Color me jealous. My last A1c was 5.9 and I’ve never even come close to consistently below 140 at one hour - hell, half the time, my insulin doesn’t even seem to hit me for an hour or two after the bolus, and sometimes much longer, leading to frequent post-mealtime highs. Of course, it’s not consistently enough like this that I could just bolus two hours in advance, as every third or fourth time, if I bolus early, I’m low in an hour, either due to the insulin hitting me more quickly, or delayed digestion (always nice to have a huge spike 3 or 4 hours after a meal!). And now, after having had some severe hypo events, I’m having to recalibrate myself to higher levels in general to get back and maintain my hypo awareness. #@%^#@^@#% I hate this disease.
Have you tried the dual-wave bolus feature (or whatever it’s called with your brand of pump)?
It takes some fine-tuning (OK, a LOT of fine-tuning), but better mimics how insulin is secreted in response to eating. Provides some insulin up front to cover carbs that turn to glucose most quickly, a trickle of insulin over a set span of time (30 minutes most meals for me, up to 2-3 hours for high fat splurges like pizza) to deal with slower-to-turn-to-glucose complex carbs, protein, etc.
I don’t think I’ll ever hit 5.9 unless I get a CGM. But that’s also because I’m trying very, very hard to maintain what hypo awareness I have left and refuse to trade a stellar A1C for too many ups and downs. To me, that’s key to my quality of life. I make sure to have the tests that tell me whether I’m at risk of kidney or vessel complications (microalbumin, regular eye exams, sensation in feet, all types of cholesterol and blood pressure in range)—so far, so good.
Hi everyone,
Trying to figure all this stuff out is certainly difficult. My post-breakfast glucose is my most troublesome reading & I have been bumping up the time i wait to eat. I:C ratios have also been changed with better results. I usually wait betw. 15, maybe20 min. to eat post-bolus. Actually, I have gotten low in the past from waiting this 20 min., but not recently. I even set a timer or my cheap sports stopwatch to remind me it is time to eat more recently. The sports watch is kind of annoying to set though.
Does anyone have a hard time with the wait? I have had times where I’ll wait too long to eat (any meal, could be dinner even), but then I totally crash. Sometimes, it is almost better for me not to wait. I believe 10 min is ok with me to wait to eat dinner. I have a very, very hard time timing my meal at dinner. It is sooo hard to time it nicely. I was getting low from trying to get it all nice: a real cooked meal, then wait long enough, not too long, and have all the utensils, beverage, etc out for the meal. I also like the food warm enough.
What order are you doing all these things? Cook the food, bolus and then wait? Sometimes, I just cannot resist the food, but other times I am good, cook the food first, then bolus. and reheat it in the microwave to avoid the low. Another thing that is rough is trying to figure out just how hungry you’ll be and what you are going to be hungry for. Sometiems, i bolus for the main entree/meal, then later, I go along and keep bolusing/eating as I go (maybe bread, yogurt, fruit). It is so hard to try to live in this perfect little bubble sometimes.
Do any of you have a tough time waiting to eat after bolusing when not at home (fast food, restaurants, parties, family get-togethers, etc.)? Usually, when at someone’s house or even when I am hosting, I want to eat right away. Everyone else is eating too. It is no fun having everyone else eat while I would just have to sit there. I do not want to go low either. I could ask when the food will be done, but that is not always perfectly predictable. Ok, i need to get to bed. G’night to all and to all great blood sugars. 
I handle those situations slightly differently, but these are my tips. It probably helps that, when I was a young kid with diabetes, taking an injection half an hour before a meal was standard practice. After nearly a decade of bolusing on top of meals (and having stopped that habit now), I find myself going back to the old methods that worked in my youth.
At a restaurant, base your decision on whether or not there is something carby to snack on pre-meal. If I know I’m at a restaurant where there is bread or chips or crackers, I will bolus as soon as (or before) I’m seated and look over the menu because I know I’m going to snack on bread when the wait is over. If we’re not having an appetizer and there’s no bread, I will bolus about 10 minutes after the waiter leaves the table. If my food is not to the table in another 20-30 after that, I assume I’ve every right to complain anyway.
At a fast food restaurant, I’ll either bolus before I go through the drive-thru (perhaps in the parking lot), before I get in line, or (and this is my favorite) right as I leave the house (if my blood sugar is stable). That’s not advisable, obviously, as you could find yourself held up in traffic, but depending on the time of day, this works great for me. I know it takes me about 5 minutes to get to Subway, for instance, and assume there will be a line when I get there, so by the time I have a sandwich in hand, the timing is fine. It helps me that I like to check carb counts online on my phone before I get to the point where I’m ordering, so that’s the best time for me to decide what I’ll have and to bolus.
At home, if I’m cooking, I gauge how long it will take to have the food on the table. Some meals need to cool - I’ll bolus right when it comes out of the oven. Sometimes it’s a meal that needs to simmer for 10-20 minutes. Great time for a test and bolus when you start the low heat simmer. Sometimes I get caught up in the cooking and forget that I haven’t tested yet. Don’t kick yourself if you don’t wait! We’re human beings!
Most of the time, I bolus during the cooking process. If it’s lunch and I’m going to make myself a sandwich or throw something in the microwave, that’s when I’m the worst about testing, bolusing, getting distracted, and then going low pre-meal. But 9 times out of 10, I’ll just watch the clock and make sure I get to the kitchen in a reasonable amount of time. I know me and I know that if the sandwich is made and sitting in front of me already, I’m going to dive in. At work, I don’t open my lunchbox until the time is up. Too tempting! (I would avoid bolusing in a meeting as it might run long and delay your lunch.)
When someone else is doing the cooking, that’s definitely tough. But I make it a habit to ask if they know approximately when it will be ready. Then I second guess them by 5-10 minutes. I’d rather make myself wait a few minutes to get settled at the table than come in begging for an early taste because I mis-timed it.
Kelly - I don’t use a CGMS - but I’ve managed over the last few A1C’s since going on the insulin pump to get below 6%. It’s just the tweaking that I do now with combo boluses for my main meals that I find on an even keel. Infrequent lows (I’m still - touch wood - hypo aware afer 40+ years) unless I goof up with too much insulin when I bolus for an “unknown” and less spikes with my BG’s. Granted, sometimes I get lazy - who doesn’t - and I do spike up - but it’s so rare - and don’t feel bad that enjoyed that sinful piece of dessert or something like that. I don’t think it’s fair for us to guilt trip ourselves when things don’t go “according” to plan all the time - but that’s just me!
My tip, which we are going to try again. Switch to a faster bolus insulin, such as Apidra when dosing for meals and corrections. DIA of Novolog is 4.5 to even 5 hours. We have tested it time and time again. Apidra is a lot quicker, supposedly leaving the system in three hours. There is virtually no way we can get post meal numbers below 180 two hours post, without a low, as the Novolog lasts on and on and on. So if you have a similar problem (not all do), you could try changing out Novolog or Humalog for Apidra.
Thanks Melissa BL & Jan for your Excellent tips. I welcome any other ideas as well. I find it hard to test while cooking sometimes. Maybe I just get annoyed w/having to wash hands, dry them off and then test and wash again or use alc. swab. It’s like, i’m trying to cook now, c’mon. It depends on what meal i’m making. I love your ideas re: waiting at restaurant! (I got low at least 2x’s yesterday – once from waiting too long to eat. Wonder if it’s because of stopping the pill recently that my BG has been so low recently. back to the drawing board). I used to wait to eat back in the day with the NPH/Reg. For whatever reason, it seemed easier to wait back then. I go low faster w/Novolog vs. Reg. It seems easier to what 30 min. vs. 10-15. Again, I am new to waiting with Novolog, so these times may not be quite accurate anyway.
I have also often wondered re: changing my DIA to 4.5 or even 5 hrs. It seems if I do go low post-meal, I tend to go low by the 2.5 hr post-bolus. Doesn’t this sound like the DIA (not to mention I:C ratio) are out of wack? My DIA is plugged in as 4.0 hrs. I have never tried Apidra. Wonder why no Endo has ever suggested it.
I’ve used Apidra for about 4 years. My DIA is 3.5 hours with it. Like, Humalog and Novalog, it comes on fast, but it does have a shorter tail.
Do you still use Apidra?
Yes. I’ve used it in my Minimed, my Cozmo, and now my Omnipod. I switched to it when it first came out.
Thanks.
Hi, just picked up 2 sample bottles of Apidra from Endo’s office and so excited to try it out. I am going to a new Endo office w/CDE nurse practitioner. My CGMS readings are showing i have highs post-meal. My CDE asked what insulin i use & was using Novolog. she recmd’ed Apidra. Why no one else in the past recom’d it, i don’t know. (that’s why i switched offices. they were hopign for some perfect sugars. The new office seems cool with an A1C of <7.0 for prepregn. They are realistic. OMG, what a relief to have a better, closer office!!!)
When switching to Apidra, did anyone have bad &/or Fast dropping sugars/lows? I got pretty low yesterday & Sat. while shopping at Menard’s for tile. those stores are huge! I finally sat down to look at latest downloads. I found a pattern of lows at ~5pm & post-dinner. so, hopefully my new basals will treat me nicer today. I believe my post-meals are not quite as high vs. Novolog, but I am new to it. we’ll see…
I didn’t notice any significant change in my severity or frequency of lows when switching from Humalog to Apidra, but I also ran a lot higher most of the time back then. My A1c was probably in the high 8s when I switched. But I would imagine it’s not uncommon.
Helmut
,
Which CGM are you using, that you can get by with two finger stick BG’s per day. I’m guessing it’s the Navigator. Am I right? I wear the MM, and LOVE it, but it cannot replace finger sticks!
June,
I use the DexCom 7+.
I’m glad you added your note. Diabetic for 18 years and still haven’t figured it out.
If I eat oatmeal, I bottom out after and hour to and hour and a half.
Pizza seems to spike my bg’s as long as 6-8 hours after I’ve eaten it.
My insurance doesn’t cover the CGM and I simply can’t afford it.
If prevention is the theme of insurance companies and such then why won’t they cover the supplies needed to achieve it?
My insurance suddenly decided it would only cover 4 test strips per day for those on insulin. Medicare guidelines they’ve decided to follow. I asked why they follow the medicare guidelines, and no on knew.
I had to have a special letter drawn up by my doctor to explain my need for more strips.
I often feel like a total failure because my bg’s have been so up and down. I’m either high or I’m ready to fall on my face from lows.
I’m still fighting the good fight but it’s hard. I’m also what they call insulin resistant. ugg.
My A1C is down but have never reached a solid 7 or below.
Plus when my site goes bad or bends or who knows, I can spike to 300 or 400 in a matter of minutes… I’m sure that doesn’t help my averages…
I will say, this is one of the most informative and friendly site I’ve been to.
Thanks for the support and for the forum to vent.