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Pre-bolus?

Discussion in 'Parents of Children with Type 1' started by njswede, Jun 7, 2015.

  1. njswede

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    What's your opinion on pre-bolusing? I.e. giving some or all of the bolus 20-30 minutes before a meal. We've been experimenting with it this weekend and his BG curve has been FLAT!

    Good practice or risky?
     
  2. KHS22

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    Flat is not necessarily ideal, but if he's not going low, and you have a dexcom than hopefully not too risky.

    We find its IMPERATIVE in the AM - or she'll spike super high. Rest of the time - doesn't seem to really affect her post meal #'s… Also depends on the meal. If its low glycemic and high fat, then we've had the insulin out run the food when pre-bolusing, and have her go low even while eating!!
     
  3. Lori_Gaines

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    We ALWAYS pre-bolus before breakfast because that spike is the worst. Everything else is done at the beginning of the snack/meal unless she is high and I have the opportunity to pre-bolus. School meals are never pre-bolused.
     
  4. nebby3

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    We always try to prebolus unless she is steady lowish and/or it is a high fat or low carb meal. There is a chart out there that tells how much to prebolus based on bg and glycemic index of the meal. Maybe in Think like a Pancreas? Of course you need to be careful if there is a chance the meal will be delayed but prebolusing should be standard.
     
  5. Snowflake

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    Can you elaborate on this a little? Isn't flat at a solid number (in the low 100s, say) ideal, or is there a reason you'd want to see bumps? Of course, we very seldom achieve anything resembling flatness, but I thought that was the goal?

    To the OP: We pre-bolus to the degree that life allows -- there are the odd mornings where it's just not possible with getting four people out the door, and there are the dinnertimes when we treat a low just as I'm in the middle of meal prep. Pre-bolusing was basically impossible when our dd was a toddler, and even with a 5-yr-old, it requires some guesswork, but it's becoming easier as she gets older. When we get the timing right and predict the carb intake well, we do see much gentler post-meal spikes.
     
  6. Sprocket

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    In the mornings I give a portion of rapid a half hour before the meal. That includes any correction plus a bit of insulin to cover what I know she will eat. Breakfast is hard to get down for her, and some days she will eat a bigger breakfast than others. Injection #2 is for anything over and above what #1 didn't cover. If she's low to begin with, we don't prebolus at all. It seems to work well most days.
     
  7. KHS22

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    Even those without diabetes have little "bumps" -rise and falls. And if the line is flat, the worry is they will go low. If they aren't, great! But, without a rise, if you don't time food/insulin perfectly then there is more risk to go low. Less risk I'd say with dexcom, as you'd notice/get an alarm! Thats all I was eluding too! :)
     
  8. wilf

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    Unless you are using Apidra or the family diet mainly features foods which are slow to digest, then prebolusing should be part of meal-time planning.
     
  9. BarbDwyer

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    I think it is preferable but my kid won't do it. I do get him to pre-bolus every once in awhile but he hates it for some reason. If he ever decides to wear a CGM he may see the numbers and decide to on his own because I'm sure he spikes even though he doesn't test to see it. He tests, counts, and boluses pretty much without fail and his A1C is fine so I leave well enough alone.

    Now if I could eliminate the middle of the night triple serving of raisin bran which resulted in waking up at 289 this morning despite the bolus - well then I'd be a happy mom.
     
  10. Snowflake

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    Got it, that makes sense. As I said, we never actually achieve flatness, and a prebolus success for us would be a very small spike or dip post-meal. However, I think I probably read too many adult T1 blogs where people post their perfect side-arrow traces!
     
  11. njswede

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    By "flat" i meant "slowly undulating between 80 and 130". That's "flat" compared to what we normally see, especially after breakfast.
     
  12. MEVsmom

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    We almost always pre-bolus unless she is low. I saw a great tip recently to pre-bolus for the amount of minutes that are the first two digits of your BG. Like if you are 120 then 12 minutes or if you are 250 then 25 minutes. We sort of follow that, but our standard time is 15 minutes. Undoubtedly the hardest part of diabetes for my daughter is the waiting. Of course, if there is just no way to work in the time, then we just don't, but most of the time we can accommodate some pre-bolus time.
     
  13. wilf

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    Brilliant - thanks for sharing.. :)
     
  14. Lori_Gaines

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    This!!!! We were given the same advice. :)
     

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