How do you bolus for a meal when you're low?

calebsmom1113 · #1 01-04-2011, 05:07 PM

I've heard conflicting things. It's tricky because we're so scared to bolus him if he's already low,, but if we don't he skyrockets! Today at school he went down to 48 and then ate lunch with no bolus (big mistake) and ended up over 300. Any suggestions? Do you give partial boluses? Only bolus after the meal? Help!

sugarmonkey · #2 01-04-2011, 05:15 PM

If Phillip is low before a meal we treat the low normally, and wait till he comes back up before eating. If it's not too low (about 3.5 (63) and up) we'll treat and eat. We still bolus for the meal as normal.

With a low of 48 (in your post) I'd treat, wait until in range, then have meal and bolus as normal.

BrendaK · #3 01-04-2011, 05:40 PM

If he's very low (under 70), we'll treat with glucotabs (1 to 3 depending on how low) and then bolus as normal.

If he's in a lower range (70-100 ish), we'll subtract 10 grams from the meal bolus. This is easy for him to do for a morning snack since he does his own bolus in the classroom.

Nancy in VA · #4 01-04-2011, 05:41 PM

We treat the low, and then bolus for the meal based on the I:C and don't factor the reading into the equation.

We are confident that our treatment carbs are the right amount, so we are comfortable going ahead and treating and moving on before a meal

Flutterby · #5 01-04-2011, 05:45 PM

For a 48, I'd treat the low, give lunch and then sometimes I bolus light for the meal, depending on what activity she'll be doing, what she WAS doing, if she had any active insulin at the time.. for something in the 60s/70s I'd give the meal/snack and take 10c off the carb count..

Heather(CA) · #6 01-04-2011, 05:46 PM

Quote:

Originally Posted by calebsmom1113

I've heard conflicting things. It's tricky because we're so scared to bolus him if he's already low,, but if we don't he skyrockets! Today at school he went down to 48 and then ate lunch with no bolus (big mistake) and ended up over 300. Any suggestions? Do you give partial boluses? Only bolus after the meal? Help!

Treat the 48 until he comes up, then eat. If he can't wait, give enough juice for the low and eat/bolus. Don't just eat without giving fastacting. Food takes too long to work on the low, that high could have been from not bolusing and/or a rebound.

Amy C. · #7 01-04-2011, 05:48 PM

If my son were 48, he would drink a juice, eat his meal and then we would bolus for all the carbs consumed (including the juice), usin the 48 as the blood sugar. The pump calculates a lower amont of insulin for the food because of the low.

mmgirls · #8 01-04-2011, 06:07 PM

Your pumping right?

I would treat the low with fast acting carbs, usually a juice box 15g, which is more than enough carbs. At school she will test again in 15 minuyes, at home she will not.

Once we verify that she is up and above 90, she can eat have a snack or whatever and we bolus for ALL carbs and including the 15 grams carbs for treatment and enter the FIRST lowest BG, allowing the pump to reverse correct for the low by minusing out the appropriate amount insulin for the low BG AND any IOB still going.

So far this has worked the best for at school situations.

I would never treat a low and have her eat and not give insulin unless there seemed to be a stomach absorbtion issue.

If I was unsure of why the low happened and was hesitant, then I may give less than recomended insulin or do a combo bolus and test early to either give more carbs or more insulin .

Mary Lou · #9 01-04-2011, 06:17 PM

Like most of the other posters, we would treat a low with fast-acting carbs (juice doesn't work fast enough for my boys, we use tabs, skittles, gluc-shot, things like that), wait 15 - 20 minutes, test, and then eat as normal.

Once in range, and eating a normal meal, it might help you to know that it takes at least 15 minutes for the insulin to begin working, so even if you bolus for the meal right away (once in range), the food and fast-acting carbs will be continuing to work to bring BG up before the insulin kicks in to bring it back down.

It has been my experience that we need to bolus for the entire meal and not take into account any negative correction factor for a lowish number that followed the 48. The fast-acting carbs acted as the correction (I think Nancy said it better

) This should help prevent a high later on...

BrendaK · #10 01-04-2011, 08:35 PM

I just wanted to ask why people treat a low and then wait 15 minutes to eat a meal? I get waiting 15 minutes to retest to make sure you come up, but why wait to eat a meal? When you are low you are SO HUNGRY that you could eat an entire house! It's not just a starving hungry, it's a desperate hungry that you HAVE to eat or you will collapse! It would be pretty rough for my son to make him wait to eat a meal when 1) he's low and crazy hungry and 2) it's time for a meal anyways. Just can't imagine having food ready on his plate and making him wait to eat it.