Just curious. Do you bolus with the first bite of a meal - or before - or after? Sometimes I think I wait too long and then I have too big of a spike.
What if your BG is less than 100 when you start eating? What if you are planning a walk after dinner?
I have heard that it is 'harder to push a stuck car out of the ditch' than keep it from 'heading towards the ditch in the first place'. 'I guess you are not actually stuck until you stop, though.' :-) Do you find that it takes more insulin to combat a high spike than it would have if you had bolused earlier and didn't spike at all - or as much? Is there a spike number you try to avoid?
Most meals (except breakfast), I usually don't bolus until after I eat because I am worried that I won't eat what I am planning on eating - will get stuck on the phone - or a computer will break - or I will bolus for a meal and then realize that - oops - I didn't eat it yet. :-( How do you keep yourself on schedule if you bolus before you eat?
What if you are in a restaurant? How do you decide when to bolus? What if your food doesn't come on time, or if you don't like it when it gets there?
Lots of questions. :-)
I'll answer what I can.
I almost always bolus 15 minutes before I start eating. Or at least I try to. I agree that the spike from a meal that occurs from not bolusing soon enough is very frustrating, doesn't feel good, and can be difficult/temperamental to combat. A lot of the time, when I do try to even out my sugars after a spike, I end up falling really quickly so it has caused both a spike and a drop. The worst of all situations! I'm not sure if it necessarily takes more insulin to fight the spike, but it sure is annoying.
It is hard to know that you'll eat what you're planning on eating, or that you won't be interrupted, but I always only eat exactly what I'm planning to eat. I didn't do this when I was first diagnosed, and for probably the first 5 or 6 years, but once I got really serious about nutrition and began weighing my food to ensure consistent portion sizes, etc, I began only eating what I plan out beforehand. It has helped immensely with the spikes. In terms of eating out, it is definitely harder. There's almost no way to know when the food will come, and therefore when to bolus, so I just try to feel it out. It's easier if it is a restaurant you're familiar with, because you have a feel for how long it takes. But a lot of times it's a guessing game, so the best thing you can do is bolus when your food comes out and wait as long as you can stand before eating (haha). Then, if you end up eating more than you planned (which is often the case when eating out), bolus as soon as you realize that during the meal for the extra amount of food.
In terms of keeping myself on a schedule, I know when I am going to be hungry, so when I think "I'm going to eat lunch now," I bolus, count 15 minutes, and then eat. It isn't too hard for me to keep up with it this way, mainly because I have made it my routine. I bolus for breakfast when I put the coffee on, and then cook the breakfast and when it's done it's been about 15 minutes. If you try and follow a pattern like that, eventually it will become routine and will feel natural for you.
It's definitely not easy, but I think the benefits are worth it!
when low i start eating then split the bolus
when high i bolus first then eat
each situation is different for different people
you have to find out what works best for you
good luck
when i eat out i never bolus until i see the food
i only eat my portion the rest i take home
i have a meal plan
45-50 carbs per meal
Disclaimer: MDI here, no pump. But I'll offer this for whatever it may be worth.
There are two distinct situations: (a) eating at home, and (b) eating out. I handle each differently.
(a) Eating at home: my at-home meals are normally low carb/high protein. I weigh or otherwise measure the portions so I know exactly what I'm getting. I prebolus with Regular insulin 40 minutes before eating, and set an audible alarm to remind me when the 40 minutes are up. (For me, Regular takes 40 minutes to start working, and its action profile fits high protein meals much more closely than fast acting analogs. YDMV). Sometimes -- not always -- I need a tiny bolus of fast acting about 2 1/2 hours later to finish off the meal.
(b) Eating out: I carry Apidra in a Frio. At a restaurant, I prebolus when the order is placed. If it's a restaurant we frequent, I can estimate the meal content pretty accurately based on experience and practice. If not, I bolus conservatively. I'd rather go a little bit high and correct it, than the reverse. At someone else's home, I ask them when the food will be served and time the bolus accordingly. (Apidra takes about 15 minutes to start working, for me.) In that case I also try to undershoot slightly, as above. In case there is an unforeseen delay in being served, my travel kit always includes plenty of glucose along with the other supplies.
I try to keep the 15 minute rule but it doesn.t always work
Lots of variables, but generally 20 min. before works for me.
Thank you! Looks like 15, 20, 40 minutes before eating a predictable meal. I definitely was not bolusing early enough. I would bet that even helps the accuracy of the 2 hour check.
Every person is different, so you just have to figure out what works for you. But eating predictable meals and sticking to what you measure out beforehand can (and hopefully will!) do wonders for your BG control!
What you are basically trying to do is mimic the behavior of a non diabetic body. When someone without diabetes eats, the pancreas starts releasing insulin as soon as the blood sugar begins to rise. So what we want is for our insulin to begin working just as the food begins to digest, thereby suppressing a sharp rise in BG. Thus we prebolus, timing it according to the response characteristics of the particular insulin being used.
I bolus then serve myself and eat right away.
with gastroparesis it is more difficult to know when to bolus.
i split the bolus at mealtime.
I'm T2, so the metabolic dynamics of my BG control aren't necessarily applicable to a T1. Of course because of IR my IC is much higher, but also the response to insulin is slower too.
All that said, I generally bolus 30-45 minutes before I eat if I'm over 80-90. If lower than that, I'll bolus 15-30 minutes ahead.
I expect to see the very beginnings of a drop 15 minutes or so after I start eating. Then in another 15-30 minutes after the first bite, it starts to head up.
Today was a perfect example. Friday's are induge day at lunch, so my coworkers and I went to In-n-Out. Now, I never have fries -- too many carbs. A single burger is about 45g carb. Had that and a diet coke.
Started at 82. Bolused before we left. By the time I took my first bite, it had been about 45 minutes, BG was at 67. A bit more of a drop than I usually like to have, but based on experience, I wasn't worried yet.
So, no hypo -- good. It's now 90 minutes since I ate, and I've peaked and flattened out at 129. It'll come down from there back into the 80's over the next 3 hours. [edit -- dang! plateaued for a bit, then headed up again... now it's 144 and showing the 45deg up arrow. Based on past experience it'll probably top out around 155]
So, consider the stats: 62 mg/dl rise from 45 carbs, AND with 11.25U of insulin put into my system 45 minutes before I even started digesting anything.
That's the toughie with T2... just as "sensitive" to carbs as ever, dull to insulin so it becomes a real art to keep yourself below 140, but not passing out from prebolus hypos. This is why the Afrezza inhalable is so exciting for us T2's
Of course, as we all know from some other authoritative PWD's around here managing T2 is really much, much easier than T1, so I don't know what I'm complaining about :-)
Absolutely.
It also varies as widely as any other variety. For instance, my T2 has nothing to do with IR, it's just plain lack of insulin. If my TDD reaches 20 it's an exceptionally bad day. I am extremely sensitive to insulin, I just can't make my own.
YDMV. Should be carved in stone.
Ahhh.... now I understand your comments in the Afrezza thread better regarding the need for tiny dosing!
So your situation is unusual, eh? What were the factors that resulted in T2 rather than T2 as a diagnosis? Lack of autoimmune antibodies?
I'm genuinely intrigued by your case, David!
As for your pancreas, what's the theory -- that it just gave up? With no IR, beta cell exhaustion would seem to be off the table, right?
Never been tested for antibodies. I have been T2 for 20 years and on insulin for less than 2. If I were anything other than T2, I'd have been dead years ago.
My c-pep when last tested was 0.3, which is not quite zero but not enough to be of much use, either.
Actually it is not at all unusual for long term T2s to have little beta cell function remaining. When I was first diagnosed, I was put on oral sulfonylureas. As the years passed, I needed higher and higher dosages to hold my own. Eventually it got to where I couldn't, so I marched in and demanded insulin. Not surprisingly, it has been life changing. My A1c is lower than it has ever been, and stable.
Is T2 associated with IR? Yes. Often. Usually, even. But not always. No two cases are alike -- the one undeniable truth about this crazy disease.
So I read this post on Friday and did not respond. Today after church we went out to breakfast. My temptation was to bolus on what I had previously done but waited because it was a new venue. Sat at 10:15 had coffee and waited. Was served around 12:00. That long takes a lot of coffee. Turns out the cooks helper showed up late and after a chewing out quit. Glad that I waited to see the food. A rare occurrence but the potential for more drama was more than there. Basel set @ .9 per hour was starting to take affect. Glad the groceries showed up when they did. Bottom line when eating out wait!!!
I was in that situation once (ridiculously long delay in a restaurant) and had not yet learned to carry glucose with me everywhere I go. Fortunately there was plenty of sugar on the table . . . .
We have a 15 year old and has been on the Omnipod for 3 years. We always bolus after eating. If she is going to eat or drink something that is very high in carbs we might bolus 15 minutes before eating or drinking. If she is going to exercise after eating we will take less insulin, maybe not dose for 15 carbs. I think as she gets older and more responsible it will be helpful to dose earlier. Now she just never knows what she will or will not eat. Sometime her eyes are bigger than her stomach.