Ooops ! Forgot to Bolus

Type 1 & LADA New T1/LADA
1

i haven’t found a post about this topic, so i will just put it out there and see if anybody relates to this and how they have handled it when it has happened.

this afternoon i bolused for my lunch. i had other things on my mind…probably still deciding what i was going to feed myself…while i was calculating the amount of carbs i was planning on eating. for whatever reason, i came up with a number in my head and bolused for that. it wasn’t until i had eaten that i looked at my pump to realize that my IOB was not making any sense to me. it should have been higher.

well, the first thing i did was estimate my I:C ratio and then bolus that into my pump manually. (1:10 ) i wanted to be conservative. i figured that it was only a half hour difference from my original bolus, so what was the big deal; the peak times of the 2 boluses would be very close together. big woop, right?

well, i waited 3 hours post meal to test my BG. totally normal. (114 ). but, i’ve retested 4 hours post bolus, and now my BG has become slightly elevated (130 ). not quite certain why this happened, but it is what it is. i’ll just accept it and move on.( yes, i did retest twice to make certain i wasn’t just getting an erratic BG reading)

but, the point of my post is that there are times when i get totally distracted after a bolus, and then i end up eating too long afterwards, and i go low before i even eat. there have also been times when i eat, but forget to bolus completely, till maybe an hour after i’ve eaten and then i have to go backwards and give myself a bolus.and, there have also been the times wherein i completely forget to bolus and then 2.5 hours later when my BG is hovering around 300, and i can’t figure out WTF happened, then i look at my pump and find that there is no IOB and that i never entered a bolus in the first place.

of course, there have been plenty of times during which i am dealing with a new food at a new restaurant, and i completely screw up the bolus and spend the rest of the day/night trying to correct the mistake. (but thats not really the point of my post)

i any case, i would love to hear from all of you who have made some silly or not so silly “delivery” mistake and how you have dealt with it. all stories VERY welcome!!

PS: just retested and my BG was 94. yippie :smile:

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2

Towards the end of my pregnancy, I had gotten my control down beautifully (literally, the docs would call my numbers beautiful; they told me I was their favorite patient, which I actually felt bad about because control was easier for me than the other mamas, with me being in the honeymoon period, but that’s another story). Miraculous kind of control, so one day I went in with my BG log, and eyebrows when up in surprise, “Uh…what happened here?” Yup…my brain had totally overridden rational thought and made up a carb number in my head that didn’t match what I ate. I blamed it on pregnancy brain. :laughing:

Of course, the past few weeks’ breakfasts mistakes I can’t blame on preggo brain. I started out on insulin again with an I:CR of 1:35, but had to bump to 1:30 at breakfast, then, more recently, 1:25. For some reason, I just cannot remember the 1:25. So I’ve had several instances of either realizing just after I bolus, so I just bolus more/eat less, or, more often, testing only to see a big spike and thinking, “what happened?!” Only to look back on what I ate and realize, “Oh. Oops.”

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3

For a forgotten bolus I will bolus for the carbs I had at my last meal and then because it it harder to bring bg back into line than it is to stop the spike I will bolus an extra amount as a correction, not a full correction based on bg as a normal correction but rather a percentage, it really is a trial and error thing based on my past experience.

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Diabetes is the ultimate disease that requires you to inhabit your body and live in the moment to get it right. With so many decisions being made in a day, and so many ways to get it wrong, it is a big challenge. I don’t think there are many of us who don’t make a mistake from time to time, i.e. bolus wrong amount, give basal insulin when you thought you were giving bolus, etc. etc.

It is amazing that more mistakes aren’t made, and every right decision should be celebrated like a mini fiesta!

fyi - I chose fiesta in honor of our friends in TX that are hanging in there in Houston and Port Aransas.

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5

So far we have never forgotten a bolus, although it is a matter of time, of course (we have forgotten a basal insulin injection for a whole night).

We log every injection (and all foods and strip readings) in an app which all of us in the family have access to (Mynetdiary, diabetes version). So there are several pairs of eyes reviewing it at all times.

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oh so true. your idea rocks :wink:

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7

that sounds brilliant. i would have never thought of that. i might have just bolused a “correction” and not even considered bolusing for the carbs/meal at all.

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8

This happens way too often, sometimes multiple times a month.

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9

how do you deal when it happens?

10

Most of the time I don’t discover it before the next meal at which point I’ve no other option but to bolus a huge amount to correct for the high BG and to cover the carbs. Otherwise I just measure my BG and guess how much I need to bolus for the carbs that haven’t been digested yet.

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11

sorry to hear that. sounds kind of complicated. what a pain in the A but totaly understandable. i can relate.

12

OMG. you are daring. how often do you get it just right? (or close to it)

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Not very often. Usually I still end up with a high BG.

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what, for you, do you consider “high?” we all have our different reference points. high for me can be anywhere from 170 to 300, and “normal” for me is around 80 - 120 ( i am comfortable around low 70s, but not when i am walking around a lot. if i am home and pop a 60 on my meter, i’ll just have a small piece of chocolate :wink: )

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I would be careful with the correction part of the equation, you can’t bolus a full correction amount plus bolus for the carbs you missed that would be likely to send you low. Just a partial correction will do, like anything else D related you have to play with it YDMV certainly applies here.

Another consideration is how far out is it when you realize a bolus has been missed. I consider it a correction only as I approach the two hour mark when most carbs have expressed themselves.

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16

Above 8 mmol/l (~145 mg/dl), but after a missed bolus anything below 10 (180 mg/dl) is good enough for me.

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17

at what point do you correct? do you wait for a meal to correct and then bolus for your food at the same time? or do you correct immediately when you notice it?

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I always correct when I notice it. I don’t wait for the meal.

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19

don’t you worry about stacking at all?

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Not too much, I worry more about the high BG. Often I actually don’t bolus enough.

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