[Subby]

In my pump orientation I was told that pre-meal bolusing is a thing of the past with pump therapy (except maybe with extremely high BG). The real story seems to be that for some it is useful or even necessary to achieve good bolus results.

What's your practise, are you happy with it and how did you arrive there (eg doctor's suggestion, self testing)?

For the bonus points, what main factor or factors do you suspect are causing the need for your pre-bolusing?

[Subby]

At the moment, a pre-meal bolus between 30 and 40 minutes seems about right for most meals. This seems to minimise my post meal spike and decrease my tail end hypos.

If moderately high (10 to 13 mmol/l) I will generally add another 20 - 30 minutes.

If really quite high (say above 15 mmol/l) I will often bolus for my meal and then test each 30 or 40 min to watch for a dip, as insulin action varies wildly once I am high.

I think the problem may be mainly that I have a range of background resistances, as occasionally with the same site I can drop back to a much better absorption, then return to typically being sluggish to respond.

I wonder if advances in subcutaneous delivery methods may improve things too.

I'd love a faster acting insulin, will hopefully be trialling Apidra soon. I currently use Novorapid.

[xMenace]

When I do controlled testing, I always come to the choice I picked. That's why I picked it. And you can get everything you want at Alice's Restaurant!

[Glucoweb]

I usually pre-bolus, but only by about 5-15 minutes, depending on what I am having, the situation, and remembering to do it before the meal is ready.

[Eddy]

Where's the choice for "it really depends"?

[notme]

Usually, I try to bolus five minutes before. I'm not always successful. Many times, I think about it while I am eating. I use a pump so it is easy to just forget until you are eating.

[Scratch]

It depends, but I pretty much always bolus at least 5 to 10 minutes prior to eating.

As MDI, I've also been using a split injection idea if my premeal blood sugar is significantly elevated, I will inject half of the bolus into a muscle for more rapid absorption than subcutaneous injection, inject the other half of the bolus into a subcutaneous layer.

[dmbfan_21]

I do the 5-15 minute unless my BG is high. It also depends on the meal, but for most of the meals I eat the 5-15 minutes prevents the spikes. If I am eating a high carb meal I may try to adjust the bolus so that it stretches over an hour or two.

[shabbie]

i have had success pre-bolusing for things like pasta/potatoes. but my problem is remembering to pre-bolus!

so i pretty much just shoot and eat!

[dar917]

I usually bolus afterward, mostly because I'm not always sure how much I'm going to actually eat. Unless I'm unusually high then I'll do it before or mid-way through a meal.

[Alice]

I do a combo of all the above...except the 30 minute prior which would almost always send me low unless I was high to begin with.

More and more, I'm doing an"intro bolus" before restaurant meals. Meaning, I know I will be following up with more, but just want to get a minimum working in me to maybe cover appetizer and such. Restaurant servings are just not predictable. And often, at home, I may eat more or less than planned.

The whole idea of one, solid pre-bolus seems to be a little too "planned" for me. I really prefer to take immediate after eating if I only had one choice. But this is diabetes...and we have lots of choices on how to take that Humalog.

[chaimb7]

Well I think I've learned something from reading all your responses. I have problems with high readings 2 hours after my first meal bolus (usually after a few mouthfulls of food)and then a drop an hour later. I'm going to try and pre meal bolus in future, my difficulty is that I never really know how much I'm going to eat (or what's coming up next when we eat at friends) I've grown acustomed to bolus a number of times during the meal

[solox316]

Depends on many things.

If my sugar is low, or trending down on the CGMS, I will eat and bolus during after after eating. If I am avg. to high I will bolus first, depending on what the reading is.

It will also depend on what foods I am eating, which also changes my type of bolus...

When I use Symlin, I bolus during or after, otherwise I drop WAY to quickly, then spike a bit later... Also with Symlin, I always dual wave bolus 50/50 over 90 minutes, seems to work perfect for me.

I used to always bolus after, but I think my post meal readings/spikes are much better now, doing it before/during.

[Subby]

A real range of replies, lots of info to think about. I'm suprised how much pre-bolusing goes on - I wonder if my team was atypically rigid or conventional in disparaging pre-bolusing for pumping.

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

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

[ant hill]

I genraly have a test and see a high then I bolus and wait half an hour.