when do people bolus?

[Cleo]

hi all,
I've noticed in people's responses in other threads that quite a few bolus 20 - 25 mins before a meal, even if they are at the lower end of the target.

When I was first diagnosed in the mid 90s I was told to bolus 20 -25 mins before the meal. I cant remember what the type of insulin was called but it was a 'mixed' insulin i.e. 70% fast acting and 30% slow acting, produced by novo nordisk.

Since I've been on Novorapid (for the last 10 years) I've been told to bolus just before I eat - unless I'm high obviously. My impression from reading people's responses in other threads is that nearly everyone (apart from me!?) seems to bolus 20 mins before a meal. Is that the case?

thanks-

 

[Northerner]

Since I've been on Novorapid (for the last 10 years) I've been told to bolus just before I eat - unless I'm high obviously. My impression from reading people's responses in other threads is that nearly everyone (apart from me!?) seems to bolus 20 mins before a meal. Is that the case?

thanks-

I used to bolus (as I was told!) just before eating. My levels were always fine pre-meal so I thought I was doing everything right. However, after reading on here that novorapid actually takes some time to get going - at least 15 minutes, I started to do some testing after meals. Sure enough, when bolusing just before eating my levels would spike around an hour later, up into double figures. If I bolused 15 mins before then levels might be in the 8s instead. Over time I have learned that around 20-25 mins before is best for lunch and evening meal, but at breakfast time I can bolus between 45-60 mins before eating due to dawn phenomenon. My meals are generally at least 5 hours apart, so I have no problem doing this if I am in the 5s, although I will be a bit more cautious and bolus closer to the meal if I am in the 4s.

You have to be cautious and patient as you build up a picture, plus of course the type of meal needs to be taken into consideration, plus the other factors like activity levels, but it certainly works well for me 🙂

 

[Cleo]

thanks northerner, very helpful response, as always 🙂

my last hba1c was 6.5 so I am presuming I'm doing something right 😉 but just thought it was interesting that everyone seems to inject alot earlier than me. As I said before, none my consultants or dietician have *ever* suggested it either, and on a recent dafne course we all shot up just before we ate, so I've always presumed thats its the norm now.

I will experiment with this though as I need to keep records of my 1 hour post meal results as I'm going through pre conception (they need to be below 7.5....that will be fun!)

The more strategies we have to explore the better !!

thanks again.

 

[Aoife]

I bolus immediately before eating, at work I only get a 15 min break for breakfast and a half hour lunch break so I wouldn't have time to wait any longer!

I rarely test after meals unless I feel hypo so I have no idea whether it makes much difference to my glucose levels.

 

[bev]

Hi Cleo,


Alex always does his bolus 25 minutes before eating.🙂We were shown a chart at FFL and it was clear that if you bolus just before eating then you dont stand a chance in matching the insulin to the glucose release so the insulin is always trying to catch up. Some clever person worked out that if your levels are potentially rising for 25 minutes (if you leave it until last minute to bolus) three times a day then that can have the effect of increasing your HBA1C by 1% I think it was.😱

Even if Alex is low he just treats and will bolus as normal and we havent seen any negative effects of that.🙂Bev

 

[everydayupsanddowns]

Like Northie it only took a small amount of post-meal testing (1.5-2hrs) before I realised that Novo wasn't very Rapid at all.

Breakfast and lunch I tend to bolus 30-60 minutes before eating. Evening meal tends to be immediately before sitting down to eat, but the meals we have then are more 'mixed' and some need extended bolus approaches.

If I make a correction I would not expect my BG to begin to come down until at least 60 minutes have passed at any time of day.

 

[Cleo]

Thanks Aoife, Bev and EDUAD, always very interesting to hear about other people's strategies and approaches. I think good d management is about continuous learning....

As I said, my last hba1c was ok, but I still think I will try out this strategy esp. as I need to start recording my one hour post meal levels. I think I will try to inject 20-25 mins before for each meal for a few consecutive days (maybe a week?) and then switch to injecting just before the meal for the same nr of days and then compare both sets of numbers. I dont think it makes sense to do it on alternate days (i.e. monday 20 mins before, tuesday just before meal etc.) as there might be too many variables at play.

Why does wanting to have a baby have to be so complicated!!!!

thanks again. 🙂

 

[bev]

Hi Cleo,

I think you have a great attitude - always willing to learn and make changes - your already on your way to being a parent!I would just add that we started off doing 15 minutes and worked up to 25 so it might be worth you thinking of trying the same just in case the changes are too much for you.🙂Bev

 

[Northerner]

Hi Cleo,

I think you have a great attitude - always willing to learn and make changes - your already on your way to being a parent!I would just add that we started off doing 15 minutes and worked up to 25 so it might be worth you thinking of trying the same just in case the changes are too much for you.🙂Bev

I would agree - best to err on the side of caution to begin with until you have started to build up a picture of the effects 🙂

 

[Redkite]

A note of warning - this technique doesn't work for everyone! My son tried bolusing 15 minutes before meals and would always be hypo mid way through eating. Now he boluses immediately beforehand, unless running high. Sometimes he makes a "downpayment" of insulin at the start of a meal, and gives the rest when he's finished and knows the total carbs. The only meal that sometimes causes a spike for him is breakfast, so we now do a superbolus (suggested by John Walsh in Pumping Insulin), where the bolus is increased and then the basal for the rest of the morning is reduced.

 

[bev]

A note of warning - this technique doesn't work for everyone! My son tried bolusing 15 minutes before meals and would always be hypo mid way through eating. Now he boluses immediately beforehand, unless running high. Sometimes he makes a "downpayment" of insulin at the start of a meal, and gives the rest when he's finished and knows the total carbs. The only meal that sometimes causes a spike for him is breakfast, so we now do a superbolus (suggested by John Walsh in Pumping Insulin), where the bolus is increased and then the basal for the rest of the morning is reduced.

Hi Redkite,

Yes I agree - it is a very individual thing and what works for one may not for another.🙂Alex tried the 'superbolus' a few times but it made no difference - but then he is a teenager so maybe more resistant than a younger child. Its all trial and error isnt it.😉🙂Bev

 

[Cleo]

Hi Cleo,

I think you have a great attitude - always willing to learn and make changes - your already on your way to being a parent!I would just add that we started off doing 15 minutes and worked up to 25 so it might be worth you thinking of trying the same just in case the changes are too much for you.🙂Bev

thanks so much Bev, really appreciate it 🙂
its tough wanting to get pregnant when you're a T1, this is a time in my life where I REALLY wish I wasn't "pancreatically challenged", but I am, so I just have to deal with it and get on with things if I want to start a family. My hospitals' targets are so strict as well, but the important thing is that it can be done so I just have to put all my effort into it and just try not to get emotional about things!!!

Will try to start with injecting 15 mins before and keep records of everything.

Thanks again!!!

 

[Cleo]

A note of warning - this technique doesn't work for everyone! My son tried bolusing 15 minutes before meals and would always be hypo mid way through eating. Now he boluses immediately beforehand, unless running high. Sometimes he makes a "downpayment" of insulin at the start of a meal, and gives the rest when he's finished and knows the total carbs. The only meal that sometimes causes a spike for him is breakfast, so we now do a superbolus (suggested by John Walsh in Pumping Insulin), where the bolus is increased and then the basal for the rest of the morning is reduced.

Thanks Redkite - point taken 🙂
If there'e one thing I have learnt on this forum its that what works for one person doesn't necessarily work for the other. I'm going to try to experiment at this stage and see what the data tells me and then make an informed decision based on that. Its always good to hear about other people's insights and to have an awareness of the different strategies available.

thanks C.

 

[bennyg70]

Depends on what im eating, time of day etc etc.

Breafast time, at work I usually eat a small portion of cereal with a handful of nuts. I inject before I leave for work and eat when I get in so say 45 mins to an hour.

At lunch I usually give it half an hour to 45 mins. And dinner around half an hour. As with everyone else a few 1 hour test showed me I needed to inject upfront!

If Im eating a fatty meal a bit more planning comes into it and ill inject with my food, an even fattier meal ill split the injection a bit with my food and a bit after maybe. All dependant !

 

[rossi_mac]

I almost always inject afterwards when I remember! As then I know how much I have had, sometime for breaky I may inject upto 10 mins before but the danger then is I forget to eat for a while and then forget I have injected so inject twice, never good. If I was better I probably would inject before hand more to match the profile of the carbs being released but I'm not! But I rarely do a 1 hr test to see if and how high I have spiked.

 

[Pumper_Sue]

Why does wanting to have a baby have to be so complicated!!!!

thanks again. 🙂

I thought babies were founder gooseberry bushes 😛

I bolus 30 mins before I eat unless a fatty meal is being eaten then I bolus just before, this saves messing around with combination boluses.

 

[Pumper_Sue]

Depends on what im eating, time of day etc etc.

Breafast time, at work I usually eat a small portion of cereal with a handful of nuts. I inject before I leave for work and eat when I get in so say 45 mins to an hour.

This shocks me Benny, what happens if you are held up or involved in an accident?

 

[astbury1]

Hi Cleo I think it was my thread that may have started your questioning

My DSN have never mentioned bolusing this early however I found that my after food blood sugars spiked alot!. Like you am trying to do the pre pregnacy thing. Im have only had diabetes 10 months and to be honest I have found out more helpful information on this website then anywhere else. It appears many people are different. Some people seem to stay in range easily and other dont. Your average blood sugars sound good so you might not spike as much as me and others! I started checking hour to 2 hour after eatings after been told that in pregnancy you have to stay within 5-7 which I laughed out loud at the hospital🙄 (they werent impressed) ha ha

It may have something to do with the insulin staying and working in my system up to 5 hours where other tend to be 3????? no idea. One of the mystrys of diabetes!🙄

thanks northerner, very helpful response, as always 🙂

my last hba1c was 6.5 so I am presuming I'm doing something right 😉 but just thought it was interesting that everyone seems to inject alot earlier than me. As I said before, none my consultants or dietician have *ever* suggested it either, and on a recent dafne course we all shot up just before we ate, so I've always presumed thats its the norm now.

I will experiment with this though as I need to keep records of my 1 hour post meal results as I'm going through pre conception (they need to be below 7.5....that will be fun!)

The more strategies we have to explore the better !!

thanks again.