Lows at Meal Time

How do you handle a low just before you sit down for a meal? The idea of having glucose tablets just before I have dinner seems almost counter-intuitive, but the carbs at the meal may not act quickly enough. I’m a pumper. For example, last night at dinner, I was 54 (but still felt fine) when I sat down at a restaurant. I had a piece of bread (probably about 30 g of carb) (unusual for me), without bolusing. 10 minutes later, I was still 54. I did not bolus my appetizer (low carb), and then did a dual wave bolus for my entree (when it arrived, bg was beginning to creep up), reducing the normal part of it. Two hours later, I was above 200.

Anyone have any suggestions?

Also, there is lots of talk here about bolusing 20 minutes before meal time, which is easy to do when I am cooking at home and know what the carb count is. But, what do you do when you are eating out and do not know (a) when the food is actually going to be put in front of you, (b) how big the portion will be or © what is in the food (I’m pretty decent at estimating once I see it, but it is tough to guess ahead of time).

Many thanks.

When I have a low before a meal I do what you did, eat something like a slice of bread or something that has at least 15g of carb. When eating out I sometimes bolus and wait at least 15 minutes but that depends on where my bs is. Knowing “your Diabetes” is important…the learning is endless.

If I am low before a meal, I always drink juice or Coke or something. I don’t rely on bread because bread does not digest fast enough so I end up, like you, being low for quite awhile. When my food comes, my blood sugar is starting to come up, but I eat just to give myself a “buffer” and then when I’m done I bolus just for the food I ate but not the juice/Coke. I don’t pay attention to what my blood sugar is because I assume the juice will bring me up to normal and I wouldn’t want to take less insulin because I’d have all this sugar going into my system from treating the low and I don’t want to rebound. If I treat the low separate from what I do with my meal, it seems to keep me from going too high or too low.

For your second question, I am horrible and I almost always bolus when I’m done eating. I take a correction bolus prior to eating, just because that doesn’t change no matter what I’m doing, but I don’t take a food bolus until after I’ve eaten. Sometimes I’ll take a bolus of 20 or 30 carbs before dinner - just because I almost always eat that much - and then I take the rest of the insulin when I’m done. So you might try a half-and-half and see if that works. And it’s not double-bolusing because you’re taking the insulin close together and you’re taking it for food, not for a correction.

Hi Jonathan, we usually give our son something that has sugar, because the dessert is too far off in time that his sugar levels don’t go up fast. Juice, glucose tablets… Since, all the ratios are in pump’s wizard, we do add the sugar he takes to get him up on top of what he eats and give insulin for that, because we put in the real bg.

For bolusing before, that depends on your insulin’s action, some recommend 10-15 minutes, some 20 minutes. We usually give what we think he’s going to take for the main meal and drink and then see if he eats it all, give/adjust before eating desert. When low, we do not give him the insulin minutes before, we it give to him right before he starts.

We usually bring our nutritional scale with us and don’t care what people think.

Allison: Thanks. When you do your bolus after you eat, what happens to your BG during the next two hours? I would love to be able to bolus after the meal. Sometimes, my eyes are bigger than my appetite, but, if I have bolused for 50 carbs, I feel I need to eat 50, even if I am not hungry enough for it or if something else might keep me from finishing the meal. I would love to be able to delay the bolus until afterwards.

Gina: Thanks. My insulin tends to be on the longer acting side, so I should take it earlier, but usually do not (so much to remember). What scale do you use? I would love to find something that is easily portable. Thanks.

Hi Jonathan,
I have run across a low several times when I sat down at a restaurant and find that asking for a small regular soda works well for me. And if you look the wait person in the eyes with a smile and ask for it “now please” there has been no hesitation or problem. I always let my family or friends know that i am running low at the time and they don’t ask for anything until the wait person has come back with the soda. A little of that sodas works just fine to put me up to where I need so that i can then go ahead and order. But the other problem for me is that I can never tell how much of something I am going to eat. If I am too high before eating, then I correct, eat whatever I am going to eat and then shoot for that. But my metabolism is so slow that I can’t normally shoot before eating anyway.
Are you able to eat more if you shot for something and find you really don’t want the rest of the food?

Saundra: Thanks. I have no problem getting a regular soda at a restaurant quickly. I just tell the waiter it is the most important thing that can be done at the moment to avoid a medical emergency (if we have to ask a second time, it comes out of the tip. LOL). My ex-wife even cut a very long line at a McDonalds to get me a Coke, explaining that she needed to help a diabetic having a medical emergency. Everyone was very understanding.
My issue with not being able to finish the meal may be unique to me and a small group of others – I sometimes have problems getting the food down. It literally gets stuck at the base of my esophagus and blocks food and drink from going down. It has happened twice at the beginning of meals for which I have already bolused, leaving me over-insulined.
When food is not stuck in my throat, I rarely have trouble having more. I just have to deal with the consequences of higher carbs, more calories and higher bg (or more time on the spin bike – and if that is not an incentive to keep the calorie count down, I don’t know what is!).

I do sometimes have high postprandials but I don’t usually test right after and I’m usually back down by my next meal.

Allison that is a neat idea.I never thought of that.When I take my BS after eating and I have to do a correction I almost feel like I failed.But getting a portion a couple hours later might stop all the corrections.Do you set up a reminder so you don’t forget to bolus for the other half?Yesterday I had 3 pieces of pizza and 2 small pieces of cake.OHHH,I was bad! My niece was visiting for British Columbia.We had a Christmas for her.The airfare at this time of the year is cheaper than at Christmastime.I was 3.8mmol at supper and at my 2 hour test I was 5.1.I couldn’t believe.The funny thing about it was that I didn’t go any higher than 5.9 afterwards.I expected it to rise because the meal I had was high in fat. We had a very nice time.

I don’t know what you mean by “getting a portion a couple hours later”. I take a correction bolus before I eat, and then my meal bolus either as I’m eating or exactly the moment I’m done (I just count what I ate). It’s not exactly what you’re supposed to do, but right now it works for me. I would never take a correction bolus after I eat. You have to wait for the insulin to work - which can take a couple of hours. So I think you may have misunderstood what I wrote.

do a realistic preliminary bolus and then test 90 minutes after your meal and take another dose as necessary

Since my diagnosis in July the only lows I have encountered happen right before lunch… either at work or on a weekend (my pre breakfast shot was lowered a week ago by my endo) and I completely agree about taking a bunch of glucose tablets right before eating a meal seems counter-intuitive. Today I started feeling a low coming on I tested and was 61 (lowest I have been) and it was about 30 minutes before I was going to eat so instead of taking 3 tablets I took 1 just to give myself a little boost figuring it would bring me up a bit and still let me eat a full lunch. I do not know if I did the right thing but it took care of my shakes that were coming on and allowed me to enjoy my lunch with only an additional 4g of carbs instead of an additional 12g-16g. I am still new to things and still learning but, it does not make sense to me to have a correction 10 min before I have a meal.

if it’s really low i’ll eat glucose tablets. otherwise i just eat and bolus less

I dont know why carbs dont work with me. What i do when i have a low between 30 - 45 i have a candy or cookies with oj. And if i have a low between 46-60 i just get the cookies or the oj.