Bolus different for different meals?

[kel4han]

I am wondering if anyone uses a different carb ratio for high fat meals? Seems every time I stick to my carb ratio, but eat a higher fat meal, I drop at hour 1.5 to 2hr needing glucose tabs.

[JediSkipdogg]

But what are you at say 4 hours after that meal? My guess would be pretty high. The reason is because the fat takes longer to digest and will generally make the carbs/glucose take longer to work therefore working faster than the insulin. On an insulin pump it's pretty simple to correct, but on shots, it may mean you have to give your shot a little bit later than normal.

[kel4han]

Yes, I realize the high fat meal and later high reading. Tried to take the shot later, say an hour. Still the same deal. No pump here yet sadly.

[MJM]

I am wondering if anyone uses a different carb ratio for high fat meals? Seems every time I stick to my carb ratio, but eat a higher fat meal, I drop at hour 1.5 to 2hr needing glucose tabs.

One of the great advantages of the pump is that you can spread the insulin over an extended period if you wish. What you could try is give part of your insulin immediately and perhaps the remainder maybe an hour or even 1.5 to 2hrs after. The problem with that is remembering to do it.

[DeusXM]

What you could try is give part of your insulin immediately and perhaps the remainder maybe an hour or even 1.5 to 2hrs after.

You don't actually need a pump to do this either; this is precisely how I deal with pizza on MDI.

[Emm]

Ditto Deus. For any higher fat meal like pizza or Chinese, I have a jab before I start eating, plus an extra unit or three about 1.5 hours later. I haven't had trouble with getting low, just the later highs.

[Cyborg]

For carbs, I bolus the entire amount and usually wait about 20 minutes before I start to eat. For proteins, I will do a 30/70 combo bolus over 3 hours. I don't bolus for fat, but for real fatty combination foods like pizza, I do a 40/60 combo bolus over 4 hours and usually take Symlin.

[poodlebone]

When I have a meal very high in fat and/or protein I need much more insulin and I need to have it spread out. Easy on a pump, not as easy on injections. As others suggested, you can take more than one injection to cover the meal. On injections I always the problem of going low before 2 hours and then battling high BGs later on.

[JJeenn]

For high-fat meals like pizza I split my injection and also give a bit of extra (usually two units). I cover the carbs in the meal and usually do the shot either as I eat or just after, and then an hour and a half or two hours later I test and correct my blood sugar if it's high, and give another extra unit. It seems to work really well! My problem is that if I've eaten a high-fat dinner I continue to rise overnight, in addition to my already-present dawn phenomenon, causing a pretty high blood sugar in the morning. The pump makes all this stuff much easier, so I can't wait to get mine!

[kessale]

Hmmmm,

Doctor says if my son's BG reads below 70 mg/ml I should skip injecting him with insulin.

Lets say if he was 50 mg/ml, and wants to eat a meal of 150 g total carbs, what should be the insulin shot

[JasonJayhawk]

I am wondering if anyone uses a different carb ratio for high fat meals? Seems every time I stick to my carb ratio, but eat a higher fat meal, I drop at hour 1.5 to 2hr needing glucose tabs.

And let me guess... 3 or 5 hours later, you need more insulin because of a sudden, unexpected spike!

For high-fat or high-protein meals, I usually spread it out over 2 or 3 shots. The only way I can handle pizza is to stay up late (say, 2 AM) and dose about once an hour for 6 hours after eating.

I imagine a pump would really help save that kind of effort, but then I'd have to learn something all over again. :flybye:

[JasonJayhawk]

Hmmmm,

Doctor says if my son's BG reads below 70 mg/ml I should skip injecting him with insulin.

Lets say if he was 50 mg/ml, and wants to eat a meal of 150 g total carbs, what should be the insulin shot

You should have a rough estimation (although I'm sure it has changed during the past 12 years, quite constantly) of how much one unit of insulin drops your son's blood glucose level.

For example, if one unit drops your son's BG by 40 mg/dl, you could reduce the mealtime insulin by one unit.

However, if his meal is high in fat, it might take a while for the food to start digesting. In this case, you could just wait 10 or 15 minutes into the meal before injecting. (You'd still probably consider reducing the intake by your calculated amount).

It takes a lot of practice, and it's just as much an "art" as it is a "math" problem!

Simply put, although not simply practiced, you've got to figure a way to balance the insulin profile with the food digestion.

[Stuboy]

sometimes i split my bolus in half, i take half straight after the meal, then the other half 1.5 - 2hours after. works well... esp. with CHINESE!! i for that i take 7 units before, 2 units two hours later, the highest i usually hit doing that is 13. i can live with that. although i could take a bolus between 1 hr after i guess to lower than number...

[sbigelow]

For carbs, I bolus the entire amount and usually wait about 20 minutes before I start to eat. For proteins, I will do a 30/70 combo bolus over 3 hours. I don't bolus for fat, but for real fatty combination foods like pizza, I do a 40/60 combo bolus over 4 hours and usually take Symlin.
Sorry for asking. Is the 60 given immediately and the 40 over the 4 hours? Or is it reversed. Just wondering.