What do you do when you are low before a meal?

[gambi]

I have this problem with ging down to the 60s before a meal - mainly because I exercise an hour or so before I eat - that is just how my schedule works out. And "NO" I'm not going to change that. :)

So if you are about 60 and going to eat dinner say 30-40 carbs which will raise blood suger about 120-150 pts right? Do you bolus or not?

On the pump the bolus wizard will not allow a bolus with a bs that low.

So do you carb count, divide your insulin ratio and subtract 1 unit?

Or how long after you eat should you test BS and give a correction?

What is the best way to do this without going up to 200?

[shiftzor]

if i was you, i would eat or drink before/while i exercise and then have your standard meal. Such as drinking lucozade sport, im not saying go mad eating alot, you will learn how much sugar your exercise consumes.

For exercise i would typically reduce my insulin dose and eat during. How much i eat depends on the exercise and its intensity. For example (for me) a 4 hour bike ride is less sugar hungry than 2 hours of playing badminton. I would eat over a longer period for biking instead of the big intake for badminton.

[gambi]

I try not to eat between meals, I guess I could have glucose tabs. I don't want to have to eat more to exercise, you know what I'm saying? I'm usually about 150-140 going into exercise so at that point I hate to eat anything else and go up to 200 and fell miserable during exercise.

This is when the CGMS would come in handy so I could see what was going on during exercise.

[Cyborg]

Based on your fine tuned pump settings, enter your bg and determine how many insulin units of insulin below your target that your bg value represents (not sure if all pumps do this). Then write that number down. Next enter the number of carbs you are going to eat and write down the required insulin for your meal (assuming you were at target). If this second number is greater, subtract the first and that is how much insulin to take. If you end up with a negative number, then you need to add enough carbs to cover the difference in addition to your meal and forget bolusing.

Or... You could pop enough glucose tabs to bring you to target and then bolus as usual. I usually opt for the first choice as eating at the edge of hypo helps greatly with post meal bg spikes. Just make sure you aren't eating very slow acting carbs or lots of fat and make sure you don't have gastroparesis and aren't taking Symlin.

[shiftzor]

Based on your fine tuned pump settings, enter your bg and determine how many insulin units of insulin below your target that your bg value represents (not sure if all pumps do this). Then write that number down. Next enter the number of carbs you are going to eat and write down the required insulin for your meal (assuming you were at target). If this second number is greater, subtract the first and that is how much insulin to take. If you end up with a negative number, then you need to add enough carbs to cover the difference in addition to your meal and forget bolusing.

Wont that just starve the body of sugar and risk going low later on when the insulin is available? I guess if its all finely tuned it would work assuming that you wanted to loose weight. Wish i had a cgm and pump :)

[JJM335]

I try not to eat between meals, I guess I could have glucose tabs. I don't want to have to eat more to exercise, you know what I'm saying? I'm usually about 150-140 going into exercise so at that point I hate to eat anything else and go up to 200 and fell miserable during exercise.

This is when the CGMS would come in handy so I could see what was going on during exercise.

Hi, I try to exercise every day (like you typically just before a meal). My target is to take on enough carbs to ensure that my BG at the end of the exercise period is the same as at the start. To avoid an instant rise in BG I use biscuits/cookies (relatively non-sweet e.g. shortbread) and take them just before I start. It will take some time and a lot of testing to figure out the system that will work for you. Depending on whether the exercise is purely aerobic (cardio) I will take 15 - 30 g for a 30 min session. I would try starting out at say 15-20 and test your BG at start, end and end + 30 minutes.

I'm on MDI so I cannot control my basals, as a pumper you may want to play with that too.

Joel

[kgm0612]

On the pump the bolus wizard will not allow a bolus with a bs that low.

Gambi...........you can override that by pressing "act", then entering the # of carbs, etc.


For me, if I was about to eat dinner and I tested at 60, I would enter my carb count and take the amount of insulin the pump suggested.

If I wasn't going to eat for another 30 mins or so, I would eat a handful of almonds to hold me over and then test again right before sitting down to eat.

Karen

[Gangrel]

I'm only on MDI, but if I was in the 3's, and knew I was eating right away, I would do my carb count math, and then subtract a unit or two of insulin, based on how low I was.

I'd probably also add some juice or something to the meal (and the carb equation) just to get faster sugar in me.

[xMenace]

I'd probably do a temp basal 2hrs before the exercise to bring that value up a bit, maybe 50-75%. I'd be wary of going down to 60 as you could trigger a liver dump and go into one of those nasty spirals.

30-40g should raise you 150-200pts.

[Cyborg]

Wont that just starve the body of sugar and risk going low later on when the insulin is available? I guess if its all finely tuned it would work assuming that you wanted to loose weight. Wish i had a cgm and pump :)

Not sure how you would be starving the body by subtracting the insulin you don't need for your meal. You simply use your ISF or I:BG ratio to determine how much insulin to subtract from your meal bolus, which is based on your I:C ratio. You don't even need to be on a pump to do the math.

As far as losing weight, I have no clue how this would cause you to lose weight. It does help with postprandial bg spikes though... ;)

[grace girl]

Like most everyone else, I'd just do the math and subtract insulin and go ahead and eat. The only time I would correct, then eat would be if I was experiencing hypo symptoms.

If I knew I was going to exercise regularly at around the same time every day, and I was hitting a low afterwards each time, I'd try to find the best way to deal with it before it happens.
Two things I've done is to either have some protein before exercising, or have something like gatoraide during.
I don't know if everyone is like me, but if I go low during or right after exercise, I tend to spiral downwards at a pretty rapid pace...so I try to avoid it.

[BriOnH]

Or... You could pop enough glucose tabs to bring you to target and then bolus as usual.

I usually do the same with some juice. I'll just sip a little then eat and bolus as usual.

[gambi]

Thanks for all the great replies.

My CDE at one time suggested that if I am below 70 to eat w/no bolus and check in 3 hours and correct. I'm not sure that is such a great idea, as I try to avoid topping 200. And why 3 hours later? I guess depending on what you are eating?

[JediSkipdogg]

Depending on how low is how I'll eat the meat. If I'm low low (say 65 and under) then I'll maybe eat dessert first or eat something faster acting for the meal. If I'm above that, then I'll just eat the meal and subtract a unit from my bolus (one unit for me is 35 mg/dl)

[Alice]

I would either pop a couple of glucose tabs and get on with the meal/bolus as usual...or for some reason, I might go ahead and eat (if soon) but take my bolus after the meal...giving the carbs some time to work first.

I really like glucose tabs for those small "boosts". One tab is only 4 gr of carb...so a couple will give me just what I need.

The problem with that 60 is that is could drop more in a half-hour before dinner. I've had that happen...just as I was trying to get a dinner party on the table. I've guzzled Coke in the middle of my kitchen just before eating...always be prepared.