[DarthDiabetes]

So I am curious, how long BEFORE you eat do you take your bolus insulin. I have been trying to wait longer and longer, as it seems to help with the spikes (occasional) but after I tried (splurged) on sushi, tempura, spring roll, and a cookie (I know, but it has been two months and I really thought I would be okay if I just took MORE insulin) I was 223 at 90min, 171 at 2 hours....still waiting for 2.5 and 3 hours (obsessive I know but I am just annoyed.)

So how long? And are there tests one can do to see how long it takes individuals? Is a pump faster? (endo said whenever you are ready call me and we will get you on one)

thx

I really beat myself up if over 140 at 2 hours....

Oh, MDI of course novolog and lantus
DX 2-08-08 so still a noob

[JediSkipdogg]

I'd say I'm 50/50 with giving it right before or giving it during the meal. I really need to get better at giving it always before but I won't "pre-bolus" at all. I see too much danger if something comes up and I don't eat, don't get to eat everything, or being a single male, burn it (hey, it happens) among many other reasons.

A pump is no faster than a shot. The only difference in speed can be found in what insulin you use. For fast acting there is Humalog, Novolog, and Apidra. Depending on your body, one may work faster than the other. I find for me, they all act the same.

[Alice]

My goal is 15 minutes prior...with a couple of exceptions:

Restaurants...unless I know the menu and staff really well, I usually take my bolus after eating. I am notorius for ordering and then only eating 1/2 of what I receive for various reasons. (Weight Watchers for one)

If I'm low or recovering from a low...then I always take a few minutes after I eat...give the carbs a bit of nurturing before attacking them, so to speak.

Parties/holidays...I often will take a small pre-bolus...then take a more exact amount after grazing. If I choose to graze that day or not...I find that takes an edge of spikes and gives me a bit to see how much I really ate. I used to go low from over-guestimating at holiday meals...now I do more of a split.

[DarthDiabetes]

111 at 3 hours....I know I am still honeymooning and all, but *%&$*#(%* I could be done with this already. The whole D thing that is, not you all.

[SGT Shoutmore]

I usually bolus about 10 to 5 minutes before I eat, when I check 2 hours later, I am usually on or under target BG.

[Jill-O]

Immediately before I eat.

[Alice]

Remember that some foods (they vary for everyone, but typically pasta, asian, etc.) will require split boluses. If you try to dose with one "big" amount...often you will go low before the carbs have processed. Some carbs just hang around longer than others...

[RobiJo]

It's often not just the timing of the bolus, it's the timing plus the type of food.

For sushi, and Chinese I take my bolus with the first bite and do a 1 hour square bolus. Otherwise I tend to go low then higher later as all that rice digests.

Other times I'll take enough to cover 30g with the first bite and the cover the rest when I'm done. Like Alice, I'm not always in the clean plate club---so I don't bolus for food I may not actually eat.

[morrisma]

I most often do my bolus 10-15 mins before the meal except for restaurants. Since I have been kept waiting far longer than expected for food to arrive, I wait until its on the table so I don't go low before it comes & spoil the meal with a glucose tab or 3.

OTOH, I have waited and then forgotten to bolus at all until those high feelings hit. At that point I check my bolus history, curse and pump extra. Tough balancing act this D.
Mike

[Lizzie G]

read 'think like a pancreas' - it gives excellent advice on timings relative to current blood sugar and type of food - that book is a must have which i got yesterday from amazon - reading that could have saved a couple of dodgy hypos and within 2 or 3 meals i have seen how it works. i dont really want to go into explaining it as everyones body works differently but if anyone is interested i can bring the table into work on monday and scan in the table?

[Gary_W]

A pump isn't faster (as far as I know) but it can easily give you part of your bolus up front and then spread the remainder over a longer period which can help with some foods.

It's really all about learning how quickly your insulin works for you and how quickly certain foods are absorbed. The amount of carbs is one thing, but how fast they run is important too. If you can match the speed and amount of insulin with the right speed and amount of food then you would (in theory) get a perfectly flat BG. Life isn't like that (not even for people who do not have diabetes) so the best we can do is get as good a fit as possible.

Whilst it is great to be under 140 at the two hour mark, you need to be aware of how much insulin you still have working in your body vs how much food. If you inject 10 units of Novo, you've probably got about 5 units still working at the 2 hour point (your body may well vary). If this is the case and all the food you ate was super-rapid absorbing (e.g. a big plate of mashed potatoes with a side of white bread and an orange juice chaser) then a reading of 140 at hour 2 would potentially be too low; you've got 5 units of insulin left and no food so you may well go hypo at hour 3 or 4.

Another thing to keep in mind is are your basals set correctly? They may be aiding and abetting your post prandials.

And another thing. The 3 rapid insulins I'm aware of (Novo, Humalog and Apidra) all have slightly different response curves. Finding the one that works best in you for the kind of foods you tend to eat is wise IMO. Apidra is a good fit for me as I like carbs, and am not one to avoid the high GI stuff at all costs. Don't get me wrong, I don't hit the chocolate cake regularly but I do go with the mashed potatoes, rice, bread (sometimes white ) etc and in me Apidra works quicker than Novorapid did.

It's a fun, learning experience At least you've gaining a decent understanding of how this works early in your diagnosis; many of us were many years in and lived in a world of confusion before learning this stuff...

Gary

[kgm0612]

I test and bolus (pump user) to cover my meals within 5 minutes of eating.

Last night I had Chinese (something I do not do very often).........Beef Terriyaki sticks, a small portion of fried rice and an egg roll. Usually I do a dual wave bolus and spread the insulin over a 3-4 hour period of time, but I wasn't paying attention and gave myself a regular bolus. Two hours later I was 215. Another 2 hours later I was 173, made a small correction, and headed to bed. I woke this morning with a 152! Chinese food always rebounds on me!

Karen

[Emm]

I almost always jab 15 - 20 minutes before my meal. Unless I'm close to low... but even then, my insulin takes at least 10 minutes to start working so I'm not too worried.

There are some meals where I take two injections - mostly heavy fat meals, the slow yet horribly carb laden things like chinese. I'll inject most of the dose a while before eating (30 mins or so for chinese to give the insulin a good 'run up' lol), and then a little bit about an hour afterwards to help knock back the endless tail that chinese always brings.

It's a matter of trial and error. If you're not at home, be careful. If you're alone, be careful. If you're not sure of the carb content, be careful. Otherwise, I totally recommend jabbing at least 10 minutes before eating. You could always pre-jab just a half or quarter of your meal dose and do the rest as you sit down... that saves you for the times when you're not sure what you'll be eating or how much carb is involved. I do that at restaurants too if I'm not sure how long they'll take.

I really can't stand being high, so I've come up with all sorts of little tricks for avoiding spikes! My biggest issue with spiking high is that the higher I am, the more insulin resistant I become (and normally I'm not insulin resistant at all).

[Lizzie G]

Originally Posted by Gary_W

A pump isn't faster (as far as I know) but it can easily give you part of your bolus up front and then spread the remainder over a longer period which can help with some foods.

It's really all about learning how quickly your insulin works for you and how quickly certain foods are absorbed. The amount of carbs is one thing, but how fast they run is important too. If you can match the speed and amount of insulin with the right speed and amount of food then you would (in theory) get a perfectly flat BG. Life isn't like that (not even for people who do not have diabetes) so the best we can do is get as good a fit as possible.

Whilst it is great to be under 140 at the two hour mark, you need to be aware of how much insulin you still have working in your body vs how much food. If you inject 10 units of Novo, you've probably got about 5 units still working at the 2 hour point (your body may well vary). If this is the case and all the food you ate was super-rapid absorbing (e.g. a big plate of mashed potatoes with a side of white bread and an orange juice chaser) then a reading of 140 at hour 2 would potentially be too low; you've got 5 units of insulin left and no food so you may well go hypo at hour 3 or 4.

Another thing to keep in mind is are your basals set correctly? They may be aiding and abetting your post prandials.

And another thing. The 3 rapid insulins I'm aware of (Novo, Humalog and Apidra) all have slightly different response curves. Finding the one that works best in you for the kind of foods you tend to eat is wise IMO. Apidra is a good fit for me as I like carbs, and am not one to avoid the high GI stuff at all costs. Don't get me wrong, I don't hit the chocolate cake regularly but I do go with the mashed potatoes, rice, bread (sometimes white ) etc and in me Apidra works quicker than Novorapid did.

It's a fun, learning experience At least you've gaining a decent understanding of how this works early in your diagnosis; many of us were many years in and lived in a world of confusion before learning this stuff...

Gary

Gary - couldnt agree more, i was kind of guided to believe that it was all down to the amount of carb you ate and that low GI foods were better for obvious reasons (like being on novo'rapid' for example!), but as you say its all about choosing an insulin that suits your lifestyle and food choices. i would also add that i am beginning to realise that managing type 1 isnt necessarily about avoiding cakes, but taking the right amount at the right time to let you enjoy the things you like. IMO a diabetics diet really shouldnt be very different from that of anyone that cares about their health - limited refined carbs, avoiding sweetened breads and cereals, plenty of fresh vegetables and lean meats, and occasional treats. but some of you might disagree!

[Emm]

Originally Posted by Lizzie G

IMO a diabetics diet really shouldnt be very different from that of anyone that cares about their health - limited refined carbs, avoiding sweetened breads and cereals, plenty of fresh vegetables and lean meats, and occasional treats. but some of you might disagree!

I totally agree!!

Although I do believe in the lower carb (not 'low' carb, just lower/balanced carb) lifestyle as a general way of eating, I also believe in eating what I want, when I want, and how I want! So long as I don't eat like that all the time, I'm fine. We don't have to give everything up - we just have to have some forethought to work it out, and a willingness to test a little more when we've gone overboard. A good diabetic 'diet' is just a very healthy way of life that pretty much everyone would do well on.