Interestingly for diabetics with gastroparesis we have the inverse phenomenon of ‘post-blousing,’ since it is recommended that they take insulin a half hour after eating because of the slowness with which their intestinal tract processes their food.
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Couldn’t agree with you more Tim. My daughter was diagnosed almost 2 years ago. She is using the G5 and Omnipod. We only started prebolusing about 6 months ago.
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Pre bolus came into my life back in the mid 80’s when the clinic I go to had what they called intensive insulin classes. This was back when I was using Lente and regular and was up to 5 shots a day. Taking this class and being up to testing before and 2 hours after gave us a huge learning about pre bolus. When you did wait that dreaded 45-60 minutes you got much less of a spike afterwards. Funny how I complain about having to wait 15 or 20 minutes currently. And this was before CGMs so it was a lot of testing. But such a great class and this is when things really started shifting for me. And ultralente also came into play for me when they finally made it in the pork variety.
Wow, when talk about stuff like this, it makes me realize how far I have come over the years.
Since so many diabetics develop gastroparesis over time, which slows digestion and makes it necessary for them increasingly to delay the time at which they take insulin in relation to their meals so that eventually they may have to take it a half hour after eating, perhaps a continuous scale should be developed ranging from pre-blousing in the earlier years after diabetes diagnosis to post-blousing twenty or thirty years after onset. Given that the degree of gastroparesis can be accurately measured by a barium swallow, an individual profile could be established for each patient.
I am using pre bolusing as well. When sugar is in range and eating a low carbish meal not so much. When sugar is higher I use 15 to 30 minutes before eating.
Sometimes I eat the low carb foods first, then about 20 minutes later I will have the fruit smoothie. I have to practice and log better for it to be a very effective tool for me. Glad folks are talking about it.
Hi All, This is an interesting question. It has been my experience that this is dependent upon various factors.
My insulin path has been through Humalog, Novolog, Apidra and now Fiasp, The speed as which the insulin begins to impact glucose is critical. There are two numbers that can play into a decision. What is the insulin to carb ratio and the insulin sensitivity. June of this year my Endo prescribed
Fiasp. The My most recent HgA1c dropped from 7.1 to 6.4. This was an all time low. My personal experience has been to watch breakfast. Humalog was the slowest, Novolog had a back side increase. Apidra was faster and Fiasp hits right after a bolus. What Fiasp allows me to due is to perform multiple mini bolus during an extended meal hour and brings into play the specific impact of the specific item being eaten. Hope this helps and as always have a great day.
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So educate me: how does one pre-bolus and eat a warm meal?
Easy. I plan my meal in advance. I know what I am having to eat an hour or two before I eat so I can prebolus an hour before the meal. The trick is what you put in for a correction since the BG can change in an hour. I just put in for the food an hour before and I handle the correction at the meal.
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I also pre-bolus for breakfast only. I must be less sensitive to insulin at that time? I spike even though I’m eating 30g of carbs, with lots of fibre and protein.
The fantasitc book “Pumping Insulin”, 5th edition, by John Walsh, has a pr-bolus chart on page 124. If I can figure out how to, I will attach a picture of it here. The book is very good! Pre-bolusIng has helped me enormously. If you can get the timing of eatIng and bolusing right, you can reduce the spiking and control your BG much better. It’s not super-easy, but worth trying!
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My biggest spike and also my largest basal is from 6-9:30. I think it is the liver producing sugar to give you energy for the start of the day. Thanks for the book reference. Pre-bolus has already helped me. I used to spike at least 80 points after a meal and it is now down to 40 or less. I also used to skip meals if BG was too high. Now if it is high I pre-bolus as soon as possible. Major improvement.
Pre-Bolus does not have to be “all or nothing”.
You could pre-bolus for half the expected insulin.
Those of us who started back before analog insulins regard pre-bolusing as a necessity, not an advanced technique. R (Regular) insulin took hours to really kick in
I am still a little scared how fast Humalog kicks in. Sometimes I am actually afraid to pre-bolus even half an hour with it. Usually a half hour is about right. BUT sometimes it kicks in super fast and I end up with a real doozy of a hypo right while eating the meal.
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I’ve had the same experience and it’s awful. I pre-bolus 10 minutes tops with Humalog.
Similar experience. I pre bolus in am and i keeps sugar from going way up after breakfast
In pre-bolusing, say you prebolus for your meal after you order at a restaurant (or your home meal, for that matter). Then halfway thru the meal, you realize you are stuffed and can’t finish the meal you focused for. Won’t you experience a dangerous low, since you focused to cover ALL the food in the meal?
Have a few sips of soda.
you hinted at an important issue: after time, we know more about the dynamics of our body than the doctor will ever know. And we can run little experiments on ourselves and learn from their outcomes. I finally worked out a general method to keep my glucose down to reasonable levels after eating one of my favorite foods, pizza. For a non-meat pizza, I take half my total bolus and spread the other half by delayed bolus over 3 hours from the start of eating. For one, I don’t eat as much, then later the delayed bolus smooths out the slower impact of the fat and protein in the meal.
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Totally agree with experimenting on yourself.
Now I pre-bolus before every meal. If I am 200 I pre-bolus and wait until it comes down to target. May be 30 minutes, May be 90 minutes. I pre-bolus for the entire meal but only eat about half. Then I will eat more or not depending on my BG later on. My average BG per day has come down from 166 to 125 with an improvement every month as I continue to experiment.
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When I started taking the R insulin in the beginning, they used to say wait 15-30 minutes before you eat. Then the Novolog and the Humalog they say wait 5 minutes. The insulin these days works faster and maybe is stronger: