when to give bolus?

[heasandford]

Does everyone give their quick acting insulin well before they eat?
I went on a walk on th eIsle of Wight recently, the exact same walk we do at least annually, ate lunch then went hypo after about 45 minutes walking (fairly strenous, admittedly) In other words, the insulin kicked in before the food had got there!

Under 'normal' conditions (how can I dare say this about diabetes?!) with a largish mixed meal in the recommended proportions - up to 30%fat, 20%protein, 50%carbohydrates - should I give insulin immediately before or longer than that?

All this to try and stop the ludicrous range of results I seem to get - 50% of my BGs are within 4-10, the rest.....

 

[margie]

I give my bolus as I am about to eat or if my BM is around 4 when I eat I delay the injection till afterwards.

Have you got a copy of the latest issue of Balance - there was a pull out which gave a list of insulins and when to take them in relation to food.

 

[novorapidboi26]

In an attempt to prevent spiking I inject 30 minutes before my meals, apart from breakfast. This mean the insulins' action time is matched to the digestion a bit better, but all depends on the digestion, or release of glucose, so lower GI or high fat foods may need a dose when you eat or possible a split dose......

When you think you will be having long periods of higher than normal activity, a reduction in BI or the insulin/carb ratio should be considered....

 

[Copepod]

Depends on some many things, that there really isn't a set of "normal conditions" eg type of insulin (only factor that remains constant for me, but you may use a different short acting), weather (very warm or very cold or walking against wind can increase effort and thus insulin sensitivity), activity (eg carrying a child or pushing a pushchair takes more effort than just walking the same route), food / meal composition (fat delays absorption), where I'm eating - if in a pub, I wait until food arrives to (a) enusre it reaches me before injection and (b) to visually estimate carbohydrate content.

 

[Natalie123]

I usually inject just before eating except if I am high then I might take it a little earlier to prevent any additional spikes, and if I am about 4 then I will take it after lunch to prevent hypos. If I am out walking I would eat first and then inject.

 

[everydayupsanddowns]

My suggestion would be to stick with 'guidelines' and inject immediately before eating initially, then take one meal at a time and throw some test strips at it in order to counter any post-meal (1 hour or 2 hour) spikes that you observe.

The correct bolus would act to keep get your BG to mid-range after 4 or 5 hours. However this may not mean that you stayed in good numbers during that time. Giving your bolus a bit of a head start can help keep you below 10 during those first 2 hours after eating.

As you've already suggested, level of activity and the meal itself can make a big difference in expected meal absorption profile, but time of day can vary it too on MDI (because our basal delivery can't be so well matched to our actual requirements).

Sometimes it does feel like you are having to hold a whole lot of threads in your mind at once, but with a little experimentation you'll be able to work out how early you need to inject for 'normal' meals at each time of day.

After a few months head scratching I ended up with these delays between bolus and eating:
45mins - 1hr at breakfast
30-45 minutes at lunch
0 minutes at eve meal

I rarely if ever need to wait until after eating to inject these days (though I did when my basal was set too high a year or so ago).

Good luck in finding your own 'magic' numbers 🙂

M

 

[heasandford]

Thank you all, as usual lots to think about, I'm not new to this but trying to get better, so interesting to see how others cope. I get variations when nothing seems different, but then you can never get back to a level playing field, always something leftover from yesterday etc!

 

[Robster65]

Not sure if I understand the exact query, but if going for a longish walk, I would inject less due to the increased sensitivity.

If you were on the low side of normal beforehand, that too could have made it hard for the glucose to rise enough once your bolus kicked in.

As for 'normal' days, I tend to go for just before if I'm in the normal range and it's a low GI meal, but will inject 10-15 minutes before if I'm high and/or I think the food may digest very quickly.
As Mike says, we all have different timings and you can only find out with testing under different conditions.

I hope I've interpreted correctly.🙂

Rob

 

[SusieGriff]

I give my bolus as I am about to eat or if my BM is around 4 when I eat I delay the injection till afterwards.

Have you got a copy of the latest issue of Balance - there was a pull out which gave a list of insulins and when to take them in relation to food.

Can you tell me what 'Balance' is, and where I could get a copy, I'm starting o MDI in a day or two and would like a few tips.

 

[Mark T]

Can you tell me what 'Balance' is, and where I could get a copy, I'm starting o MDI in a day or two and would like a few tips.

Balance is Diabetes UK's magazine, you can find it here

But that specific supplement can be downloaded for free from here (although having the paper copy is pretty useful).

 

[FM001]

I generally take my insulin just before eating but my morning dose I give 5-10 mins before breakfast. Tonight just before my evening meal I was 4.2, I delayed my injection and ate my food first then reduced my dose by 2 units which is the standard advice. Exercise speeds up the acceleration rate at which the insulin is absorbed, always give a reduced dose when combining the two.

 

[shiv]

There have been studies done (which I don't have access to but could probably be found with a good google) that showed that the optimum time to inject to prevent a post meal spike was 15 minutes before eating. Obviously, that's going to vary for some people, and the practicalities. When I can, I always wait 15 mins (eg breakfast, at work - basically times when I dictate when I eat) but sometimes it isn't practical to wait...but I will always bolus first before eating to give the insulin chance to get into the bloodstream at the same time as the food.

 

[Phil65]

I generally take my insulin just before eating but my morning dose I give 5-10 mins before breakfast. Tonight just before my evening meal I was 4.2, I delayed my injection and ate my food first then reduced my dose by 2 units which is the standard advice. Exercise speeds up the acceleration rate at which the insulin is absorbed, always give a reduced dose when combining the two.

Absolutely spot on Toby! I would always inject pe-meal but if in the 4's I would inject during or just after eating

 

[rossi_mac]

I take mine anything from 15mins prior to 1 hr after (memory man!)
I got quite keen when I heard it reported here that 15mins prior is all for the good.
If I was going to walk around be active a lot I would always reduce my dose too.

it's a game🙄

 

[Doghouse]

Hi heasandford,
I almost always take Bolus insulin about 0 to 5 min before eating. I never seem to have time or organisation to do anything else.
I do arrange for there to be at least one hour between eating, and decent exercise. I think that inside that time, there are two mechanisms for getting glucose into the cells - driven in by insulin and being invited in by GLUT4 resulting from exercise. Beyond say 2h, if I am doing strenuous stuff, I expect a hypo to occur, and just keep feeding in small amounts of carbs on a 0.5 to 1h basis.
Mike.

 

[MeanMom]

My daughter is on Novarapid and it seems to work very quickly for her - she once went hypo whilst eating as we had had to wait (only) about 5 mins for a meal when out. So now for her peace of mind - and ease of carb counting - she injects after the meal when we are eating out.

Meals out tend to be higher fat than those at home which also slows down digestion I gather. She always injects after a pizza even at home.

Where was your walk on the Isle of Wight? We love the island - it is our plan to retire there (in many years of course)

 

[heasandford]

Thanks again everyone - I am going to copy out the replies to keep!

We walked from Yarmouth down to Freshwater (via lunch at the Red Lion!) then up Tennyson Mount and back along the coast, Totland, Colwell Bay etc to Yarmouth - good 12 miles, but lovely walking!