Pre-bolusing

[Northerner]

Just wondering if, and for how long before eating, people pre-bolus their mealtime insulin? I've always given my insulin a bit of time to get working since I first heard about it several years ago, but using the Libre I've been surprised at just how long it can take before novo'rapid' has any impact. Here's an example - I got a 5.9 at around 11:00 when injecting my insulin, tested almost an hour later and my level was...5.9 😱 Not even touched it! 😱

 

[mikeyB]

I find the same with Humalog, but it varies during the day for some reason. Works quicker in the morning and early afternoon, but slightly slower in the evening. That’s not inconvenient, mind, because my gut slows down in the evening, so my body is quite content with the arrangement.

 

[Kaylz]

Before breakfast 15 minutes, before dinner 10 minutes, before tea 5 minutes, was working relatively well to combat any spikes however the last 2-3 days has been shocking in spiking up to 12 but my ear canals were a bit swollen and I'd been feeling a bit rough, just scanned and got an 8.4 an hour after I've eaten but I'm not surprised or concerned as unexpectedly had to have a packet of sweets at 11 as felt awful at 4.4 was 5.9 when tested at 11:30 for dinner, don't have a clue what's going on with me at the moment lol xx

 

[Lisa66]

I definitely have to pre bolus further ahead first thing. Seems to be more of an issue for me lately. Can be 20 mins, 30mins but can even be an hour before breakfast...or more...driving me a bit mad at the moment. (It’s like somethings messing with me and having a laugh) Although I do notice that the lower the test is, at whatever time of day, the less time is needed. Generally I need less time as the day goes on.

I wonder how your , shall we say “unusual” diabetes impacts on this, compared to us “normals”?

Did the graph line show if you’d gone up between the two 5.9 readings?

 

[Northerner]

I definitely have to pre bolus further ahead first thing. Seems to be more of an issue for me lately. Can be 20 mins, 30mins but can even be an hour before breakfast...or more...driving me a bit mad at the moment. (It’s like somethings messing with me and having a laugh) Although I do notice that the lower the test is, at whatever time of day, the less time is needed. Generally I need less time as the day goes on.

I wonder how your , shall we say “unusual” diabetes impacts on this, compared to us “normals”?

Did the graph line show if you’d gone up between the two 5.9 readings?

I also inject (even) earlier for breakfast (up to 90 mins when I forget to eat! 😱), generally less for lunch and then less in the evenings - the first two injections I do into my rear end and this does slow the absorption, but I found some time ago that I have to do the evening one into my abdomen otherwise I can end up having night hypos 7-8 hours after injecting - from the abdomen it's generally all done within 3-4 hours.

The graph is dead level between the two 5.9s - half an hour later (after eating) I was 4.8, but then 6.0 half an hour after that 🙄 Last week I was in a situation where I couldn't pre-bolus at all prior to eating and my levels shot up to 15 before I eventually came back down within range:

 

[Robin]

An hour ahead in the mornings. If I’ve got a libre sensor on, I inject, watch the graph still climbing steadily and only eat breakfast when it suddenly turns a corner and starts heading back down. That’s normally after an hour.
Half an hour before other meals, in theory. I’m sometimes too busy cooking and doing something else simultaneously to remember. In which case I get a nasty spike, like yours.
Once my novorapid gets going, it gets going with a vengeance, though, if I bolus and don’t eat, suddenly after 40 minutes my graph jumps off a cliff.

 

[everydayupsanddowns]

Once my novorapid gets going, it gets going with a vengeance, though, if I bolus and don’t eat, suddenly after 40 minutes my graph jumps off a cliff.

That's what I find too. I've basic 30 or 20 minute pre-bolus timings for breakfast and lunch. Eve meals don't seem to need anything much.

But I often find it's nothing... nothing... nothing... nothing... ALL AT ONCE!

Interestingly what I've noticed more in a recent run of sensors is just how inconsistent my needs have become day-to-day and week-to-week. I've needed to develop completely different dosing strategies, and then abandon them... only for them to become needed again.

I wouldn'y have a hope of spotting that without sensors!

 

[nonethewiser]

Your one oddity Northie.

Thanks to libre now bolus 25 minutes before brekkie and 20 before lunch evening meal, it can vary depending on bg before food, out of range and high the pre bolus will be extended, below range and the bolus will be closer to eating. Another thing is the food, a meal like fish and chips will be split 40/60, so the 60 will be on a extended bolus the 40 upfront.

 

[AJLang]

Lol I don’t bolusing for anything until after I’ve eaten it

 

[everydayupsanddowns]

Lol I don’t bolusing for anything until after I’ve eaten it

The added complications of dealing with gastroparesis I guess Amanda!

Must be very tricky to manage for you.

 

[AJLang]

Yep Mike, the fun of the gastroparesis. I can eat something small earlier in the day, bolusing afterwards and have a smooth line for ages afterwards BUT it might go up straight after the meal or it might go up two hours later. If I have what most would consider a normal lunch then there is no pattern and I can still be doing corrections several hours afterwards.
As for dinner...well usually that’s 1 unit after I’ve eaten followed by a six hour extended bolus BUT every few months for just one night only it will go up in the teens almost straight after dinner.
It’s all good fun. Unfortunately the Libre isn’t particularly accurate with me so I’m still having to do lots of finger prick tests as well.
But I’m lucky - I don’t think that when I was diagnosed with severe gastroparesis over nine years ago that anyone would have expected me to be doing as well as I am with it 🙂

 

[Pumper_Sue]

@Northerner perhaps the non movement of your blood sugars after a bolus is due to not having any basal insulin?

Using Fiasp I bolus 2 mins before I eat 🙂

 

[rebrascora]

I don't have the benefit of Libre but I am monitoring quite closely with finger pricks just now. I can go an hour without showing any effect in the morning and stretched it to nearly two hours the other morning which seemed to work pretty well with the Protein bar I had.... I am running high again at the moment, so I have plenty of wriggle room as regards waiting until the insulin starts working before I eat and I will only do this if I am having a few carbs for breakfast, so the bolus is small and therefore minimal risk.

8.28am 9.6
8.42am 2 units of NR
9.45am 10.4
10.05am 10.1
10.35am 8.0 Nature Valley Protein Bar (9.6g carbs)...... I intentionally overdosed the NR by 1 unit to try to bring my level down
10.59am 7.2
13.26pm 8.7
I went back up into the 10s later in the day without eating any significant carbs .

I usually just have a snack of olives/cheese/nuts at lunchtime so rarely bolus then, although generally I have a hearty omelette and salad for breakfast. This was just one of my occasional "try a carb breakfast option" experiments. In the evening I usually give it 20-30 mins due to time constraints but I think a bit longer would be better to prevent me spiking... I have yet to do significant testing at that time.

@Pumper_Sue
I use Levemir and I seem to experience the same lag with NR as @Northerner

 

[SB2015]

In the same way as I have different ratios for my Bolus during the day, I need to previous different times through the day. First thing is about 45 min, and I need more insulin then than later in the day. Evening meal is about 20 min, which often gets chopped if I forget to do it in time. I can then counter the post meal spike by going for a walk.

However having said all of that, then I need to factor in the weather, what I have been doin, and consequent differences to the stability of my levels. Oh the joys of Diabetes. Keeps us on our toes.

 

[TheClockworkDodo]

30 minutes before breakfast, 5 minutes before lunch, a minute before dinner. I find lunch is best split a bit though - if I bolus earlier I'll hypo before I start eating, but if I stop and do something physical in the middle of eating I'm less likely to spike mid-afternoon.

Lately I've been going out to water the garden just after dinner, and finding that I hypo almost immediately, so wondering whether I should be bolusing in the middle of dinner rather than beforehand or eating a more sugary desert (can't cut the insulin any more than I have already - then it would rain and I wouldn't be watering!).

Once my novorapid gets going, it gets going with a vengeance, though, if I bolus and don’t eat, suddenly after 40 minutes my graph jumps off a cliff.

That's what I find too. I've basic 30 or 20 minute pre-bolus timings for breakfast and lunch. Eve meals don't seem to need anything much.

But I often find it's nothing... nothing... nothing... nothing... ALL AT ONCE!

Yep, me too! In the morning especially it can take an hour to get going, and then suddenly I'm hypo.

 

[Northerner]

@Northerner perhaps the non movement of your blood sugars after a bolus is due to not having any basal insulin?

Using Fiasp I bolus 2 mins before I eat 🙂

Yes, I have speculated that, particularly in the mornings, my liver is ramping up its release of glucose, and the insulin is working to keep this element steady, so it appears as if the levels aren't changing 🙂 People should certainly not base their experiences on mine, I'm just too weird! 😱 🙂

 

[khskel]

Breakfast 30 mins before, lunch just before and evening depends on what it is but usually a split with the first just after eating and the second half an hour after.

 

[Pumper_Sue]

@Pumper_Sue
I use Levemir and I seem to experience the same lag with NR as @Northerner

Just seeing your before breakfast reading would lead me to suspect you do not have enough Levemir. (this is just my opinion) Do you split your Levemir as most people need to as it doesn't last 24 hours.

I use a pump so no long acting insulin for me everything is done using Fiasp which is a faster version of novo not so rapid 🙂

 

[eggyg]

I have found that lately I am having to pre bolus earlier and earlier for my breakfast. Today I was 7.2 before, injected 6 units of NovoNotSoRapid and 50 minutes later before I ate my breakfast was 7.1! Like @Robin quite often I’m too busy cooking and forget to pre bolus, like last night, 4.7 before eating, 11.4 two hours later! 😱 ( I did have oven chips).

 

[rebrascora]

Just seeing your before breakfast reading would lead me to suspect you do not have enough Levemir. (this is just my opinion) Do you split your Levemir as most people need to as it doesn't last 24 hours.

I use a pump so no long acting insulin for me everything is done using Fiasp which is a faster version of novo not so rapid 🙂

I was getting pretty steady readings in the normal range on 8 units of Levemir until a couple of week ago, then it jumped up into the 10-12 range and was pretty stubbornly stuck there until the day I was booked to see the nurse to discuss it and then it came down to 5.4 that morning and I had a hypo that afternoon. We agreed that I would increase the Levemir if it went back up, but I had a couple of days of reasonable in range readings and then it has gone back up again and is very steady in the 9-12 range again so I increased the Levemir (yesterday was the second day of that) but this morning I have woken up on 10 again which is a bit disappointing, The consultant does not want me to split the Levemir dose just yet (I did specifically ask about that when I saw him) and I don't see him again until the end of October. I find it surprising how steady my readings are at this level even though I am adding an extra unit of NR here and there to try to bring it down..... something which would normally cause me to hypo or at least get a reasonable dip but it is staying pretty steady. I do suffer from stress/anxiety but didn't feel that I was having a bout of that when this started. I am however starting to get that way a bit now that it is continuing to run high, which I know is self defeating. I think I need to add more exercise into the mix as I have slacked a bit on that the past few days.