What do you do if you have bolused for a meal and you end up getting too full to finish all of your food? what can you do about all the IOB that won’t be compensated by your meal?
all suggestions and solutions are greatly welcome. desperate to know some answers.
I’d suspend my pump for a time span that equalled the same amount of “extra” insulin I’d taken and be watching my CGM and with a snack nearby for if I needed it (probably would need a bit of a snack some point, like when the insulin peaked, but not as much had I not suspended the pump).
I’m on MDI. I just have a candy, in particular those fruit slice jujubes that are unbelievably high in sugar so one is enough for me usually. (Basically, I get to have dessert for once!)
this may sound like a stupid question, but how do you know the time span of the extra insulin? do you suspend your pump until all IOB is over?
I would drink some juice/glucose tabs and shut off insulin if necessary. For me it can be a crisis to have too much iob for a meal so I would have to compensate in some way or force myself to keep eating. Do you have dexcom? You can watch it to see what is happening when the insulin kicks in full force.
I would just estimate, though I suppose you could calculate it exactly. If I had bolused five units but then only ate enough food to “use up” three units, then I’d suspend my pump for the equivilent of about two units (which would vary, if the basal rate were 1.5 u/hr it would be maybe an hour and 15 minutes, but if the basal rate were only 0.5 u/hr it might be four hours). I personaly wouldn’t suspend more than two hours, though, so that’s where eating something in addition would come in. You could also just suspend and keep an eye on the CGM (if you have one, or test lots) and then resume delivery once your blood sugar was no longer drifting down and/or your IOB was used up (I did this the other day in a movie where I bolused but then for some reason dropped low, though it backfired later because I went high!).
I’d have a sweet drink / glucose tabs / sugar nearby and use as and if required to bring up blood sugars.
I’d also have a small snack nearby.
If this is a regular occurrence, you could consider in future blousing say half the meal before you start, and the balance of the meal as soon as you finish eating, if required.
I do the suspend when I make mistakes like that; I sometimes use a temp bolus instead so I can put the suspend on a timer where the temp basal is 0.0. I am bad about forgetting that I put the pump on suspend. Especially at night after correcting for a low; I’ll fall back asleep and wake up sky high after the pump has been suspended for 4 or more hours. Also I do it with a technique called a super bolus; where maybe I am higher than I want to be. So I take a correction, plus the basal insulin, if I am going to eat something I go ahead and throw that in too; I then suspend the pump with the hope of getting the insulin to peak and tail out quicker. Can work nicely if you get all your calculations right. I always carry fast acting sugar on me in case the unexpected happens too. Can never be to safe. Its an awesome feeling when you can get it right and come from say a 240 to a 115 and flat line after a meal in oh an 1 1/2 to 2 hours. But a word of caution to all; insulin stacking can be pretty dangerous if you are not familiar with how it all works with your body.
If this happens often you can also take a conservative strategy of counting your meal, taking half the bolus before the meal and then after you stop eating estimating what percentage of the carbs you actually did eat and then bolusing for that portion after the meal. It won’t be an insulin profile that matches the meal but it can enable you to take the right amount of insulin for a meal and avoid hypos.
This can be done with a pump or MDI. I sometimes use the same split dosing on MDI for protein/fat heavy low carb meals. I just take half the dose before the meal, leave the pen needle on and then the other half dose an hour after the meal.
This is a rare occurrence for Caleb, but we use this same approach - shut off basal for a best guess period of time, but not more than about an hour, and then see what happens with fingers crossed!