the longest i wait for a pre-bolus is 1/2 hour when i am in target range, and that is for very carby meals like oatmeal at bfast time. usually 15 - 20 minutes is a good enough pre-bolus which will keep me from spiking. i have experiemnted with that timing and it has proven to keep me at a nice flat line throughout.
if i am very high (above 150 ) i can wait much longer after i bolus so that my BG has time to come down. (i also add a correction to that bolus)
i want to reaffirm here that i must bolus for proteins and fats. always. so if i am planning on eating fish for dinner, i still need to pre-bolus. i cannot just start eating just b/c its protein and not carbs. dont know why this is; it has just always been this way.
Right. I’m not saying not to bolus at all; just much later than you normally would. Have you already tried dosing about 30 mins into a meal when you start low?
There is a way to do this. I do not know what the specifics would be for you, DM. And it would vary of course for different meals and different BG’s.
But certainly if you are low, there is a way to eat a meal without waiting for that BG to come up first and then taking insulin and then eating.
It might take you some experimenting to find your formula, but waiting for the BG to come up before you can eat dinner seems crazy.
Emily has some good suggestions. Waiting a little longer before your meal bolus. Or bolusing less. But probably you’d need a combination of both of those - waiting longer and taking less insulin.
i havent tried this yet. i am so dependant (much to eric’s chagrin) on my pumps WIZARD feature that i am not so good at flying solo and making correct bolus decisions. my pump is programed with different ICRs, diff amounts to bolus for diff BG levels, etc. i know that i can just guesstimate it, but i get nervous that i will screw it all up and end up with some crazy BG finale.
PS: my fall back method for bolusing is doing a 1:10 ratio and ignore the current level of my BG.
i.e. i want to eat 10 grams of food, so i bolus for 10 gms of food. i take nothing else into account. i know that this can be foolish and seemingly uneducated, but its what i’ve done when i am in a bind…for example, if i have already bolused for a meal, have been eating for a while, and then decide i want to eat more; i just add on extra insulin. i take the best educated guess that i can. lucky for me that most of the time it works out.
Totally makes sense to have a fall back method. I think we do very similar. If we have had food and insulin and corrected for BG and now something extra (additional serving, desert, whatever) than at this point, there may be “too much” going on to account for everything. So, we just assume all that “other stuff” will work its way out and just dose right now for the carbs immediately in front of us. I find this works quite well. Mostly. Not always. And if not - correct for it later when we see where things are ending up.
The insulin we dosed for the actual meal, the insulin we dosed for the BG correction. The food itself. The BG moving after the meal. Before we start eating, we figure all this out then eat and dose (in whatever order seems appropriate).
Normally, we are not going to be doing any additional BG corrections after this all is done for at least a couple hours as we are waiting for everything to “shake out” and it realistically takes a few hours.
So, if we change our mind(s) and decide to eat more, no point in re-visiting all the computations already done. We continue to assume that all will work out and just dose right now for the food we see and ignore everything else.
We are probably not anywhere near the “norm”. My son takes 5 grams of carbs for a low, 40-50-60 doesn’t matter, he starts with 5g. He also takes 5 extra grams for every active unit of insulin on board, per his pump’s calculation of IOB.
Then he waits for 15 minutes, if it hasn’t started moving upward on the Dexcom, he treats an additional 5g. If, after giving a treatment, he gets a strong upward trend, he doses more insulin to blunt the upward trajectory.
I expect to see a change on the Dex in 20 minutes when treating a low.
As long as I see a single uptick then I am fine to wait longer and see where it goes.
When treating a low, it really is a bunch of stuff that comes into play. Is it the first low or a repeat low? How much IOB? Are there carbs that we are expecting to still hit? What activities (excercise / sleep / ???) are in front of us? What are the actual physical symptoms? How low is the Dex or meter reporting? If Dex, what is the angle of the graph?
When my son is low and needs to go uip fast, he takes hard candy and checks on his hand BG meter. With hard candy, he will see effect within 5 mins on the BG meter.
The CGM results do not correlate to the BG meter sometimes for half an hour or more.
“Hard candy” isn’t all that hard. I don’t think he’s talking about jaw breakers. Bite it, chew it up, swallow it…works great. Anyone CAN bite/chew “hard candy” unless they just don’t have teeth that function correctly.
Really easy. We use Skilttles (and other things too), and weighed a bunch of them to figure it out. 8 Skittles = 7 grams of carbs. So it’s really the easiest thing. For smaller numbers, he rounds 1 Skittle to one carb, it is close enough. You can do the same thing, essentially, with jellybeans.
We keep them in G-tab plastic tubes. He does not even need to touch them with his fingers, he can just bring them to his mouth and count them with his lips.
Btw, @daisymae, he normally takes 6-8 grams of carbs in one go.
Yep, Liam now eats Skittles for corrections and they work great. Also, they are able to be more accurately used than tablets since each skittle roughly equates to a single carb as opposed to 1 tablet worth 4 or 5 carbs.
Bite it, chew it up, swallow it…works great. Anyone CAN bite/chew “hard candy” unless they just don’t have teeth that function correctly.
