Any tips on mastering how to pre-bolus? My type 1 is well controlled with my last A1C being 5.7%. But I have a hard time not having BG spikes after I eat. I carb count, but it seems my BG goes up faster than the insulin working. So I will spike with a BG around 200-250 after I eat. And i dont know what else to do. I’m assuming it’s me not waiting enough time before I eat. My normal BG readings hover around 90-110. Any tips? TIA!
Do you use a Continuous Glucose Monitor (CGM)? If not, I personally would not be sure how to advise you. For me, pre-bolusing is something I only felt comfortable attempting when I began using a CGM.
Can you tell us any more about your treatment? Do you use MDI or a pump? Do you use a CGM? Do you use rapid acting analog insulin or do you prefer Regular? If you use a basal insulin, which one and how often do you dose?
I found the best way to understand pre-bolus time needs is to take my insulin and watch the CGM trace but don’t eat until the glucose line bends downward. I think optimal pre-bolus timing is the most underutilized treatment tactic. And it’s not that hard to do once you get the hang of it. My pre-bolus times vary in the 15-60 minutes range with the most common being about 20 minutes.
If my before meal BGs are riding the low boundary, I will skip any pre-bolus time and just dose and eat right away.
Your overall control appears to be good and perhaps mastering the pre-bolus tactic will be all that you need to do. (Although, diabetes has a way of presenting a new problem once you finally solve the current one!)
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Yes I use a tslim pump with a dexcom g6 CGM. My carb ratio is 1:10, correction factor 1:25, basal is 1.6/hr, target BG 110. I am currently using control IQ with my tslim. I use humalog as my pump insulin.
What is your typical total daily dose of insulin? Would you mind sharing your time in range % and range limits? How is your glucose variability as measured by standard deviation in the Dexcom Clarity reports?
Is your basal rate a single flat rate for all 24 hours?
Sorry for more questions than answers but these details give us a better feel for your situation.
My total daily dose is around 50u daily. My basal is a single flat rate of 1.6u/hr 24 hrs per day. My range is 70-180. I am in range about 95-100% daily. Standard deviation is around 22 according to clarity.
Yes, you need to wait (or pre-bolus) before eating the carbs. I usually start with lower carbs 10-15 minutes after bolus, generally with a small salad.
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I didn’t want to give my two cents worth to BoBa_TeA as while I am on MDI I am type 2 DM, plus my experience with MDI is about 7 months. What you said about watching the trend line is right on for me.
It’s been a lot of guess work as I had to basically learn my own unit to carb ratio and correction factor. This changes, being a type 2. I am like those with LADA still secreting some insulin.
If my BG is trending up or a bit high before meal time, I add a small correction dose to my usual dose based on U:Carb, and then wait until treading down before eating. This has worked well for me. Since I am retired, I can delay meals as much as I want.
Your last line, “(Although, diabetes has a way of presenting a new problem once you finally solve the current one!)” is spot on. It, diabetes, keeps us on our toes.
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What I do when the sugar starts to spike after a meal, at about 160 I do exercises. I do this when Dexcom arrow is trending upward. I do exercises I,e, about 5 situps and 3min on a treadmill and it stops the spike Do a little as need to hold off a low
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Thank-you for providing this important data that better describes your situation. With these numbers, especially that stellar SD of 22 mg/dL, I can understand your status better.
It appears that you’ve already accomplished most of the “hard work” and discovering a good protocol for pre-bolusing is a great goal to work on next.
Your personal experimentation with various pre-bolus times should include keeping a written record for a time so that you can cement this new habit quickly. I would track the time of the bolus, the time of the meal, and the carb content of the meal. If you are calculating your “carb dose” partly on the carbohydrate equivalent of protein, then you should note that in your journal.
You don’t need to worry that you will need to journal for the rest of your life! This is a technique that can be used episodically when you really need to focus on solving a glucose management problem. It helps to keep those individual trees from obscuring the greater truth of the forest.
I’m sorry for the detailed interrogation but your situation is much different from someone who is experiencing a high degree of glucose variability complete with insulin resistance swinging and making good glucose control difficult if not impossible.
In short, I think you are making excellent glucose management decisions and focusing now on optimizing your pre-bolus timing is a great idea. Mind your CGM and do your experimenting when you are not forced to compete with other important tasks like earning a living or family duties.
That’s easier said than done. My diabetic management ability soared once I retired; I’m well-aware of the fractured attention of people with diabetes who need to work and who maintain family responsibilities. I do think I could have done better managing glucose before my work-life ended. Good glucose management and earning a living are definitely not mutually exclusive.
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I’m a Sugar Surfer and have followed Stephen Ponder’s techniques for pre-bolusing for years and years with good results. It works amazingly well in most respects. I don’t wait any set period of time between bolusing and eating but rather watch my CGM and only when it deflects downward do I start eating. How much downward deflection before eating depends on the meal’s macros. Lots of carbs and not a lot of fat/protein I’d wait to see a pretty profound dip. Much of this is getting to know your body and how long it will take for ingested glucose to be available in the bloodstream. @Terry4 mentioned he does similar, I believe.
But, here is the rub. I found when I went to CIQ it all fell apart. As soon as Tandem’s algorithm sensed a downward trend it immediately cut basal delivery thinking it was doing me a favor. At first I didn’t believe simply cutting basal for that 30-45 minutes could have such a profound reaction but it did. I had to make a choice to either give up aggressive Sugar Surfing or turn CIQ off. I turned CIQ off and eventually went back to MDI where I have manual control over my numbers and insulin delivery. I’m 71 year old Type 1, eat carbs, and have an A1c of 6.0. I’m okay with that although I suspect others would not.
So, I’d suggest you take a look at what happens to your basal line if you do start pre-bolusing. You may find with CIQ it’s not all that easy to accomplish.
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I have the same frustrating experience. CIQ begins cutting insulin off the moment my BGs begin to trend down. I haven’t been able to overcome that and refuse to turn CIQ off because it keeps me so level at night.
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Is it possible to just turn on CIQ at night and then use the manual pump mode during the day?
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More and more I am turning off Control IQ during the day. Not for the whole day but just when I want to prevent insulin suspensions. Or when I have had a suspension that IMO is “long enough” and I want to resume basal insulin. It is very easy to turn it on and off. The big deal for me is remembering to turn back on Sleep Mode when I reactivate Control IQ. Even if you have a Sleep Schedule, it won’t go back to Sleep Mode unless you turn it back on.
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@Terry4 and @Laddie,
Of course its possible to turn off CIQ during the day. Trouble is that I forget to turn it back on.
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Set an alarm on your phone. You can set an alarm to go off every day at whatever time you want to be sure to restart Control IQ. Or to turn off Control IQ.
I wish that there was a way to limit insulin suspensions with Control IQ. IMO Control IQ is great at preventing lows. But terrible at preventing highs. For the most part it is because the insulins we use do not act quickly enough to do what we need them to do.
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Have you tried Fiasp or Lyumjev? It doesn’t fix the Tandem IQ problem but I’ve had an easier time w spikes since Fiasp. Best of luck.
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I don’t use the Tandem, I have an Omnipod.
I don’t wait to show a spike down to eat, if I do then I usually drop too fast. There are a lot of variables for each of us that you just have to learn from trial and error. And it can really vary person to person. I aim to stay around 95-100. But I don’t really care if I am 80 or 105 unless I am trending up or down.
Generally I prebolus 30 minutes before I eat. Unless I am hovering around 80-90 then I have to shorten it to 15 minutes before I eat. If I am eating a salad I don’t prebolus at all for it as I really don’t spike very much for very long. So I might prebolus, eat my salad and then that’s about the time to heat my other food to eat, or make a sandwich etc. Sometimes I just have a huge salad with a ton of fixings.
If it’s a higher fat meal I might only bolus when I eat, if it’s pineapple I might wait 45 minutes to eat it. If I misjudge I get on my exercise bike to stall the spike and give any insulin in my system a kickstart. What I never do is eat when I am above 110. I will wait until I am at my normal level.
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Same thing drove me nuts with the 670G, and was a factor in why I gave up on it. I guess the idea would be that you give up these techniques for controlling things yourself and Just Trust the Algorithm, but I found that my DIY version worked better than their wannabe-AI version.
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Exactly. I’d never want to discourage anyone from trying a smart insulin pump as the vast majority of people find life easier and their diabetes under better control. But, I’m a raging Type A and I know what I need and when I need it and I fought the algorithm far too often. I guess I’m more of a manual transmission kinda gal.
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