[weejules83]

with my son its usually after a meal because hes only three and we can never be sure of what hes going to eat but if he was exceptionally high i would do it beforehand his consultant told me that before or after shouldnt really make any difference as long as its within about 15 minutes?

[Scratch]

Originally Posted by Subby

Non pumpers are more than welcome to join in the comments but this was intended mainly as feedback on people's pumping strategies.

I see the pump as a tool, pumping is a subset of the basal/bolus strategy of insulin treatment.

A pre-meal bolus covers both MDI and pumping, IMO.

[Eddy]

Originally Posted by Subby

There is no "mix of all" or "it depends" tick box because then I think most of us would tick that option rather than go for a "typical" trend... if I didn't cover a general category that you are happy with just skip it - your comments about your approach are the most interesting and valuable thing anyway

I select my insulin mix and timing as a function of what I'm eating, my preprandial BG, anticipated after-meal activity... and the positions of the planets.

Pineapple? 100% rapid, twenty minutes before eating... and eating slowly.

Pancakes? 70% R and 30% rapid, five minutes after I start fixing/eating them.

Dates? 100% rapid, ten minutes after eating them.

Spaghetti? With between 50% and 70% N, and about 20% rapid, the timing just isn't so critical... so before/after depends on how eager I am to eat the first few mouthfuls.

If in doubt? Whatever mix looks right, right at the beginning of the meal.

I'm happy with this approach, and arrived at it through much self-testing. My doctor will step in if I get into trouble, refer me to a specialist if needed, et cetera, but lets me do my own thing.

[dar917]

Originally Posted by Subby

Non pumpers are more than welcome to join in the comments but this was intended mainly as feedback on people's pumping strategies.

Whoops, I didn't notice the category. nevermind then...:/

[Alice]

Sorry, I didn't notice the category either...but a bolus is the same whether on MDI or pump...I split boluses all the time with MDI...I guess the "square" boluses are different...but all-in-all, the two delivery methods are the same on a bolus. And timing also.

[cheryl]

For breakfast....20 minutes..Lunch and dinner....I can eat immediately....or not, it depends...on the bg's.......I have never gone over 30 minutes though ever, cause any kind of bolus I take, my insulin starts it's working within 45 minutes...

Cheryl

[blue eyes]

If I'm low or in range I don't pre-bolus because I never know how much I'll actually eat. On lantus/novorapid I did (pre-bolus 5-10mins before) and there were plenty of times I'd bolus and then find I couldn't eat all that I bolused for.

[Emm]

I'm not a pumper... and I can't answer anyway because mine would go in the missing category, I mostly bolus 10 - 20 minutes before a meal.

Well I try to anyway. I often forget. But even a 5 minute head start is helpful

[Subby]

Originally Posted by Scratch

I see the pump as a tool, pumping is a subset of the basal/bolus strategy of insulin treatment.

A pre-meal bolus covers both MDI and pumping, IMO.

Yes of course pre meal bolusing is just as pertinent in MDI, would never doubt that for a second, especially being on MDI for 15 years and having much experience with all sorts of pre-bolusing situations.

But my original context for this poll was in context of what pumpers are up to. This was not an arbitrary thing: as I said in my first post my team said pre-bolusing was a thing of the past for pumping therapy: part of this poll was to get a handle on what other pumpers found they had to do as opposed to what the so called convention said.

Also, absorption "generally" improves or at least "may" become a little more predictable with the same set site, again interested what other pumpers found with this and if it reduced their pre-meal pauses, if coming from MDI.

My downfall came with not framing the question to pumpers more specifically and not realising that the poll was put on the front page, negating the fact it is in the pumping forum. So of course all responded and there are great responses here and since the cat was out of the bag so to speak let this poll enjoy itself as a cross-therapy poll.

[Subby]

Originally Posted by dar917

Whoops, I didn't notice the category. nevermind then...:/

Nope, my bad, I didn't make it clearer at the start. Let us know what you get up to!

[Scratch]

Originally Posted by Subby

My downfall came with not framing the question to pumpers more specifically and not realising that the poll was put on the front page, negating the fact it is in the pumping forum. So of course all responded and there are great responses here and since the cat was out of the bag so to speak let this poll enjoy itself as a cross-therapy poll.

Part of the difficulty, at least as I view these boards, is that the board doesn't in a sense correctly frame these discussions. By that I mean this board as it is set up presently has a way of emphasizing the pump in such a way that MDIers may at times feel a bit left out as it were.

Notice that there isn't a forum about the Basal/Bolus Methodology, instead the ideas of basal and bolus are to be covered in this forum, the pumping forum. I suppose the type 1 or general diabetes section would qualify for use about basal/bolus, but I still feel it is unfortunate that there isn't a Basal/Bolus forum perhaps with subforums for pumpers and for those of us who use MDI.

A consequence of this set up is that MDI users are somewhat forced to use the pumping forum. It annoys me some, not enough so that I want to make a big stink about it, and I have one time prior made such a suggestion for an MDI forum. Response wasn't enthusiastic and it was suggested that the pumping forum adequately covered the idea of basal/bolus.

Maybe, maybe not.

I do think a thorough understanding of basal and bolus principles are key for a patient to take full advantage of MDI or insulin pumps.

I apologize for derailing some here, I suppose my annoyance about this issue with the forum structure is annoying me a bit more today.

[Subby]

No worries. My impression, being relatively new, is that the type 1 is a more general purpose forum focusing naturally on MDI, and the pumping forum is in my mind a subset for pumpers to share pump stuff that would simply not interest other type 1ers. Personally I would have put it as a subset of the type 1 forum, but anyway...

I would not have hesistated in putting this poll in the type 1 forum instead if it wasn't originally meant to address pumping. If only MDI, in Type 1. So I guess I think it's reasonably clear where things go at the moment. But for sure there is some messy overlap.

I don't see that a basal/bolus discussion belongs only to one or other forum... there are different factors and dynamics at work with each therapy, and if the discussion is about something unique to that therapy (eg, pump: variable basal settings, or MDI: getting a split lantus dosage right) it would simply go in the respective forum. If general, hopefully in the type 1 but mistakes do happen. And, the territory may move through the discussion to a common ground... ah well. Ces't la vie, perhaps.

[Micha82]

I always do Pre-Bolus, because I don´t know how much I can eat.
Sometime we start eating and my son is finished much to early, so it could be that I eat the rest when he is sleeping. I had many hypos with bolus before eating.

[Alice]

Subby, I'm curious as to the reason you were told that pre-bolusing was a thing of the past...in regards to pumping.

I'm on MDI, but regard the bolus aspect to be almost identical to pumping...the method of delivery is just different. So, I'm curious why they told you pre-bolusing wasn't necessary.

[Subby]

Originally Posted by Alice

Subby, I'm curious as to the reason you were told that pre-bolusing was a thing of the past...in regards to pumping.

Alice, you and me both. At the time it "just wasn't part of pumping". Being a little more experienced now, I consider the attitude completely inadequate. But, I won't be debating it with the educator again any time soon because there is some attitude problem going on and difficulty with communication which I simply have no time for and which is, all said and done, negative. For my needs, I luckily have a great endo to deal with, she's just not confident with all pump decisions. I need good information: thus this thread, to find out what really goes on out there "in the trenches".