Insulin users - when do you inject before a meal?

[Northerner]

There's a lot more people these days seeing the advantages of injecting some time before eating rather than injecting immediately before or even after eating - post-prandial levels are generally improved by this as the insulin has a chance to get working as the food starts to digest.

Obviously, how long before eating you inject will depend on what you are about to eat (the GI of the meal, your BG levels etc.), but I was wondering how many people do this as a matter of course, and also if you do inject at least 15 minutes before eating, do you do this because you were advised by your nurse or doctor, or because you have read it on a forum such as this?

Should it be standard advice?

 

[bennyg70]

Taking advice from forums, I think the nurse would be horrified by hearing for certain meals Ill inject up to 40 minutes in advance.

Very low GI - Ill consider split injections now
Low GI - 10/15 minutes upfront
Med GI - 20/30 minutes upfront
High GI - 35 / 40 minutes in advance (Fairly a rare occasion)

I get struck by the occasional hypo... Ie Im a naff cook and my timings can sometimes be a little off. However my Post prandrials have become greatly improved.

Im not sure about standard advice however - Ive only learnt this works for me by trial and error and recording my results.

 

[Phil65]

I generally bolus just before I'm going to eat, especially if I am bordering on low levels. It seems to work for me as my 2 hour post prandials are pretty good, possible that I may be spiking for a short time as my bolus catches up....either that or I might go hypo If I bolused 15 mins before.

 

[everydayupsanddowns]

I picked it up on forums, having been told (several years ago) that one of the benefits of 'rapid acting analogues' was that you didn't need to inject up front any more - I suspect this was part of the Big Pharma sales pitch.

I vary less on GI of meal (apart from high GI obviously!) and more by time of day. If a bit high before a meal I may well add an extra 20-30 minutes to these timings:

Breakfast 40-60 minutes before eating
Lunch 30-40 minutes before eating
Eve meal 0-20 minutes before eating

After a correction dose I would not expect to begin to see my BG come down much before 45-60 minutes. At breakfast time 45 mins after bolus if I'm lucky I might be holding steady, often I will have gone up a little (good ole DP/FHTF). At lunch time I have waited 1hr before now (by accident) and only seen a relatively minor drop.

Altering the timing of my injections (and now button pressing) was one of the most effective strategies in keeping post-meal levels in check. It doesn't always work perfectly, and does need a fair amount of experimenting to find what works for you as an individual, but I stay in single figures after food *far* more often when I bolus a bit early.

 

[Northerner]

Our timings are very similar Mike! 🙂

 

[Emmal31]

I usually inject 30 mins before breakfast and 15 minutes before all other meals. I do this because I started checking bg's post meal times and found that my blood sugars were high for the 2hrs after the meal. Once I started doing so I found that blood sugars are usually below 9mmols 1hr after eating.

 

[FM001]

having been told (several years ago) that one of the benefits of 'rapid acting analogues' was that you didn't need to inject up front any more

Same here, just inject before or after eating. Tendency now to inject 15 minutes before food, if the food is low gi or high in fat then injection is given before sitting down to eat.

 

[Phil65]

having been told (several years ago) that one of the benefits of 'rapid acting analogues' was that you didn't need to inject up front any more

Same here, just inject before or after eating. Tendency now to inject 15 minutes before food, if the food is low gi or high in fat then injection is given before sitting down to eat.

....I often inject after eating if my bg was lowish and especially if a low carb meal.

 

[everydayupsanddowns]

having been told (several years ago) that one of the benefits of 'rapid acting analogues' was that you didn't need to inject up front any more

Same here, just inject before or after eating. Tendency now to inject 15 minutes before food, if the food is low gi or high in fat then injection is given before sitting down to eat.

Interstingly what I meant by that was that *and this clearly isn't the case for me*. Got to find what works for each of us I guess.

For the most part even if I'm 4.0 I can inject immediately before eating and not dip after food. These days I might consider a 30 min square wave 'ease in' of the bolus though if it was relatively low-med GI.

Last night was a howler. Granary/seedy bread with soup (should have eaten burgen but fancied the fresh-from-the-bakery treat. 7.3 before eating, left it 15 mins after bolus. BG at 2hrs pp was 19.6 😱 I guess if I was to do that again I'd have to bolus about 1hr before eating - but I was driving at the time so that would not have been wise 🙄

 

[Pumper_Sue]

Normal meals 30 mins before high fat just before I eat.
I use animal insulin though.

 

[Phil65]

Interstingly what I meant by that was that *and this clearly isn't the case for me*. Got to find what works for each of us I guess.

For the most part even if I'm 4.0 I can inject immediately before eating and not dip after food. These days I might consider a 30 min square wave 'ease in' of the bolus though if it was relatively low-med GI.

Last night was a howler. Granary/seedy bread with soup (should have eaten burgen but fancied the fresh-from-the-bakery treat. 7.3 before eating, left it 15 mins after bolus. BG at 2hrs pp was 19.6 😱 I guess if I was to do that again I'd have to bolus about 1hr before eating - but I was driving at the time so that would not have been wise 🙄

Interesting, did you take a correction for the 19.6? or did it come down on it's own accord, what happened?....for me, my insulin definitely peaks at 2 hours. Damn, I wish I had a CGM to tell me exactly what is going on!

 

[everydayupsanddowns]

Interesting, did you take a correction for the 19.6? or did it come down on it's own accord, what happened?....for me, my insulin definitely peaks at 2 hours. Damn, I wish I had a CGM to tell me exactly what is going on!

Well, this is where the bolus advice/correction on the Veo falls down a bit in my experience - probably quite rightly it errs on the side of not 'overcorrecting' while there;s still a good amount of IOB - after all it can't know the GI of your meal.

Artoo suggested that at 2hrs I should add 0.85u because of the insulin on board, but I *knew* that there is no way I should have been anywhere near 19 at 2 hours so I corrected with 3u to allow for the extra insulin resistance I seem to get at higher levels (over a certain BG corrections seem less effective) figuring I could snack later if necessary. I checked after another 1.5 hours and was dropping nicely, but not too fast and then again before bed by which time I was more or less back on track without any extra carbs.

In the last few months I find myself manually overriding 'IOB caution' if I get a biggish spike after a meal that I think is pretty much down to my error. I add a slice of extra correction sufficient to get me back to 8-9 where I would have wanted to be at that point after the meal.

I'm not sure but I *think* the combo might do this automatically via the 'meal rise' setting - it's kinda where I got the idea, from my time with the Expert.

 

[bennyg70]

For me, Im pretty sure with my insulin absorbtion rates and food digestion rates if im anywhere over 10mmol at 2 hours, I will need to correct and that bad boy isnt coming down by much more than 2 - 3 mmol

 

[Phil65]

Well, this is where the bolus advice/correction on the Veo falls down a bit in my experience - probably quite rightly it errs on the side of not 'overcorrecting' while there;s still a good amount of IOB - after all it can't know the GI of your meal.

Artoo suggested that at 2hrs I should add 0.85u because of the insulin on board, but I *knew* that there is no way I should have been anywhere near 19 at 2 hours so I corrected with 3u to allow for the extra insulin resistance I seem to get at higher levels (over a certain BG corrections seem less effective) figuring I could snack later if necessary. I checked after another 1.5 hours and was dropping nicely, but not too fast and then again before bed by which time I was more or less back on track without any extra carbs.

In the last few months I find myself manually overriding IOB caution if I get a biggish spike after a meal that I think is pretty much down to my error. I add a slice of extra correction sufficient to get me back to 8-9 where I would have wanted to be at that point after the meal.

I'm not sure but I *think* the combo might do this automatically via the 'meal rise' setting - it's kinda where I got the idea, from my time with the Expert.

Thanks Mike, makes a lot of sense to me....I often ignore the IOB based on the GI of a meal. It looks like we differ in that my Insulin works very quickly and for a lesser duration than yours....no wonder HCPs and DSNs get it wrong so often! 🙄

 

[Phil65]

For me, Im pretty sure with my insulin absorbtion rates and food digestion rates if im anywhere over 10mmol at 2 hours, I will need to correct and that bad boy isnt coming down by much more than 2 - 3 mmol

yep, same for me Benny.

 

[bennyg70]

Thanks Mike, makes a lot of sense to me....I often ignore the IOB based on the GI of a meal. It looks like we differ in that my Insulin works very quickly and for a lesser duration than yours....no wonder HCPs and DSNs get it wrong so often! 🙄

I think this is one of the BIGGEST failings of the DSN advice and general NHS advice system. They seem to think we're all the same and respond to treatments and regimes in exactly the same ways. We are all different and that is most of the battle. It would be too easy other wise.

 

[everydayupsanddowns]

Thanks Mike, makes a lot of sense to me....I often ignore the IOB based on the GI of a meal. It looks like we differ in that my Insulin works very quickly and for a lesser duration than yours....no wonder HCPs and DSNs get it wrong so often! 🙄

Hehe! Yes... The imponderable for me is always how much of the food still has to chug though.

Last night I think it was everything all at once (liquid and bread), but most meals have meat/veg/fat etc which would spread out the carbs a bit I guess.

I've not tested my insulin duration John-Walsh-style but I suspect it is still doing something for at least 4 hours, probably more. It's just that *some* of the meal is usually active over a similar period I think, so for me the result often tends to look like not much is happening.

Sooooo maaaaany vaaaaariables 😱 😱

 

[novorapidboi26]

I started doing this after advice on here, it just made sense that you would need to let the insulin get going...

And the results were good....


I think it should be standard advice from the HCPs......

 

[trophywench]

Yes, but you would have too many people going hypo, because they wouldn't know what the GI of their food was.

If I jabbed Novo 15 mins before, I wouldn't get to serve up - cos I'd be too busy hypoing anyway.

Animal insulin yes, you do your jab after you've lit the gas under the spuds. Standard advice, always, Sue ! And of course it worked for everyone the same.

 

[Lizzzie]

I inject 30 minutes before, in theory. I've never had any problems with the GI of the food (unless it's the sort of thing I'd split the bolus for anyway) but what has caught me a few times, is the damn practicality of the whole thing.

For instance, you inject, then the meat isn't quite cooked so you put it back in the oven, then there's a pooh-nami (like a tsunami) from the toddler and you have to clear that up, which involves bathing the toddler, then you realise it's actually been ages since you injected and your BG's on the floor..... (that time was my one and only paramedic-called assistance-needed hypo).

Or: you're in a rush to go out, grab and sandwich and don't gave time, or decide that lunch is really nice and have an extra helping.....


Or you're in a restraunt and it takes ages to come and you end up ordering orange juice, or not ordering until it arrives.

So while it helps the BGs, you need tonne careful to fit it in with everyday life.