Bolus / basul question

[Karen999]

Well it looks like I'm headed down the insulin journey , which I can't say I'm happy about. I'm on a small evening basul. My question is . As someone disorganised who doesn't always plan when I'm going to eat can I inject bonus after food not before. Also if I take a pre food bonus and don't want all my meal what happens to the extra insulin load. Arnt you forced to over eat.

 

[Bruce Stephens]

As someone disorganised who doesn't always plan when I'm going to eat can I inject bonus after food not before.

You can. That may cause more of a spike after eating that if you had injected before, but that might be acceptable. It might also be just fine, depending on what you eat and how much natural insulin you're producing.

Also if I take a pre food bonus and don't want all my meal what happens to the extra insulin load.

Again it can vary a bit but in general, yes, you'll need to consume enough to cover the insulin. You're usually only injecting 15-30 minutes before so it shouldn't often be much of a problem, I think? If it is (maybe because you find you need to inject a longer time before eating) you might try injecting part of the bolus in advance and the rest later.

 

[Inka]

You can inject after @Karen999 but it means your blood sugar will spike higher. Yes, if you inject for X amount of carbs, you have to eat them, but you soon get used to this and judging in advance how much you want to eat. You can also split your bolus, ie take some ahead of eating and the other portion only if you’re sure you’ll have the full amount of food.

Importantly, you should be shown how to adjust your bolus so that you’re not just taking the same amount each meal, but tailoring it to the amount of carbs you want to eat.

 

[rebrascora]

Sorry to hear you need insulin, but it will give you more flexibility on what you can eat and when, especially with a basal/bolus system.

If you inject after meals you will likely find your levels spiking pretty high and then coming crashing back down later because the glucose from the food hits your blood stream before the insulin. Spiking and then dropping can make you feel a bit rubbish and isn't good for your long term health but timing of meal insulin is what I would call "advanced diabetics", so I would suggest you get used to the routine of injecting and eating first before perhaps starting to look at the best timing of insulin for the time of day and the food you are eating and the insulin you are using. Some insulins are faster acting than others. Which insulins have you been given?

As regards injecting and then not being able to eat it all, you could inject a proportion of the calculated insulin before the meal and then if you eat it all, then inject the rest after, so maybe roughly 60 or 70% of the calculated dose before and the remainder if you eat it all. We also do this "split dosing" for fatty meals like pizza and creamy pasta dishes and maybe fish and chips where the fat slows the release of glucose from the carbs. If you injected all the insulin before the meal you might end up hypo not long after you finished eating and then go high a few hours later, so having some insulin before and the rest of the dose after, helps to balance the release of the glucose.
There is a lot of trial and improvement with finding what works for you and we are all different. I usually need to prebolus 45 mins before breakfast for my yoghurt and berries and seeds but just 10-15 mins before lunch or evening meal. Many people would hypo in that 45mins, but that is what my body needs in the morning because I have a strong flow of glucose from my liver in the morning which is like a strong tide that my insulin has to swim against, so it takes longer to be effective whereas later in the day my liver is not pumping out so much glucose and so the insulin works quicker.

Hopefully that makes sense but it really is very much a question of seeing what works best for you. Initially, follow the advice your nurse gives you but once you get some experience under your belt then it is perfectly acceptable to do some careful experimenting to fine tune your insulin dosing to what your body needs. It may seem really complicated at first but gradually once you start doing the basics on autopilot, you are probably then ready to learn how to adjust things to suit your body betterand tailor your diabetes management to your individual body and lifestyle.

Do you have a Libre or other Constant Glucose Monitor or are you just finger pricking to monitor your levels?

 

[helli]

If you inject after meals you will likely find your levels spiking pretty high and then coming crashing back down later

Can you explain why the BG will be “Crashing down” ?
I agree the BG is likely to spike higher if bolus is taken after eating but, in my experience, the BG fall is quite gentle afterwards.

 

[rebrascora]

Can you explain why the BG will be “Crashing down” ?
I agree the BG is likely to spike higher if bolus is taken after eating but, in my experience, the BG fall is quite gentle afterwards.

Mine used to go up to 15 nearly every morning and then crash when I was on NovoRapid. Now that I think about it, it was when I was fairly newly diagnosed and perhaps had some residual insulin production which was kicking in to deal with the highs, but it was quite a severe rise and drop and the drop was particularly unpleasant even though I didn't drop into hypo most times. With Fiasp I find it is frustratingly slow to respond to highs, but I also probably have no residual endogenous insulin to help out either.

 

[Karen999]

Sorry to hear you need insulin, but it will give you more flexibility on what you can eat and when, especially with a basal/bolus system.

If you inject after meals you will likely find your levels spiking pretty high and then coming crashing back down later because the glucose from the food hits your blood stream before the insulin. Spiking and then dropping can make you feel a bit rubbish and isn't good for your long term health but timing of meal insulin is what I would call "advanced diabetics", so I would suggest you get used to the routine of injecting and eating first before perhaps starting to look at the best timing of insulin for the time of day and the food you are eating and the insulin you are using. Some insulins are faster acting than others. Which insulins have you been given?

As regards injecting and then not being able to eat it all, you could inject a proportion of the calculated insulin before the meal and then if you eat it all, then inject the rest after, so maybe roughly 60 or 70% of the calculated dose before and the remainder if you eat it all. We also do this "split dosing" for fatty meals like pizza and creamy pasta dishes and maybe fish and chips where the fat slows the release of glucose from the carbs. If you injected all the insulin before the meal you might end up hypo not long after you finished eating and then go high a few hours later, so having some insulin before and the rest of the dose after, helps to balance the release of the glucose.
There is a lot of trial and improvement with finding what works for you and we are all different. I usually need to prebolus 45 mins before breakfast for my yoghurt and berries and seeds but just 10-15 mins before lunch or evening meal. Many people would hypo in that 45mins, but that is what my body needs in the morning because I have a strong flow of glucose from my liver in the morning which is like a strong tide that my insulin has to swim against, so it takes longer to be effective whereas later in the day my liver is not pumping out so much glucose and so the insulin works quicker.

Hopefully that makes sense but it really is very much a question of seeing what works best for you. Initially, follow the advice your nurse gives you but once you get some experience under your belt then it is perfectly acceptable to do some careful experimenting to fine tune your insulin dosing to what your body needs. It may seem really complicated at first but gradually once you start doing the basics on autopilot, you are probably then ready to learn how to adjust things to suit your body betterand tailor your diabetes management to your individual body and lifestyle.

Do you have a Libre or other Constant Glucose Monitor or are you just finger pricking to monitor your levels?

Thanks for that, yes I've got a libre, and a small evening basal. I'm resisting at the moment. I've just gone to max gliclazide with the hope something might happen, my DN thinks it's time to go over to just insulin. It makes my head spin. Most of December and Jan my BG was 23. Going to bed 18 / 20. and lowest when I got up was 15

 

[rebrascora]

With levels that high you really do sound like you need insulin and you will feel so much better when they are down and into range.
I know it is really complicated at first and overwhelming but it does get easier with practice. Great that you have Libre as that will give you much more insight into how your body responds to different foods and your insulin and exercise etc. Just do the very basics at first and comfortable and into a routine with that.

Which insulins have they given you.... I mean the actual names?

 

[Karen999]

With levels that high you really do sound like you need insulin and you will feel so much better when they are down and into range.
I know it is really complicated at first and overwhelming but it does get easier with practice. Great that you have Libre as that will give you much more insight into how your body responds to different foods and your insulin and exercise etc. Just do the very basics at first and comfortable and into a routine with that.

Which insulins have they given you.... I mean the actual names?

I'm taking semglee. It's made a huge difference to my night and morning readings but I'm still in the 15/17 in the day. Like I said we haven't agreed on full time insulin , just giving it a last ditch attempt at glic. Feel a bit sorry for myself to be honest

 

[rebrascora]

Must confess, I had a few tears the day I was started on in insulin, but it is now just my new normal and the good people on this forum kept me right with anything I wasn't sure about until I gained some experience and confidence.
Sounds like the Lantus is doing a good job and hopefully you will find the mealtime insulin makes things better too but can understand you being apprehensive and reluctant. None of us wanted to need insulin but life is definitely better with it than without it! It just takes time to get into a routine and gain experience. The forum is always here if you make a mistake (we all do from time to time) and to learn tips and tricks for improving your management when you are ready to learn more.

 

[Karen999]

Must confess, I had a few tears the day I was started on in insulin, but it is now just my new normal and the good people on this forum kept me right with anything I wasn't sure about until I gained some experience and confidence.
Sounds like the Lantus is doing a good job and hopefully you will find the mealtime insulin makes things better too but can understand you being apprehensive and reluctant. None of us wanted to need insulin but life is definitely better with it than without it! It just takes time to get into a routine and gain experience. The forum is always here if you make a mistake (we all do from time to time) and to learn tips and tricks for improving your management when you are ready to learn more.

Thanks

 

[everydayupsanddowns]

You can also split your bolus, ie take some ahead of eating and the other portion only if you’re sure you’ll have the full amount of food.

Yes I wondered whether that might be a good strategy for you @Karen999

Getting shown how to adjust your doses is a very important part of living with diabetes and insulin in my opinion. And don’t be afraid to engage in a little cautious experimentation too - you may make a few mistakes (in either direction), but that’s all part of the learning process 🙂