eating and avoid the spike bc more insulin is delivered up front and working hard against those carbs, but heâs not overbolusing bc his basal is off for two hours. He doesnât need this for other meals - just breakfast.
2 Likes