+1
I’m fairly new at this Diabetes (T1) thing - diagnosed 1 1/2 years ago at age 53. Quite a life changer to say the least! And I’m also new at sharing all this with people I don’t know, but this site and all of you are so awesome! Please forgive me if I become a pest.
I’m so glad this discussion was started. Have been on the OmniPod for a year, no CGM. I’ve feel that I’m fairly under control (7.2 A1C) but know I have more spikes than I should have. My question(s) are: I have been trying to bolus 15 min ahead (that has been working fairly well) but am going to try a little longer, as you have, I generally walk 10-15 minutes after breakfast, 30-45 after lunch and 15-20 after supper. In the last few weeks things have been changing and I’ve been OK at 2 hours, but going steadily lower after that, and low by the next meal if I can’t get a snack in. Do you think that a earlier pre-bolus might prevent these lows? Yesterday I had a 42 and didn’t feel it.
Also: If you have more fat/protien at the meal, besides the pre-bolus, do you also extend your bolus at all? I’ve been trying extending the bolus - generally at supper time - but either end up low post-prandial and then going high during the night, or missing the boat completely and going high at 2 hours and all through the night. I may not be going long enough or adding enough to the bolus?
If you are going low post-prandial you are getting too much insulin so the pre-bolus would not help you unless you cut down the total bolus amount at the same time. My guess is that the 10-15 minutes you are using is just fine, and is what many people use. If you are going steadily lower after the meal and before the next it is a different matter and suggests that your basal rate might be too high. Without CGM it is much harder to rejig your basal rates unless you test 15+ times a day. I will sometimes do a square wave bolus for higher protein and fat meals and have found this helps quite a bit. There’s a lot of trial and error involved and imho the best tool for figuring out one’s regimen is to use CGM which provides immediate feedback and actionable data. Good luck with program! Mike.
I think I should pre-bolus because I spike after a meal, but I don’t. I have had many hypoglycemic events some with trips to the ER, so I live in constant fear of it. I do have CGM, so I should bite the bullet and try.
Thanks, I guess I’ll just keep playing with it. Have been trying temporary basals when I walk, but am getting only .20/hr for most of the day, and don’t know how much lower I should go. That brings up something else, but it’s a whole other question. My % of bolus/basal is about 75/25. From what I’ve been reading, it’s usually closer to 50/50. Am I the oddity here? Maybe I need to take a look at that also. Sorry to get away from your quetion.
Sounds like you should be doing some basal testing - your endo can give you a protocol and maybe lend you a CGM to help the process. Before even dealing with the bolus and pre-bolus issue I think you need to nail down your differing basal rates throughout the day. Good luck!
Given your hypo’s I’d be careful about pre-bolusing too far ahead. Maybe just change a few minutes at a time to ensure you don’t end up dealing with unforseen hypos. Worth trying on a controlled basis imho.
Thanks Mike. I actually had the Dex7 but it makes me act too fast and over act. I’m an A personality and treated lows that did not need to be treated and same with highs that I ended up chasing my tail soo bad that my Endo thought it would be better for me not to have all that info. LOLOL Plus my insurance won’t cover and it just got too expensive.
Wow, I have been waiting to join in to this discussion all day. I registered in the morning, waited for approval, went grocery shopping, went to a SB party, and finally back at home. Hi everyone hope you still want to talk pre-bolusing and a handful of Omnipod, CGM, and insulin issues. My 15 year old son was dianosed in Dec of 09. He’s had the Omnipod about 8 months. We love it. I would like him to have the Dexcom, hoping the intergation comes soon because I think the honeymoon period is over. I count carbs very well, thank you gram scale, and most post-meal (2hrs) are ok at lunch and dinner. But mornings are a mess, pre-prandial is high some the time and posts are high on school days. Reasons- Early rushed morning? Stress?(1st & 2nd periods Honors Math and English) Teenage Hormones? Dawn Phenomenon? Ratio off? Basal needs to be increased in the early morning hours? Would pre-bolusing help? A typical breakfast is eggs, cand.bacon, eng. muffin, low carb choco. milk, and fruit- about 36 carbs. Lunch around 53, After school snack varies and Dinner around 75. I never know what % to extend his meals. I usually tell him between 70% and 80% depending on the foods, but I really dont know how that affects him inbetween checks. His endo never gives us any detailed help, his A1C has been 5.5 twice since dianoses and up to 6.3 this last time. Want to do some testing of basal/bolus but the whole skip a meal doesnt make this teenage vacuum cleaner smile and eating the same meal over and over again doesn’t thrill me either. Is there other ways? Yes, CGM, I know, wish I had one now. Help. Thanks in advance.
Emily, the way our forums work, the conversations are always ongoing. You can search for a topic, find a discussion that was started two years ago, and still add your two cents and get responses. It’s wonderful. Don’t feel like you have to apologize for timing because they’re not real time chats - more like bulletin boards where you can leave posts and come back and check later.
As far as skipping meals to do basal checks, it’s a necessary evil, I’m afraid. I have always hated it. But you can think of it as delaying meals or doing them early - such as a 5pm dinner and then nothing to eat until breakfast, or pushing breakfast to mid-morning, etc.
It sounds like you could benefit from a great resource for understanding how insulin works to help you with those extended boluses, etc. I highly recommend the books “Pumping Insulin” by John Walsh and “Think Like a Pancreas” by Gary Scheiner.
Personally, I extend about 15-25% of my bolus if I’m eating a particularly high fat meal or just eating out. The rest of the time, I don’t extend any of it. And I usually try to initiate my bolus about 15 minutes before I start eating…although it doesn’t happen all the time.
Thanks for the info on forums, its my first. I am excited to get an insight to how other people manage there diabetes as well as get detailed feedback on our concerns. Oops, we dont extend 70% - 80% its the opposite 30% - 20%. Those are books Ive heard of, I’ll get them, I hope they are recently published. Can you do accurate basal checks over a weekend. I would hate to do it during school, maybe spring break in mid-March after Ive read and learned more to use the imformation better. Maybe a CGM by that time. Or would you say to do it now. How about other small changes until then.
Do you have the forms for basal testing?
I have not had a successful basal test yet - I have had to stop every time because of my hypoglycemia. Based on the layout of forms, it should take several days. After the first night, you contact your medical professional for an adjustment and then test again. You repeat until it is correct.
Yes, have the forms. We went to an advanced pumping class about 3 months ago, learned about doing the basal/bolus testing there. Unfortunatey the instructor used up most of the class to trying get thru to a 13 year old boy who had was out of control, type 1 and over 200lbs. I felt bad but I wanted more detailed information for us. I guess we can try it on his upcoming 3 day weekend, and again during spring break.
+2. Sam would definitely give up the pump before the dexcom. He wanted a Dexcom shortly after diagnosis, but wasn’t convinced about a pump until a year later.
For me, especially since I hate to do basal testing, I just try it for a couple of days. You could easily do it on a weekend. You could say, let’s check out your morning basal rate and skip breakfast Sat & Sun. Then maybe during the week once or twice, have him eat a low fat dinner right after he gets home from school and check that evening one. Then the next weekend, you could skip lunch. I think it can be very do-able. Record the results and run them by your medical team.
Essentially, you have to assume that a current basal rate has an effect on the blood sugar a couple of hours from now. So if he ate a light dinner at 5pm and began to drop around midnight, your doctor might suggest dialing back the basal at 10pm.