Pre-bolusing


Pre-bolusing.

Most of us know what that means (bolusing for a meal or snack 10-20 minutes before you begin eating) and why it should happen (to give the insulin a chance to start working, so that the insulin action more appropriately matches the timing of digestion), but few of us are really truly doing it as often as we should. It’s just not convenient so much of the time – we don’t always plan our lives around exactly what time we will eat. And in some cases, like at a restaurant, it can seem next to impossible to safely do.

My dad always pre-bolused me as a kid – I was on Regular insulin then, though, and that insulin could take 30-60 minutes to even START working.  More ‘modern’ insulins take around 10-15 minutes to begin working. I’ve become lazy about pre-bolusing in the past few years, I’ll admit it. Lazy to the point where I’ll finish a big meal before I even CONSIDER bolusing. By which point my blood sugar is already going up, sometimes rapidly.

As I believe I’ve mentioned before, I had to switch from my beloved Novolog – per what my insurance company wants – to Humalog. I’m not a fan of Humalog. I’m using a lot more insulin (my I:C ratio went from 1:10 to 1:7.3 (yes, with a t:slim you can be THAT specific), my correction factor went from 1:40 to 1:30 during most of the day and down to 1:25 during the mid-day, and my basals went from mostly being 1.2 units per hour up to between 1.5 and 1.75 units per hour)…and with a lot more insulin use I’ve seen issues with my weight (again) going up. I also have noticed that Humalog takes longer to start working and has a longer ‘tail’ or action time than Novolog did.

A few weeks ago I began downloading my D-devices to Diasend – which I’ll admit I’d been very lax in doing at all. I did not like what I saw at all. I was giving way too much insulin chasing highs after meals and my blood sugar average was not where I want it to be.

I started making changes and the biggest one I’ve started implementing in the past week is pre-bolusing. I can’t always pre-bolus (in the morning I need to get up and eat right away, because I don’t have 15 minutes to sit around and wait for my insulin to start working) but when I can pre-bolus, I am.

Look at my results/the change I’ve made, in just one week:

graphs

stats

Just by pre-bolusing I’m spending 14% more time in range (between 70 and 180 mg/dl) and because I’m not chasing highs after the fact (highs can cause insulin resistance, and then you need MORE insulin to get you back to your target than you may have needed if you’d just bolused appropriately to start with) I’ve decreased my average insulin usage per day by about 15%.

And bonus: I lost just shy of 1 lb this week, without trying at all (I know, big deal…haha).

How many of you, my readers, regularly pre-bolus for meals? Does it make a noticeable difference for you, the way it does for me? Also, for anyone out there with gastroparesis, how do you handle the entire idea of pre-bolusing during a flare-up? I have flare-ups pretty irregularly, but when I do, I cannot imagine pre-bolusing would at all be safe – my food can takeover 16 hours to digest (I won’t even tell you how I know this). I’m still unsure how to handle bolusing during a gastroparesis flare-up, despite being diagnosed over a year ago.

 

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