This topic is what I am dealing with. I use insulin lispro and I had been doing only a Post-Bolus, fearing to crash. But that would be after BG soared over 200. I would use 5 to 8 units and then catch myself with some crackers. I want to start Pre-Bolus but I have been a coward. Three units before a ball of sticky rice, and then 2 or 3 units afterwards. I have had several scary lows… That is why I usually ran my BG so high, and why I am so dissatisfied with my A1C. - Robert
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Robert, have you ever read the book Using Insulin by John Walsh or Think Like a Pancreas by Gary Scheiner? If not, I think either of those would give you a great deal more confidence to take steps to better control aspects of your diabetes.
I personally don’t pre-bolus for a regular meal that includes some relatively high carb foods unless my BG before the meal is at least 80 with Apidra or 70 with Humalog or Novolog. That’s assuming I start eating within 15 minutes of bolus. For a low GI meal like pasta, though, I don’t pre-bolus with Apidra unless my pre-meal BG is about 90 or with Humalog or Novolog at least 80. Pre-bolusing most of the time has helped me to keep my A1c in the 5’s in spite of being on MDI and eating a moderate carb diet (120-150+ daily). I do have to test about five or six times a day and occasionally up to 8 to do this, however.
Perhaps you might want to do some testing to see how fast your BG starts to rise and by how much with different types of meals. Or when you initially start to pre-bolus, you might want to do so only when your pre-meal BG is a little higher, like over 100 or 110.
My digestion and BG curve seems to be quite similar from meal to meal as long as I’m eating similar types of foods, but it is possible that for some people like the OP, that a great deal of variation might make things a little more difficult. Or even a** lot** more difficult. We each have to do a little experimentation to find what works best for us.
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I purchased “Using Insulin” on your recommendation.
As far as food, I have found that the portion size idea is very liberating. I can almost anything, if I pay attention to portion size. I do not like white table sugar, but I love rice and bread. And I love salads.
When you talk about pre-bolus at 80 before meals, I’m thinking that I start sweating and shaking at 70. We had several nightmares when it got to 54 and 62. I am very active for an old (?) man. But that is why I like to keep my numbers around 100 to 120. During the day, I cannot stop what I am doing and click. Traveling is a disaster because you must eat out.
I do not understand how diabetics here can talk about staying around 80 or 90. My numbers fluctuate so wildly throughout the day. I love my doctor but he can’t tell me why I sm so labile.
Robert
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Oh, I can stay reasonably flat – when I eat nothing. Night before, I went to bed with BG at 80, woke with BG 83, though most of the time there’s more fluctuation than that for me. I do pre-bolus unless I’m already low and wait as much as an hour to eat – helps me soften the spikes somewhat, though, again, certainly not always! (Or any time this week! 
).
We’re all different, and we have to follow what works best for us individually. As uncomfortable as you are below 80, it makes sense to avoid that threshold. I get bad headaches over 150 - so I try to stay below as much as I can. The only thing consistent about diabetes is inconsistency!
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“Prednisone-induced Diabetes” is what I have. Prescribed by a doctor, I took massive doses of this steroid, to treat a completely different medical treatment, so now I have diabetes. One of the “other-” types of diabetes. With mine, I just need insulin.
I used to sprint to the corner to burn off numbers. I could eat up 70 glucose by doing that. At that time, I took no medicine to control my D. Then I moved to pills. Then to insulin.
I am active, so it is difficult to imagine checking my glucose more than I do. Eight times a day I look at my numbers. When I shoot too much insilin, I eat crackers. It is a guessing game as to the size of the bolus. I estimate and use experience be my guide.
My wife told me: Do not follow the advise of people on the internet ! Hurumpf! What she does not get is that, I do not always follow her advise…
Our wives are of the same mind! After all, everyone on the Internet is weird, right?
(Well, I am, but who’s counting?)
Somewhere along the way I was counseled by my parents and then by teachers to always “consider the source” when evaluating information. This way of thinking would value the advice I receive from doctors, nurses, and dietitians over the experience of my peer diabetics.
My big breakthrough in treating my diabetes came when I stopped listening to the medical professionals and started listening to my fellow diabetics. It turns out that people that live with diabetes 24/7/365 know more than the doctors, nurses, and dietitians will ever know.
Not only do the medical professionals suffer wide areas of ignorance about living with diabetes and dosing insulin, they’re dangerous in that they think they know more than they do.
Now, I know I’m guilty of sweeping generalizations here but my life with diabetes took a marked turn for the better when I started listening and acting on the ideas written about by my fellow travelers on this diabetes journey. Doctors and other medical professionals have their rightful place in the resources that we need but I definitely see them as very limited in their usefulness. They are simply educated humans trying to help. They are not gods and they need to extend respect to earn respect.
I don’t listen and act on everything I read on diabetes forums but there are pearls of wisdom here that I never heard from a doctor or dietitian. Like in all areas of life, we need to be discriminating consumers of information and just because someone has credentials after their name doesn’t mean that they necessarily know what they’re talking about!
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I have a hunch that you’ll have better luck at figuring out yourself why your BG is so labile than would your doctor. Pay close attention to your activities in the 12-24 hours prior to surprising changes in BG and to your emotions, also. Differences in either can cause some big changes for some people.
I’m fortunate in that emotional stress doesn’t seem to affect my BG at all, even though it can send my systolic blood pressure to 170 or even over 200. (I usually reserve the over 200 episodes for the doctor’s office.) 
But for some, emotional stress can cause BG to skyrocket as much as 100 or 200 points.
However, one thing I wasn’t aware of until I read that book Using Insulin was that sometimes unusually heavy exertion can cause one to have a delayed hypo. Once when I’d only been on insulin a couple of months I had a hypo of about 52 in the early morning hours. It came as a surprise because I had my basal adjusted to where I could expect to stay within a few points of my five-hours-after dinner bedtime reading until about 4 AM, when my dawn phenomenon (DP) typically starts raising my BG. Then it dawned on me - that is what John Walsh was talking about regarding delayed hypos from unusually heavy exercise! I had spent about four hours the previous day spading a flower bed. That’s a whale of a lot more activity than this quilter and computer-user normally does. And sometimes things like that don’t show up in the BG until hours later.
I hope that in analyzing your own activity and stress levels that you might be able to find some of the things that influence your BG. And if one can predict, one can be better prepared.
Totalmente de acuerdo. I was in the hospital for pneumonia and the nurses wanted to treat my diabetes. It seemed dangerously “cookie cutter”, and way too dependent on the medical bureaucracy in the hospital. Asked the doctors and they said to go ahead and do it myself, just tell them what I did.
D is very very individualized. I like reading how other people are treating the same disease. It’s not that I would do just any old thing people say.
The Chinese have a saying: 旁观者清 。Sometimes other people can see things more clearly than the person involved.
One thing I learned by reading was that Type 1 comes from the person’s own immune system attacking the beta cells in the Islets of Langerhans. Amazing. I had no idea. T1Ds have my sincere sympathy.
I get all of my major illnesses as side effects of medicines that I take. I took massive doses of predinsone and got diabetes. I took Humira and got a rare and dangerous form of pneumonia. A bacteria that “acts” like a fungus (actinomicosis) came to live in my right lung. Very rare. I almost died. All because of Humira. They cut out part of my lung. Unintended consequences are a very serious issue for me.
I took Metformin and my stomach became violently sick. I took Invokana for a bit, but I don’t like peeing every 15 minutes, so I quit that. More side effects.
For Diabetes. I plan to ask my doctor if Levemir as a basal insulin might steady me. And I would still spank the meals with fast acting Lispro. That is my plan.
My job stress is manageable. My wife just retired and I want to spend quality time with her. My twin sister moved far away and I think that got me a little. I’m really pretty laid back as a person. We are birdwatchers, so you can use your imagination.