To prebolus or not to prebolus?

[everydayupsanddowns]

Have just been pondering about pre-bolusing (taking your insulin dose, then waiting a set amount of time before eating)

For those that take insulin, is this a strategy that you find helpful?

Was it recommended to you by HCPs or did you work it out for yourself?

Do you have any hints and tips for those who currently don’t use this as a strategy?

Any pitfalls or horror stories?

 

[Ralph-YK]

I wonder how well this goes when going out to ear. You're having to wait on someone else to bring the food; and sometimes it can take some time.
If someone orders a starter, no one else gets their food for an extra 45 minutes.

 

[Pumper_Sue]

I always used to pre-bolus when on bovine insulin. Now using Fiasp and there's no need to pre-bolus, unless I'm higher than I should be (8+)
My near neighbour who is in hospital at the moment was told quite firmly he should not be having his insulin before his breakfast (this is mixed insulin) the nurse injected it an hour after he had eaten found him to be very high then promptly got the Dr to prescribe 10 units extra insulin to bring it down, end result...…………….. yep you guessed it one huge hypo 😡 neighbour in question is almost 92 years of age thus the staff think he's a village idiot.

 

[eggyg]

Over the years I have learned I need to pre bolus up to 1 hour before breakfast and that’s with a 1:5 ratio ( 1:10 the rest of the day). Even then I am quite often still at the same number or higher before I eventually get my breakfast! The dreaded Dawn Phenomenon. Lunch and dinner I usually pre bolus half an hour before, dependant on what I’m going I to eat ( fatty food etc) or what my BG is, quite often I’m low, last night I was 4.1 when I tested so I only bolused minutes before I sat down to eat. As @Ralph-YK mentioned, eating out can be a problem. I usually pre bolus as soon as I’ve ordered, unfortunately that could back fire if they’re running late. Quite often I’m usually too busy talking or drinking, or both, and I forget until the food is actually in front of me but I don’t get too het up about it, after all I’m not eating out every day!

 

[Kaylz]

Yes I pre bolus but it varies to time of day and injection site used, breakfast is one thigh and 20 minutes, dinner the opposite thigh and 10 minutes and stomach for tea instantly before eating, my timings have changed so its something I've got to keep an eye on xx

 

[Robin]

Like @eggyg, I bolus an hour before breakfast, and that’s mainly because of the dawn phenomenon. I use my usual 1:10 ratio though, and add on two extra units, rather than changing the ratio. So if I have a zero carb brekky, I still give myself two units. It’s normally an hour before I have porridge or muesli, if I've got a Libre sensor on, I watch it, and eat when I see the trace start to turn downwards.
Lunchtime, in theory I bolus half an hour before, because I have a fairly carby lunch, with a couple of pieces of fruit. but in practice, if we’ve been out, or I’ve got involved in something, I forget, so then I have to put up with the resulting spike.
Evenings, I bolus at the time of eating, because I have fewer carbs in the evening (no particular reason, but I find a cooked meal works better with a larger ratio of protein and fat to the carb element,).
When I’m out, I never bolus til the food is in front of me, just in case there’s a long wait, or the fire alarm goes off or something. This does cause a spike, but I don’t go out often, and it’s just something I live with.
I have been caught out when I've pre bolused and the insulin seems to have got going a bit too quickly, and i think there’s nothing worse than having to stuff something glucosey just before you’re going to eat something savoury that you’ve been cooking and looking forward to.
I’ve worked all this out for myself, I've never been sent on a course, (though. have done the Bertie online course) I was taught the basics at the hospital clinic, and my surgery nurse knows little about carb counting.(and what she knows is mainly what I've taught her!)

 

[Sally71]

We found that it would be useful for my daughter to prebolus at breakfast time, especially if she is eating cereal as they seem to shoot her into the stratosphere faster than anything else! But unfortunately we rarely remember to do this However we find she comes down again just as quickly once the insulin gets going, and the consultant is happy that her control is excellent (hba1c has been steadily in the range 46-51 all through puberty which is no mean feat apparently) so I don't worry too much about it. In the evening she's more likely to go low so we don't prebolus, and eating out we wait until the food arrives so that we can count it properly. In fact sometimes if eating out daughter will bolus afterwards if it's a massive portion and she isn’t sure how much of it she will eat. She's 13 now so I’m trying to encourage her to make her own decisions about it as much as possible, bolusing late isn't ideal but better late than never and there's logic in her decision!

 

[Amity Island]

Have just been pondering about pre-bolusing (taking your insulin dose, then waiting a set amount of time before eating)

For those that take insulin, is this a strategy that you find helpful?

Was it recommended to you by HCPs or did you work it out for yourself?

Do you have any hints and tips for those who currently don’t use this as a strategy?

Any pitfalls or horror stories?

To pre-bolus, not-pre bolus or post-bolus.
The only advice I got after I was diagnosed was to take your mealtime (bolus) insulin after you've finished eating. That way, you know exactly how much you've actually eaten rather than how much you thought you were going to eat (buffets a good example). This advice is actually correct in terms of how much carbs and insulin you need but...….not great for avoiding spikes! Far better to have some self control and know exactly how much carbs you're going to eat and stick to it, then pre-bolus if you need to. I pre-bolus for breakfast and lunch by 20mins with increased ratios. Dinner I don't pre bolus and use 1:1 ratio.

 

[novorapidboi26]

Its essential for me to pre-bolus with everything, why? Because the insulin simply doesn't kick in immediately......

it keeps the spikes down and in quite a few occasions has kept me in range for the following 4 hours......

I realised about pre-bolus when I done DAFNE and was reading the different onsets, peaks and duration's of the various insulin used in MDI......from then on I experimented and believe it or not, found others on here doing it and succeeding...

 

[nonethewiser]

Have to pre bolus otherwise bg spikes badly. In range goes like this, before brekkie 25 mins, dinner 20 mins same for tea, before libre info all meals were 15 mins before.

Worked it out on my own, always told you could bolus right before eating or after using novorapid.

 

[stephknits]

I try to remember to pre-bolus - although not always very successful. Tend to be better at dinner time, cos I'm at home preparing it. Lunch I am usually teaching or in a meeting before so forget.

 

[Thebearcametoo]

This is great for me to read. I suspect we should be prebolusing breakfast but it doesn’t work in the day. The rest of the time I think just before eating works at the moment.

 

[rebrascora]

I'm pretty much identical to @eggyg and @Robin .
I experimented to find the optimal prebolus timing and breakfast would probably be an hour and a half but it is just not practical, so I aim for an hour but sometimes it is less as I weigh my breakfast out and prep it and then forget that I am supposed to be waiting and find myself eating it. Like @Robin I stick with a 1:10 ratio throughout the day but add 2 extra units at breakfast time for DP.
Half an hour is usually enough for lunch and dinner.
The problem with prebolussing so long at breakfast time is that I try to fit things in between bolus and breakfast and a couple of times I have left the house to do stuff (stable duties etc) and got distracted and gone low and once I ended up out on a carriage drive with my partner several miles from home in a rural location without any hypo treatment and managed to get home on 2 mint imperials intended for the horses which we found rolling around loose in the bottom of his coat pocket ....fluff and all! 😱 I now have emergency rations in the carriage and all my pockets.

 

[everydayupsanddowns]

Thanks for sharing your approaches everyone 🙂

I’m another who finds that generally breakfast and lunch need 20-30 minutes and evening meal does better immediately before.

As @Ralph-YK suggests, it’s not always possible if the timing (or amount) of food is uncertain, but where it’s my ‘regular’ routine (HA!) then I’ve had much lower post-meal BGs by giving breakfast and lunch insulin a bit of a head start.

Confusingly over the past couple of years my prebolus timings have become a bit more ‘twitchy’. I used to have fairly steady expectations and 45-60 mins would see no change in breakfast traces, but more recently breakfast has dropped to 20 mins max, with a reduced insulin ratio, otherwise I risk dipping below 4 before the food starts to kick in. My DP seems to have wandered off somewhere?!

And of course... getting distracted at the critical moment (phone going... knock at the door... losing track of time...) can be a real challenge if you have a full dose of insulin chugging away.

It’s possible to DW or split the dose of course, but that can get a bit fiddly!

 

[eggyg]

I'm pretty much identical to @eggyg and @Robin .
I experimented to find the optimal prebolus timing and breakfast would probably be an hour and a half but it is just not practical, so I aim for an hour but sometimes it is less as I weigh my breakfast out and prep it and then forget that I am supposed to be waiting and find myself eating it. Like @Robin I stick with a 1:10 ratio throughout the day but add 2 extra units at breakfast time for DP.
Half an hour is usually enough for lunch and dinner.
The problem with prebolussing so long at breakfast time is that I try to fit things in between bolus and breakfast and a couple of times I have left the house to do stuff (stable duties etc) and got distracted and gone low and once I ended up out on a carriage drive with my partner several miles from home in a rural location without any hypo treatment and managed to get home on 2 mint imperials intended for the horses which we found rolling around loose in the bottom of his coat pocket ....fluff and all! 😱 I now have emergency rations in the carriage and all my pockets.

Well I’m a lazy nowt who just sits on her backside and comes on here or FB or reads her book! Because I’m usually up mega early, I don’t clatter about as Mr Eggy needs his sleep otherwise I’d be hoovering, doing washing etc. Before I retired, I didn’t have the luxury of an hour pre bolus and as I always walked to work ( 3 miles) I found it was fine, it helped the resistance I suppose, maybe I should take myself out for walk, armed with JBs of course! Sometimes I am so hungry though I sometimes can only wait 40 minutes! Naughty girl! 😉

 

[eggyg]

Thanks for sharing your approaches everyone 🙂

I’m another who finds that generally breakfast and lunch need 20-30 minutes and evening meal does better immediately before.

As @Ralph-YK suggests, it’s not always possible if the timing (or amount) of food is uncertain, but where it’s my ‘regular’ routine (HA!) then I’ve had much lower post-meal BGs by giving breakfast and lunch insulin a bit of a head start.

Confusingly over the past couple of years my prebolus timings have become a bit more ‘twitchy’. I used to have fairly steady expectations and 45-60 mins would see no change in breakfast traces, but more recently breakfast has dropped to 20 mins max, with a reduced insulin ratio, otherwise I risk dipping below 4 before the food starts to kick in. My DP seems to have wandered off somewhere?!

And of course... getting distracted at the critical moment (phone going... knock at the door... losing track of time...) can be a real challenge if you have a full dose of insulin chugging away.

It’s possible to DW or split the dose of course, but that can get a bit fiddly!

I’ve been known to split my dose if we’re in a ‘ posh’ restaurant where quite often the potato advertised on the menu is barely a smear and I’ve bolused four units for it!

 

[Ljc]

I started off with the suggested 10 minutes which seemed fine, then for breakfast due to getting the Libre spotted that I needed to allow more time, this gradually increased to 50 minutes for breakfast.
Even though I set an alarm on my reader I did on a couple of occasions forget to eat.
Some time passed then.
Once again due to my Libre spotted that I needed less and less time for my breakfast bolus, now depending on my levels, if I am in the mid 4s I bolus directly before eating as I can fall very quickly, if I am 8or above I need about 20 minutes and if in normal,vrange, 10 minutes , it’s the same for other meals unless they are fatty or I am eating out.
Fatty food I split my dose in half , I have half 10 minutes before eating then the rest about 15 minutes after finishing my meal.
Eating out , I’ve been caught out once as my meal was very delayed, so now I wait till my meal is in front of me

One thing I have learned along with everyone else here , is that with diabetes nothing seems to remain the same for long , it sure dies like to keep us on out toes lol.

 

[Flower]

I’d never heard of prebolusing before joining here. I read what others were doing but was nervous to try as I don’t have hypo awareness and didn’t want to risk it. As my control improved I became more aware of the spikes I was getting due to the time lag between insulin kicking in v glucose reaching my bloodstream and decided to experiment.

I don’t do breakfast so no need for it but prebolus about 10 mins before lunchtime and about 5 mins before my evening meal . It really has helped me to turn some post meal spikes into more gentle hillocks and my control is definitely better for doing it.

 

[KookyCat]

I pre-bolus for breakfast but that’s the only time of day my body will cope with it, but it works really well. I have to take my basal in the morning because my body over reacts to insulin more as the day goes by, so when I wake up there’s a lag before the insulin kicks in. I do a 15 minute pre-bolus for breakfast based on when I expect the Tresiba to kick in and it keeps the 1 hour post breakfast peak at bay. What I will say though is, if I’m not careful it can have the opposite effect because I have a good counter regulation mechanism so I had to experiment a bit. I basically did it by starting with a modest 5 minutes and then tested all morning to see the impact, then took if from there. It worked well as an investigative tool because it showed 20 mins was counterproductive and 15 was the golden time. I only use if my waking reading is 6 or over. I do have to qualify this with the newly confirmed insulin hypersensitivity diagnosis, so obviously that all plays a part in it 🙂

 

[everydayupsanddowns]

Fascinating to see the similarities and differences in the strategies that work for people 🙂