Post meal sugar

I need help with my insulin (bolus) timing before meals, as my aIc is waaaaay above where I know it can be. Since I’m a single father of two toddlers, my fear is going low to the point where I pass out, therefore I’m always hesitant to take a bolus too far in advance. Add to that, the fact that I am ADHD, it’s not out of reach for me to take a meal bolus and then move on and forget to eat. It’s embarrassing to admit that but, oh well, any help would be appreciated.

It takes 45 minutes for insulin to start working and 15 minutes for carbs to hit your bloodstream, so a 30-minute pre-meal bolus as long as you put a reminder on your phone to actually EAT w/in 30 minutes should solve some problems. Also, start with the carbs at your meal if you're at the 30-minute mark. Good luck! - Jen

Actually that's not correct. Regular insulin takes 45 min or so to kick in.

Michael what insulin do you use to bolus meals?

What kind of insulin(s) do you take? Can you go on a pump? either way, there are things that will help to keep you away from lows.

When I was on multiple injections, I took Apidra for carbs and corrections because I could take insulin right when I sat down or even a few minutes after dinner, and I was okay (kept my HbA1cs in the 6-7 range during that period). At the same time, I took long-acting (lantus or levemir) 2x a day. Apidra is the fastest-acting insulin as far as I have found. Its duration is only about 2.5-3.5 hours, I found, which meant it was less likely to linger and cause me trouble later on.

I also find that eating very low carbohydrate and making sure I eat some fat with all protein makes all my food digest more slowly besides being a healthy way to eat. For more about this, and everything else you need to know, see Dr Bernstein's book Diabetes Solution (lots of low-carb information also from various low-carb gurus such as Eades, Phinney and Volek, and Eric Westman). Dr Bernstein has great tips, including a way to bolus for protein (instead of ignoring it or letting your basal cover it), which will help you if you are on injections...he doesn't cover pumps yet. I think one of his most important points is that the fewer units of insulin for carbs you can take, the better; the "law of small numbers" dictates that absorption variations or errors you make about carbs/units are smaller and therefore less troublesome. And SAFER.

A pump, which I use with Apidra gets me even better results (below 6). The pump delivers a minute amount of basal (in my case, Apidra) round the clock; and then does great for me even if I take insulin for carbs right before meals or just afterwards. I take an "extended" bolus for protein and fat which I set for 2.5 hours out from meals (not sure how you would do this with multiple injections). The great part is, it's a tubeless, wireless pump (OmniPod) and (other than applying a new one every 3 days) all you have to do is take out the handheld and punch in the amount you need. Lows are much easier to avoid also because it calculates each bolus based on insulin already administered, so you don't have "stacking," which for me was the main source of lows in the past. It also has a food library on it. And, with the pump, I can get as few as .05 U of insulin, which helps keep guesswork out of it--therefore fewer lows.

Hope this helps. I think your doctor or educator might also say you can also set your targets a little higher than 80-120 (but with the pump, that's where mine are set, and I still have fewer lows than on injection). Seems like the studies show that more moderate target may still protect you from long-term complications...I am going on hearsay with that.

Good luck!

I almost never take a bolus more than 10 or 15 minutes before I eat. I'll bolus for breakfast when I put the eggs on the fire, for example. On the other hand I structure my meals so that I eat most of the protein up front and most of the carbs towards the end of the meal so that my insulin has some time to catch up.

Is your problem that you spike very high at 1 or 2 hours and then get back to target at 4 hours or is it that you are in general running higher than you want. If it is the latter, then you need more bolus insulin no matter how you're timing it.

It all just takes time and frustration to work it all out. Everybody has to do something different depending on what works for them. I usually bolus when we sit down to eat and don't normally spike over 200. Others will have to bolus more ahead of time others might go low depending on what they eat. Good luck on trying to figure things out!!

Wow, I didn't expect (but am very grateful) for all the quick replies. I am on the Omnipod (newest generation), I consider myself a pretty educated diabetic in theory, but yet applying the theory to everyday life is where I am experiencing the hiccups, so to speak. I am in an area on MI that doesn't have a lot of Endos so I go through my primary care physician, whom I like, but the fact that I know more about the practical applications of diabetes than he does; somewhat scares me. I use NOVOLOG (1.2 units/hr) and my ratio for carbs is set at 1/10, I programmed the pump for the sensitivity of 50, and active insulin of two hours. I also have a crisper drawer (don't we all) filled with Symlin, but again, with the kiddos and the ADHD, I cant say Im always faithful to the Symlin (which works AWESOME, but I get scared of the post-meal drop that can often occur)...

I'd like to add, that I'm going through a very stressful time in my life, which I know adds to the variability of our sugars. THANK YOU ALL WHO REPLIED AS ITS NICE TO KNOW THERE ARE PEOPLE WHO STILL CARE IN THIS UGLY WORLD. (Yes, I'm a cynic....thats what divorce and a custody battle do to you)....

I agree with other posters and just want to check that you have gone through the checklist of what might be causing a high A1c. If you have confirmed that your basal rates are keeping bg in control when you are not eating, then the culprit could be the meal time bolusing. If your bg returns to normal within 4 hours after blousing for a meal then you know you are taking the right total amount but maybe not prebolusing in advance enough. Btw, I use alarms constantly due to needing to cover my meals with multiple boluses. You may want to be extra diligent taking notes and using alarms until you figure this out.

Most of us have different I:CR for different meals. Also, are you certain your ISF of 1:50 is correct when pumping with a 1.2 units/hr. basal rate? Do you have different basal rates set for different times of the day? Most insulins last more then 2 hours, your duration may need adjustments? Are you working with a pump educator? I do prebolus about 20 minutes prior to meals. I don't want to be anywhere near 200 at any time, whether it's one hour or two or three, of course. Can you get a CGM, it really is an incredible tool/technology and would help alleviate some of your stress, I think?

So, in all your humble opinions, what should be the setting for the lenght of time my insulin will work? Two hours, three hours or Four hours? Again, I am using Novolog. Or to complicate matters more, would anyone out there recommend I possibly switch to a different type of Insulin for my pump?

The last time I saw an Endo was in 2010 (my endo in Naples, FL was AWESOME), but since moving here to MI,and losing good insurance, my options are limited. Ive tried to recall all of his good advice and whatnot, but clearly, I need to be doing something differnt. I realoize that as we age, our bodies change and adapt therefore our insulin needs (and/or types needed) may change as well.

To ask even MORE of the Group, is there any opinions on what my settings should be, if you think they are off??? (DISCLOSURE, Yes, I understand that advice given on here should be double checked with a medical provider.......blah blah blah...) LOL

But seriously, I would welcome the input.

I am an avid weightlifter and I enjoy doing cardio most everyday..... I have a large frame, weigh 225, and am 5'10''.... I am FINALLY seeing a four-pack in my life time, so Im not over-weight ,per se, but according to the BMI (which I think is VERY flawed as it doesnt account for body types) I am Obese. But if you saw me; one would not think of me as obese....

you have to figure this out (as we all do) by trial and error, what works for one may not work for you. who put you on the pump? what are you goals (fasting 2 - 3 hours after meals) what are your blood sugar readings like?

I think most people set their insulin duration to 3 or 4 hrs but if 2 hr were too short for you, it would cause lows not highs. I've read that weight lifting can spike your bg vs cardio which lowers it.

thx, Don

I set my duration as 4 hours. If you are going to try to "reset" you first should get your basal set correctly. As a first approximation, what is your blood sugar when you go to bed and what is it when you wake up? If you are waking up too high, you know at the very least that your overnight basal has to be adjusted.

I would suggest getting the book "Pumping Insulin" by John Walsh which has a very detailed discussion of basal testing in addition to almost everything else you might want to know about pumping. If your basals are off, it is very difficult to get the other parts right.


I continue to think the drugs (e.g., Symlin) are a bad idea for someone who is a single adult particularly, because of the possibility of lows that don't wear off. I feel safest with Apidra, plus a meal regimen of small numbers (of carbs particularly). Then, whatever errors or variations I have, they are not as lasting with short-acting insulin and/or low numbers of carbs to cover. Smaller more frequent meals could also help. I know it's a pain to have to be so consistent, but you have a lot of responsibility right now while your kids are too young to understand how to help you--you have to be a hero (like all parents, only even more so). Good luck!

I set mine at 2 hours. I know people swear insulin lasts longer, but really doesn’t for me. I tried else itching it to three, because I thought, surely 2 hours is too little, but switched back after a week.

Switching, not “else itching” haha

Can I ask where in Michigan you are? I live in Michigan as well and have not had any trouble with finding an endo or dealing with insurance. Just curious.

Are you watching your carbs? Then you might not need so much insulin. Is medical diabetic counseling avaibable to you. If not Read Jenny Ruhl's Blood Sugar 101.

I live in the saginaw/midland/bay city area. (Freeland)