Gastroparesis and postmeal bolus

[hmrich]

:questionm
I am trying to establish some method of dealing with the high postmeal blood glucose spikes. The dual and square wave boluses are not effective. I have gastroparesis and now am attempting to bolus post-meal. Currently I test my blood glucose premeal. Should I be basing my bolus on my pre- or post-meal blood glucose? Also, what about high premeal blood glucose values and correction of this? Do I correct for high premeal values and take more post-meal?
Heidi Huber

[Mich]

Heidi,

Some of the best advice I've read for dealing with Gastro is in Robert Bernstein's book. He goes so far as to suggest not using fast acting insulin at all,only regular. My Bernstein book is old and doesn't have the pump advice, so I'm not sure how he would suggest handling it with a pump. It's definitely a balancing act. I test very often.

It does lessen a bit if you are under very good control, just like peripheral neuropathies.

Mich

[Busy Betty]

It can be VERY tricky. I have dealt with gastroparesis for several years and there is no set rule that works every time.
I do take the entire amount of my correction bolus premeal, but everything else can vary.

For me, there are foods that I know I can eat and foods that will practically turn to stone in my stomach and just sit there. I try to adjust my bolus based on what I am eating. An easy to absorb food like SF pudding or other liquid diets, I go ahead a just give the full bolus as I sit down to eat. With almost everything else - I try a dual wave or just giving half the insulin with the meal and checking my BS after the meal and giving the rest if my BS starts to rise. If I don't wait for that slight rise, I can become severely hypoglycemic. I am very careful. Treating lows with gastroparesis can get scary.

It takes a lot of practice and gastroparesis can vary from day to day so be conscious of how you feel each day and how quickly the stomach seems to empty.

I have had better BS control lately and I do think I am better. Only time will tell.

[Lilly164]

The Bernstein book has advice that includes both insulin timing and other methods, such as exercises and gum. If your public library has a copy, it wouldn't take long to read just the gastroparesis section.