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Bolus: Timings and dose mismatch

M

Mike3

New Member
I don’t feel as though I am learning from my mistakes. How can I tell whether a blood glucose spike, or dip, after a meal is due to mistiming, incorrect insulin dose, or both? I have a CGM.

For context still producing some of my own insulin and have been taking additional Lantus and NovoRapid for 2 months.
I’ve been focusing on my basal dose and think that’s in a good place.
 
If the dose is correct but the timing is out, your BG should be at target in around about 4 hours after your bolus.
If the timing is correct but your dose is wrong, you will be higher or lower than your target after 4 hours.

Ok, that is really simplifies and assumes you don’t do anything else to impact your BG in those 4 hours (like exercise) and that the food is not one of those annoying things (like pizza) that takes hours to digest and may still be affecting your BG after 4 hours.
But it is a good approximation of logic.
 
helli said:
If the dose is correct but the timing is out, your BG should be at target in around about 4 hours after your bolus.
If the timing is correct but your dose is wrong, you will be higher or lower than your target after 4 hours.

Ok, that is really simplifies and assumes you don’t do anything else to impact your BG in those 4 hours (like exercise) and that the food is not one of those annoying things (like pizza) that takes hours to digest and may still be affecting your BG after 4 hours.
But it is a good approximation of logic.
Click to expand...
Thanks for that, makes sense. How much does the increase in mmol/L matter? I’ve been told that a rise of 3 mmol/l or less is good but I can often go above that but be back in range within 4 hours.
 
The rise of 3 or less is guidance for someone with type 2 treated by diet.
You are on insulin and it is too challenging to maintain these guidelines with insulin that is slower than human produced insulin.
I focus on Time in Range and minimise long periods (for me, this would be longer than 90 minutes) in double figures.
 
Mike3 said:
Thanks for that, makes sense. How much does the increase in mmol/L matter? I’ve been told that a rise of 3 mmol/l or less is good but I can often go above that but be back in range within 4 hours.
Click to expand...

Then that’s fine. As @helli says, the target you quoted is for diet-treated Type 2s. Your avatar doesn’t show your diabetes type - are you Type 1?
 
Ah - I remember you! You were trying to gain weight but finding it hard. I’m not sure if I replied to that thread but, apart from pancreatic tests, have you had a coeliac screen?
 
Hi @Mike3 Glad that you have found the forum and can tap into a wealth of knowledge on here about the practicalities of living with T1

I regularly deviate more than 3 mmol after a meal but I am more focused on coming back in range after 4 hours. I find that I can reduce the post meal rise by the timing of my bolus, but if I eat out I am not able to pre-bolus so I know that I will have a bit of a spike. For meals at home I have, through trial and improvement, worked out how long to wait after my bolus before eating, and this changes through the day.

As @helli has said it is more useful to focus on our time in range, and looking to get that over 70%, which is very good management.
 
Inka said:
Ah - I remember you! You were trying to gain weight but finding it hard. I’m not sure if I replied to that thread but, apart from pancreatic tests, have you had a coeliac screen?
Click to expand...
Yes that’s me.
Yes have had coeliac screened and it was normal. Had enzymes test on Friday.
 
SB2015 said:
Hi @Mike3 Glad that you have found the forum and can tap into a wealth of knowledge on here about the practicalities of living with T1

I regularly deviate more than 3 mmol after a meal but I am more focused on coming back in range after 4 hours. I find that I can reduce the post meal rise by the timing of my bolus, but if I eat out I am not able to pre-bolus so I know that I will have a bit of a spike. For meals at home I have, through trial and improvement, worked out how long to wait after my bolus before eating, and this changes through the day.

As @helli has said it is more useful to focus on our time in range, and looking to get that over 70%, which is very good management.
Click to expand...
I’m 71% at the moment. Was 90% a week ago but it’s been a challenging week. Pleased 70+ is considered very good as I was a little disappointed at the decrease.
 
Prof. Kar reckons anything in the 70s and we're 'Legends' - I said the other day with me, perhaps I'm more like a leg end than a legend? (rhetorical there; ie don't answer)
 
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