Does anyone else find that the only way to control their blood sugars is by waiting a MINIMUM of 30 minutes to eat after bolusing (even longer if BS is already high)?
My doc says it’s pretty rare and most of his patients actually eat immediately after bolusing, so I just want to see if there’s anyone else out there finding this delay annoying / unrealistic sometimes. If I have a lunch appointment with a client for instance and only leave 15 minutes between bolus and eating, my BS shoots up immediately and takes well over 3 hours to come back down… I guess I have the opposite of delayed stomach emptying.
Doc says Simlyn may help by delaying my digestion, but I’d hate to be on a pump (Omnipod) and then ALSO need to carry syringes around and shoot Symlin manually…
I started waiting 20 minutes to eat after bolusing recently. I’ve been type 1 for 13 years, and the doctors always told me to eat within 15 minutes of taking Humalog–even saying I could take the insulin 15 minutes after eating.
I started waiting 15 minutes before eating, then I thought 20 minutes was better, and now I’m wondering if 25 minutes might be better still. It can be a pain, but my lifestyle is such that I generally have time to wait. When I eat out, it can be tricky. I’ve tried waiting the 15-20 mins with a burger and fries sitting in front of me at a fast-food restaurant and it was hellish. For regular restaurants, the wait could be 20 minutes or 45, you never know. I generally take a unit and then take the rest when the food comes. I don’t eat out very frequently, so I don’t have this problem often.
I agree that it can be a huge drag to wait before eating, but it certainly helps my post-meal blood sugar.
(I live in Canada, and Symlin is not available here).
For the times you can’t wait 30 minutes, eat mostly protein because that takes longer to digest. Eat the carbs at the end of the meal.
Taking the short acting insulin back when it was Regular, was usually done 30 minutes to an hour or maybe sometimes more before the meal. Maybe your endo is too young to remember those days.
What I have found in a couple cases with Humalog, is that it is the “neutron bomb” of insulin and sometimes kick in so incredibly fast with a resulting scary hypo at mealtime, that in some cases I don’t take it until after the meal. This is especially true for something that I know is going to be slow in hitting my bloodstream bg-wise.
I believe most insulin manufacturers, state that you should take the insulin 15-20 minutes before eating. This is true for most of the fast acting insulins. Some do say you can take after eating. This is due to the fact that it will still effect glucose levels and also based on that most pumps calculate dosage on glucose, carbs and active insulin (IOB). You get past 15 minutes or so, they recommend a new BG reading and starting over. Note: If you take insulin after eating, you may find that your glucose levels will rise a little higher than if you took it before eating.
You need a little time for the insulin to begin to start working and then the timing for when it hits its peak and the food you eat begins producing glucose. This will vary from person to person, so YDMV (your diabetes may vary).
I have noticed that once I began waiting 15-20 minutes before eating, my glucose levels are more stable. It isn’t always possible to wait, better to eat, then get caught not eating until its too late.
I was told way back when (in 73) to always wait atleast 30 minutes before eating after taking my insulin. Yes it gets annoying but that’s the way I have to do it & have for quite awhile.
Same with me, with Dexcom, I’ve found my sweet spot is 20-30 minutes. Doctors like to be on the safe side - you MIGHT go too low with longer periods between bolusing and eating (and sue them afterwards).
The whole point of bolusing is to avoid excessive swings. Not even being high(ish) for long periods is as dangerous as having good average with lots of ups and downs.
I wait 20-30 minutes for breakfast and then usually about 10 for the rest of the day unless I’m eating something that is carby and easily digestible…then I try to wait the 20-30 minutes. I’m also having great luck with a super bolus before I eat bread or anything white…rice…pasta…ice cream…shoot…I need a super bolus when I see those things on the counter!
I usually take about 1/2 to 3/4 of the bolus 15-20 minutes ahead and then the rest right before I dig in. That seems to work well for me in preventing the post-meal high. There are, of course, times when it isn’t practical. Or the times that I forget. In those cases I simply try to push the carbs towards the end of the meal to the extent that I can. Or save some of the carbs for a snack later.
There are unfortunately doctors out there that think of the fast acting analogs as ‘meal-time’ insulins. I don’t have a problem if someone choses to use them that way and accepts the high that will probably follow, but people such as yourself who are willing to put in the effort should be encouraged to continue doing so. I think you have it right. Don’t base what you do on the ‘vast majority’ of his patients that probably don’t have as good of control as you do.
This is not as rare as your doctor thinks. My ‘quick’-acting insulin takes two hours to kick in. Yes, you read right, 2 hours. Verified by a week of checking my BG every 15 minutes after bolusing. (Ouch! Ran out of fingers for a while there!)
I have mentioned this at my diabetes clinic but so far nobody has come up with any useful suggestions on how to solve this.
Obviously one way is to bolus 2 hours before eating but this is not very practical in real life. It sometimes feel like a game of Russian insulin roulette.
I also find that waiting 25-30 minutes it the right time for me. If I am low or eating something that digests more slowly, then I bolus and eat right away, but most of the time I wait.
I found that Novolog starts acting a bit sooner than Humalog for me.
It’s funny you should ask because I was wondering this as well. Personally, I usually wait 30 minutes and will usually save anything more carby (like yogurt until the end of the meal). Even so I never see what I would consider a “peak” in the insulin (I’ve watched it on my Dexcom both after correcting highs and bringing down post meal spikes). Usually it’s such a slow drop that the arrow remains flat…so I don’t really worry about it becoming too low, so wait longer.
As far as symlin, I think it’s a lot more complex than suggested (based on my own previous experiences and reading about others). I do know that some people did not use with each meal, but just for breakfast when insulin resistance was higher or if the meal had a lot of carbs… So it’s something to consider, but it’s not so simple as just injecting and letting it work (it’s a whole new set of timing issues).
I take Apidra and usually pre-bolus by about 20 minutes otherwise my BS goes up. I agree with Tom – don’t base what you need to do on what the majority of his patients do. Ask yourself what kind of control you have and/or want and ask your doctor what kind of control his other patients have.
I usually bolus 30 min before meals with Humalog. Like you I bolus even earlier when starting with above normal readings for lunch then just wait till the Dexcom tells me I’m getting down near normal numbers. If my Omnipod rec’s 3 units to just drop me to normal range w/o food and 10 total units for the food and “correction” to normal levels, I take the full 10 at once. This knocks it down quicker than separating it into 2 separate boluses.
Meals aside, the Omni just works by a formula of carbs to insulin ratio and another gluclose correction units to glucose level ratio. If I see a 200 glucose, the Omni rec’s 1.8 units to correct to normal levels (140 MgDl) and if I wait a while it will get me back to normal BUT it takes too long (in my opinion) to do so. When doing a glucose level correction bolus I usually add alot (sometimes even double) to the Omni estimate to bring it down faster, then just correct it from going too low with some carbs.
great tip Gerri… thank you!
OMG that’s nuts! Certainly makes me feel better about the 30 min wait. How long have you been type 1? I’m in my 20th year, I wonder if we build up a resistance after a while? I used to take insulin right before I ate when I was younger. Also, I’m on Novolog; I forgot to mention that… maybe Humalog is faster to kick in…
I should wait at least 30 minutes to eat after bolusing. Even my Endo recommends 30+ mins. He has done a lot of work with CGMs and says that insulin won’t affect most people for at least that long. When your CGM starts to dip it is time to eat.
Metformin… any other Type 1’s out there using it?
My doc think it might help me with my insulin resistance and allow me to eat sooner after injecting. I looked up Metformin on wiki and it sounds pretty miraculous (reduces cancer risks, acts as an antiviral agent, reduces cholesterol and cardiac risks, etc.) it also seems to work by increasing insulin sensitivity and also reducing gluconeogenesis (liver producing glucose and dumping it into bloodstream) by over 1/3 - maybe I can lower my basal rate as well.
I am also trying Apidra (so far no difference in time between dosing and BG reduction) and will try Humalog next.
Any other type 1’s using Metformin? It’s typically a type 2 pill, but I’m really interested in seeing if it makes a difference.
for me it’s 25 minutes. I have learned that the hard way. I usually “guess ahead” how much I will need get in my system and if my lunch or dinner is different (breakfast is always at home- so no surprises there) I take more insulin during the meal, but since the majority is already in my body it’s not so bad.