When do you bolus?

[gary.keith]

I've been told to bolus 20-30 minutes before meals.

I suppose that worked well enough at first when I ate the same exact things at each meal and knew exactly what the bolus dose should be.

Now that I'm back in the real world and trying to live my life again, I'm finding I don't always know exactly how many carbs I'll be ingesting, or how each type of food will affect my BG until after I've eaten it.

So my question is, do you always bolus before a meal, or do you wait to test your BG in the hours following a meal and bolus according?

I will discuss any change with my endo, it's just I would like some real-life experiences to help guide me in how I present this to my endo.

[telizas]

I bolus before I eat. I eat a set amount and if I want another helping of something I bolus right before I have it. I don't do this often. If I am at a restaurant, I look up the carb counts on CalorieKing or wing it and bolus after ordering.

It doesn't work as well to bolus after, as you'll be chasing your blood sugar all night. I also find bolusing before helps me keep my portions smaller.

[dbaratta]

I've been told to bolus 20-30 minutes before meals.


So my question is, do you always bolus before a meal, or do you wait to test your BG in the hours following a meal and bolus according?

I will discuss any change with my endo, it's just I would like some real-life experiences to help guide me in how I present this to my endo.

I was told to bolus right before I eat. Sometimes I bolus before I eat, then 2-hours post meal if I am a little high I take another couple units.

[gary.keith]

Thanks to both of you.

I was told to bolus right before I eat. Sometimes I bolus before I eat, then 2-hours post meal if I am a little high I take another couple units.

That's exactly what I was hoping to see. I too feel like sometimes I should bolus at some point after a meal. I know this will be a huge issue for Thanksgiving where I have no idea at all what ingredients are going into most dishes.

[jenb]

I always split my boluses: 2/3 of it (including any correction needed based on pre-meal BG) 25 to 30 minutes before a meal and 1/3 of it between 15 and 30 minutes after begining to eat. I test at 1 hour post-meal and give a little correction if I see a higher than anticipated spike. For high fat or excessive protein I also test at 3 hours and may do a little "kicker" bolus if BG indicates it's needed.

When out for social occasions I inject about 2 units just prior to arriving, then continue with 1.5 to 2.5 units hourly depending on the foods we're eating. I test quite frequently to make sure I'm not totally insulin stacking.

Not for everyone, I'm sure, but this regimen has worked well for me.

Jen

[Subby]

Gary, I'd suggest that the more you become adept at "casting ahead" for your meal and predicting carbs, the better of you will be. With a bit of lateral thinking and practise in how you handle food, I don't think it's that restrictive (unless one eats a very high carb diet.) Even if you decide that predicting an amont of carbs is problematic, understand that it really is a cornerstone of insulin therapy and that there isn't really a good alternative (except perhaps very low carb diet): bolusing afterwards may work somewhat, or it may just be a case of "chasing your tail". Something to remember is that insulin injected into fat is far slower than the insulin processes of a non-insulin dependent. Many people really are working at a disadvantage as far as catching up with carbs. not everyone, but it seems a lot of people.

That said, two things worth keeping in mind:
1. These are your own decisions to make, payoffs to consider and,
2. Aspects of insulin therapy varies so much between people (such as speed of insulin, speed of carbs, reactivity of BG to both) that careful trialing or experimenting with any reasonable theory should guide your way to finding both effective and less effective practises.

As for the endo, I hope they help guide you, I also hope they give you the wheel to your ship with blessing, in making a lot of decisions and being involved in decision such as how much to prebolus, or in adjusting your i:c ratio.

[gary.keith]

Thanks, Jen. My units will be higher than yours, but it seems reasonable that the basic idea of how you handle parties (and in my case Thanksgiving dinner) should work for me. Guess I'll find out.

Subby, my problem is more along the lines of eating a diet too low in carbs, which is why I keep making myself hypo. I need a formula I can work with to determine how much I should bolus based on what I'm going to eat. This business of 25 units before each meal that the endo told me to do just isn't practical in the real world. So, you're right, the endo needs to give me more room to experiment and see how different scenarious play out for me. My guess is she'll do that and has been extra-cautious until now because I'm still so new to this and haven't had my D management classes yet. I ordered the Using Insulin book, it'll be here Wednesday, and I'm sure that will help me a lot too. I'm sure when she sees how much progress I've made in so little time she'll be quite pleased.

[Subby]

Gary, I'm glad you explained your dosage situation.

Set dosaging like that is very old school and you really can have a much better system. You should be looking to use carb counting (grams are best I think), then you use what is called an insulin to carb ratio. That means that you have a personal number, for how much insulin you need to cover the carbs you are about to eat.

An example, my most common I:C ratio is 1:6. That means that 1 unit of insulin will cover 6 grams of carbs.

So if I am about to eat a snack of 12g carbs, I take 2 units. If I am about to have a plate of 60g carbs, I would take 10 units.

This number can vary wildly between people, and you are right to be looking to your endo, or some medical help, to help you move to such a system. First, you want to be very firm in what you are doing, and second, finding the correct I:C ratio is mainly a case of trying and adjusting, but at least initially is probably best guessed at by an endo or someone else in the know that you can talk with face to face. I hope they are up to date enough to help you with it. If not, I would suggest you need more help elsewhere. It's you who has a vested interest in getting this right - not them.

[gary.keith]

Yep, I'm hoping to find an I:C ratio that works for me. Right now it seems like I'll need more like a 1:3 ratio.

I'm love my endo. She's been my doctor for many years for other endocrine issues and now for diabetes too. I have every confidence she'll set me free to experiment, within reason, once she sees how good a job I'm doing of educating myself. I think I see her on the 10th. BTW, I've learned more in my few days here than the entire three weeks since I was DXed. :)