Timing of bolus related to blood sugar

I know this has been discussed before but, i wanted to get more feedback. Last night was a good example, my husband was home with my son and his bs was 280 before dinner, I always have him test 15-20 before so he can bolus then if he is high, he does not do this and in two hours he was 305 i bolused for his snack waited a good 1/2 hour for him to eat and tested in 1 hour 15 minutess and he was coming down 220 beter anyway. so i think it helps alot to bolus prior to the meal if running high, i'm not sure if i can enforce this rule when i am not around but i wanted back up! anybody? thanks for any input, amy

I presume that Jacob is the son upon whom this is being "enforced"? If my BG is at 280, I will bolus and wait like 30-45 minutes before I'll even think about eating. A lot of times, I'll "cheat" by bolusing and taking the dog for a walk, 15 minutes, to help nudge the insulin into action faster. I know that exercise is counterindicated for highs but highs are counterindicated for me and I've seen no evidence that I've done anything too dangerous by doing this. It's probably harder with a kid who has 1) expectations of "breakfast/lunch/ dinner". If by "he does not do this..." you are meaning Mr. Jacob's mom doesn't do what you think (and I'd agree...) he's supposed to, I think the issue of why he thinks he doesn't need to take care of Jacob? I can't quite place how old Jacob is either but I'd think that he is getting to an age where he'd want to be taking care of himself or at least able to discern and vocalize the difference between how he's feeling running up to the 200-300 range and how he'd feel at a more normalized BG or at least working towards that, rather than playing "slot machine" with a BG meter?

Hello, Jacob is 13 and feels totally fine to be honest unless his bs is consistently over 300 for a bit, he is ussually under good control, yes mr jacobs mom does not want to be told different! this is why i am asking for solid advise here whether the timing of the bolus is indeed important as you and I both seem to know it is! still learning all the tricks and yes it is hard to tell a hungry 13 year old that he needs to wait to eat, hence why i try to test him while i am cooking to get an idea of where he is at, he is on board with his plan but also a teen and has some sadness over his D so i try to be the primary decision maker for now he will have his whole life to deal with it! thanks for your input! amy ( aka jacobs mom!)

Hi Amy-Even when my blood sugar is in a normal range I have to bolus 45-60 minutes before I eat breakfast to prevent huge spikes, and 20 or so minutes the rest of the day. Depending on Jacob's appetite, one thing you don't want to do is have him bolus in advance for something he may not eat. Could this be what your husband is concerned about?

With 280 I would just bolus the correction without the meal bolus ([280-120]/40 = 4 IE for me). Then I would at least wait one hour and test again to check how this develops. If the situation improves I would bolus for the meal and eat it. If not I will skip the meal completely. If this happes more often then he should test 2 hours before the dinner to catch it earlier with a correction. He will then have normal numbers when he is coming home. This additional test is a small price to pay for a good dinner.

thanks kim, the issue of him not eating is not the problem, the issue is getting my husband and jacob to do something different that they ussually do not do that would take extra effort and thought! it seems like from what eveyone is saying so far it does make a big difference so i should get them on board with this... diabetes is overwhelming as we all know i've tried to dumb it down so to speak for jacob and my husband but they need to be on board with what is going to work best! holger good advise but asking a 13 year old to skip a meal is not an option he is aways hungry and tries to go for noncarb snacks when he cannot wait like cheese sticks, pickles, cerlery, i can hold him off but not skip! thanks so much for your thoughts! amy

Yes, that was my thought as well, that you did not mention either just correcting first and waiting or adding a correction to the bolus. Do you know his ISF? (How much one unit of insulin lowers his blood sugar for corrections)

How bout a protein snack if the BG is high, so the hungry teen gets something tasty and tummy warming while he waits for his numbers to improve?

his correction is bs-100/50 he has an omnipod and ISF is not one of his setting options, so i'm not really sure, the issue is for jacob, and most people i would assume, if he is high it takes 1 hour/15 minutes for him to show some downward progress, i'm honestly having a tough emotional day thinking about him in general ( he was pretty down about his D last night " i feel not in control of my body, i would be 5 X happier if i didnt have D, i would be more confident without it.. so hard to hear what is a mom to say!) but asking him to wait that long to eat would be a tough one, he honestly is always hungry .. i guess i just wanted to get a feel for how long others wait to eat when they are running high ..

I'm sorry you (and Jacob) are having a rough time. I can only imagine how hard it must be both for a mom and for a kid that age to integrate Type 1 into their lives. I'm sorry I don't know what you mean by his correction is bs-100/50. Your omnipod may call the ISF something else but I'm sure it has some setting for correction factor. It's usually expressed like this: Mine is 40 during the day and 60 at night which means one unit of insulin will drop me 40 points during the day and 60 at night. So let's say my target goal is 110 and I am 190 during the day. My pump will compute that 190 minus 110 means I'm 80 points high which means I need two units to correct on its own or it will add 2 units into my bolus when I get ready to eat.

I'm a lot older than Jacob and I don't like waiting to long to eat either. I try and do a correction earlier but I always add a correction to my bolus if I'm over target before eating. I actually believe correcting for highs both before and after meals is one of the most important things I do to keep from spending too much time high.

Can Jacob connect with some other young Type 1's, at a group or diabetes camp? I've heard so many Type 1's say how much this helped their self image when they were his age.

Hi Zoe, his ISF is 50 then, and it ussually seems to work pretty well, yesterday probably was just an off day all around! but i do think the testing early and bolusing is smart, now to get my husband on board with that, he thinks i am over the top with jacob's management! jacob is definitely not a joiner, so camp is pretty much out, good idea though, he is starting high school with a lot more kids next year so we are hoping he branches out, perhaps he will meet some kids with type 1 there, although there are some kids at his school now with D that he doesnt really talk with, he is a take care of it and move on kind of boy, i am just glad he takes care of it if you know what i mean! my husband and i were thinking maybe an empatheic girlfriend may ease his anxiety about his D.. time will tell, he really is a great kid with high hopes for his future and a good heart.. maybe i try to protect him too much ..just doing my best to deal with his D myself and help him live a normal life despite it! thanks for your concern amy

I actually try to always bolus 15-20 minutes before my meal and find that works best. The only exception is if I'm low or borderline low. In addition, sometimes if I've been running on the high side, I will do exactly what you said and test even earlier so I can correct first and wait longer, 1/2 hour to one hour depending on the high, as long as I can wait, then I test again and depending on the IOB will add a correction to the bolus as well.

I think it must be a hard balance between protecting too much and just enough. If he is taking on the responsibility for his own care, then that's great and you can just nudge a little from the sidelines like you do as he integrates new skills. There's so much to learn! I think you're doing great, and Jacob's good heart and hopes for the future will carry him through and make him an even stronger adult - despite, and maybe because of his Type 1.

thanks zoe, somedays are harder than others, i appreciate the kind words! amy

I have to say I'm not fond of hearing junior+ dad= all over the place numbers vs. mom being on top of things and having to be in charge of both of them? To develop habits now that lead junior to think "250 isn't bad, I feel fine, let's eat!" *greatly* increases the likelihood of problems down the road and they need to have the riot act read to them. Bolusing early is a short-term fix, and a good one, and a lot of the other posts have great suggestions too but the bottom line is that those numbers can become dangerous when they create a pattern that can spread out for years and years?

thanks for the advice, his numbers are generally good, i am well aware of the long term results of poor diabetic control, quite a few of my wakng ( i even dream about it to) revolve around his care and how best to manage him and teach him well, obviously you do not have a child with diabetes and if you did and you had a wife that wasnt as knowledgable about diabetic care as you are, you might understand my strife...my husband has grown in knowlege but i am the medical person in the family that does all the reading ect. trying to be less reactive .. but just had to react.. its been a long day with many more to come, we all walk the walk here no need to put me down

Sorry, it wasn't my intent to put you down as much as Mr. I know what you're saying about the peculiar challenges of kids w/ diabetes. Two of my best friends from high school have a 3 year old who was dx'ed when she was 18 months old and I've seen tons of other posts from parents and from members (e.g. AnnaBanana, who is a shade older but has been around here for a while...) too.

I'm glad to hear that things usually run well but my intent isn't to put you down but to suggest that Mr.Jacob's Mom ought to get on the same plan as you. and, if he isn't as knowledgeable as you, well, he ought to be working towards it?

I have a 13 year old who regularly tries to "divide and conquer" to get leverage between MrsAcidRock and me so I know that can be challenging as well.

There's been some other posts advocating "taking breaks" or "vacations" from various aspects of diabetes, which is sort of what this seems like and, when I run into them, I will comment that I don't think that's a good idea. Again, I don't want to put you down, your original question is very good and shows a great level of engagement with the process. Junior and Mr should join you! *goes off to yell at 13 year old to clean up her room or we're NOT going to Target to buy nail polish*

Hi Jacob's mom, I don't have much to add as far as timing of bolus - I too try to wait 15 to 20 minutes before I eat but sometimes, depending on the circumstances, it's hard. I remember one morning I went to breakfast with my husband. I tend to wait until I see the food in the restaurant to bolus just in case there's a delay (been there, done that). So I'm fixing my coffee and waiting a bit to start eating. The waitress came up and asked "Is there something wrong?" because I wasn't eating yet. :) I just smiled and told her I had to take some meds before I ate.

Balancing tight control and quality of life can be hard for an adult...but I would imagine even tougher for kids. I'm Type 1 but wasn't diagnosed until I was 27 so I didn't have those stressors in those early years.

I admire the parents of kids with diabetes so much. My heart has always gone out to the little ones because I truly think it's not fair for a child to be burdened with diabetes. I know as a parent how much you wish you could just take this off of Jacob and take it upon yourself if you could.

Remember too that it's a marathon. Take one day at a time...they grow up so fast. You're doing a great job, by the way. :)

thanks so much for the encouragement, blessings back at you! amy

I agree with your statement "so i think it helps alot to bolus prior to the meal if running high." I would say it this way "so i think it is very important to bolus prior to the meal and wait longer before beginning to eat if running high."