Pre-Bolus?
One (more) thing I can't seem to do very well is to time my meal bolus to be a few minutes ahead of the actual meal.
I think in the ideal situation I would like to get my meal bolus in and started somewhere around 15 minutes before I start eating. This is assuming I'm not low (or heading low), not dealing with any delayed digestion (don't think I am yet), or any other weird situation.
This has been recommended as long as I can remember - back in the days of bolusing with Regular insulin, and now using the faster acting insulins. The time was different though. Back with Regular insulin we were told to bolus 45 minutes before eating.
Getting this timing down has always been near impossible for me, and since the consequences of not getting that meal are pretty heavy - such as a sever low blood sugar, I have always bolused when the food is either a certainty or is actually right in front of me.
But the times where I can get that insulin in my system and working ahead of the food by a few minutes, I have very nicely matched curves - closely matching the digestion with the peaking insulin, resulting in spikes that are very tolerable and that are quickly back to normal.
But again - the potential for disaster is HUGE if for any reason that meal is delayed or drastically different than what you planned for. So that part of it scares me off most often.
Another approach that I've seen, but not tried, is to take a partial bolus up front, then finish it off at mealtime. I guess that way if something changes you are trying to catch up to a much smaller bolus rather than the entire boatload.
I think the primary reason I've not been very successful at this is that most days I can hardly get my act together enough to know what will happen 15 minutes from now.
Not to mention, I think it adds yet another level of complexity to the already painstaking tasks of doing all the diabetic stuff that surrounds mealtime. And that kind of ticks me off.
This is practically impossible for parents of young D'ers - where you don't know what they will eat until it's down the chute!
But what about you adult OC'ers? How many of you pre-bolus? Do you do the entire meal bolus beforehand, or just a portion? How far in advance do you do it? Does it matter for you what type of food you are eating, and do you adjust the lead time accordingly? Does it make a big difference for you?
And lastly - how the HELL do you keep track of it all?!! Do you pull a modified "flava-flav" and wear a kitchen timer medallion on your gold chain? "Ding! - time to eat!"
I think in the ideal situation I would like to get my meal bolus in and started somewhere around 15 minutes before I start eating. This is assuming I'm not low (or heading low), not dealing with any delayed digestion (don't think I am yet), or any other weird situation.
This has been recommended as long as I can remember - back in the days of bolusing with Regular insulin, and now using the faster acting insulins. The time was different though. Back with Regular insulin we were told to bolus 45 minutes before eating.
Getting this timing down has always been near impossible for me, and since the consequences of not getting that meal are pretty heavy - such as a sever low blood sugar, I have always bolused when the food is either a certainty or is actually right in front of me.
But the times where I can get that insulin in my system and working ahead of the food by a few minutes, I have very nicely matched curves - closely matching the digestion with the peaking insulin, resulting in spikes that are very tolerable and that are quickly back to normal.
But again - the potential for disaster is HUGE if for any reason that meal is delayed or drastically different than what you planned for. So that part of it scares me off most often.
Another approach that I've seen, but not tried, is to take a partial bolus up front, then finish it off at mealtime. I guess that way if something changes you are trying to catch up to a much smaller bolus rather than the entire boatload.
I think the primary reason I've not been very successful at this is that most days I can hardly get my act together enough to know what will happen 15 minutes from now.
Not to mention, I think it adds yet another level of complexity to the already painstaking tasks of doing all the diabetic stuff that surrounds mealtime. And that kind of ticks me off.
This is practically impossible for parents of young D'ers - where you don't know what they will eat until it's down the chute!
But what about you adult OC'ers? How many of you pre-bolus? Do you do the entire meal bolus beforehand, or just a portion? How far in advance do you do it? Does it matter for you what type of food you are eating, and do you adjust the lead time accordingly? Does it make a big difference for you?
And lastly - how the HELL do you keep track of it all?!! Do you pull a modified "flava-flav" and wear a kitchen timer medallion on your gold chain? "Ding! - time to eat!"
posted by Scott K. Johnson | 12:12 PM
13 Comments:
Scott, even when I know what I'm about to eat I bolus like, 30 seconds before I start eating. I know I should do it before, but when I am cooking or having a conversation, I don't think about it. And sometimes, I forget to do it at all. I catch myself halfway through my meal and have to go back, test, and bolus. Thankfully, I haven't noticed anything out of control- but I am sure that being more careful can get your numbers close to perfect.
I don't think I've ever successfully pre-bolused. I honestly almost always remember to bolus during the meal (if I'm lucky) or 10 -15 minutes AFTER I'm done eating...
hehehe Flava-Flav!
Even in the days of Regular, I rarely shot up 45 minutes beforehand.(unless I was high)Now, I usually do it right after the meal, or if its a high fat meal I will square wave it. Unless its simple carbohydrates, the food doesn't hit my system fast enough for me to be able to bolus it all pre-meal.
Pre - bolus???? I'm lucky if I remeber to bolus at all let alone ahead of time. Love the image of wearing a gold chain with a kitchen timer medallion - LOL! There is such a hilarious visual in my head right now of a 'pimped out' PWD with a diamond studded pump on their belt (whcih also palys tunes), the gold chain kitchen timer combo, sideways ballcap with 'PWD' in glitter letters, and a hot pink finger pricker...I really have been studying way too much :)
Pre - bolus???? I'm lucky if I remeber to bolus at all let alone ahead of time. Love the image of wearing a gold chain with a kitchen timer medallion - LOL! There is such a hilarious visual in my head right now of a 'pimped out' PWD with a diamond studded pump on their belt (whcih also palys tunes), the gold chain kitchen timer combo, sideways ballcap with 'PWD' in glitter letters, and a hot pink finger pricker...I really have been studying way too much :)
Melissa - love the image you've given me LOL!
I go through phases of being really good and pre-bolusing - usually 2 units, which is around 24-30 carbs depending on time of day - whilst I'm cooking/preparing or ordering my food, so around 15-20 minutes before. The proviso is that my blood sugar is above 6.5 (117) and I have an appetite. As any 'proper meal' for me always contains at least 30 carbs, I'm pretty safe, but 30 grams of juice/regular soda/glucose tabs would be easy to get if a catastrophe happened with the food. And the fact that I'm actually doing something positive to get food - preparing/cooking/ordering makes simply forgetting about it pretty unlikely.
An advantage for me of doing it this way is that I can then forget about the rest of the bolus until after I'm done eating, and know how much I had. If I don't take anything at all until after I'm done, I know I'm really going to spike.
I also definitely have better results when I pre-bolus, but I also get out of the habit of doing it for long periods. Generally I tighten up on it if I feel my control is slipping.
I got very strange looks today in Starbucks as I was bolusing with one hand and paying for my Panini with the other!
I am always trying to figure out a pre bolus time and uaualy I am so afraid to do it just in case I get side tracked then I add the stress of oh boy now I need to find something fast and all that jazz I usually end up giving my bolus right as the meal is arriving ugh !
I am horrible at pre-bolusing too. I was taught when I first started pumping to bolus while I ate, or after. Now, I am being told to do it before. It is next to impossible to do with dorm food. I have no idea what is going to be edible. I try to bolus when I check my bg before I walk to the dining hall, but I always forget.
What Caro said about pre-bolusing at lunch. I often bolus while my sandwich is being made at the cafe near where I work. Then I pay, walk back to the office, and chow down. I don't think anyone's ever noticed, though. I've never noticed anyone noticing me.
I rarely get O prebolused. She checks herself and most of the time, forgets to ask me the carbs until she starts eating. We're getting better about it, but there are still days that she forgets.
I think she'd forget her brain if it wasn't locked inside her skull....
Yeah, my routine is like Caro's. If I'm close to target BG, I bolus some minimum amount 10 min before the meal when I'm getting my food ready, then add the rest when I've finished eating and can count it all up. If I'm low I start eating immediately and bolus 100% during the meal or right after. If I'm high I bolus the correction and a large portion of the meal amount beforehand and wait. At breakfast, when my postmeal spiking is worst and my food is easy and consistent, I bolus the whole amount 10-15 min ahead.
It sounds complicated but it's pretty intuitive and all done close to the meal, so I haven't ever screwed up and forgotten to eat. So far I haven't needed that big clock around my neck...
Cool. I've never heard of the phrase pre-bolusing before. I used to just always take my boluses right before the first bite - even when I was on Regular.
Recently, I've been a bit better. This mostly works well only during the work week when my schedule is relatively fixed and I pack both my breakfast and lunch. I usually take my boluses 10-15min beforehand for breakfast and lunch. And if I'm high, I take my bolus and test every 15min or so and won't put food into my mouth until my sugars are "in range."
I'm less diligent with dinner (perhaps that's why I see bigger spikes after dinner, huh?).
And on top of the uncertainty and wild-ass guesses when eating out, I too never bolus until the meal is under my nose and I can do a slightly better than wild-ass guess as to the amount of carbs I'm about to swallow.
I really like the idea of taking a portion of it in advance, though, especially when eating out. And if I/you/we were to only take what we could cover with glucose/snacks on hand, then that would seem pretty safe to me. 'Cause I too have an inordinate amount of fear re: bolusing in the abscence of food!
Scott, I can't tell you how happy I am to find your journal. I was diagnosed in Dec.2005 and though my readings haven't gone over 200 since starting Glucofage I still have so many issues with control, when to and how to eat. Thank you for being so open with your issues in your daily life. I look forward to reading your archives to learn more and realize how much there is to know. Thank you SueG
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