Prebolusing is a thing of the past.

DD had her endo visit today. Her A1C has creeped back up after a couple of very nice numbers, so there was lots of talk about why that happened. I mentioned that she has not been prebolusing when eating foods that spike her blood sugars like a bowl of cereal or a bagel. The endo said that they no longer recommend prebolusing as new research has shown it is not helpful. In previous years we were told that prebolusing could reduce A1C's by .5.

Seriously????? What the heck will be disproved next?

 

That makes no sense-did your endo say why they don't recommend prebolusing? My daughter always pre boluses breakfast by 30 minutes before eating her yogurt, whole grain toast and apple breakfast.

If for some reason she doesn't she goes really high.

 

The endo obviously doesn't live with a CGM showing what happens when living with a non-working pancreas. Our CGM shows the difference in real time what happens when we don't prebolus. It matters!!!

 

If I don't prebolus my son before he eats, especially at breakfast, his numbers shoot up faster than my blood pressure when dealing with those numbers later on. I was always told that it gives the insulin a chance to start working before getting bombarded with carbs, and it really does help. I've tried bolusing halfway through a meal, as well as after and his numbers don't lie. If it's not hurting anything and it's helping to prevent spikes, I don't see anything wrong with it-whether or not the endo recommends it.

 

Our clinic has been involved in trials for the Enlite and Veo and they are always downloading pumps and CGMS'.

 

That research must be part of the 'artificial pancreas' project as they have no way to predict when and how much we will eat in order to prebolus. Much easier to prove it isn't important to do so.

This is just my cynical nature, I don't really know.

 

This is a no-brainer. If you prebolus and spikes are prevented and A1C is low because of it, then it works.

If you stop prebolusing and spikes result and A1C then goes up, it makes perfect sense to return to prebolusing. I can't imagine how any Endo can't figure that out.

Any studies would be irrelevant because your talking about YOUR DD and not a group of people. The only data that matters is the data you already have for your daughter. Do what you believe is best. Don't let your Endo talk you out of it.

 

One of the dumbest things I have heard of an Endo saying. I hope you don't follow them.

 

Me as well - we are living in the land of prebolusing in the past...but it isn't based on endo suggestions .

 

I was just thinking about our appointment this week and how the issue of pre-bolusing would be a topic of discussion. When I saw your title I thought, "Yup, us too, so hard to get those independent teens to pre bolus" "It certainly is a "thing of the past""

But I think your endo is way off base on this. Even without the cgm I know it's the cause of so many of my dd's highs.

 

As a long time T1 I find the prebousing impact really depends on type of insulin used,age of kid, duration of time from diagnosis, type of food eaten, pre-meal BG levels. So,as usual generalizations are a problem for the individual.:cwds:Ali

 

It is a YDMV moment. My DD post-boluses breakfast to prevent lows on the school bus. If she is starting the meal at a good BG, the insulin acts faster than the food and pre-bolusing causes a low followed by a spike. At lunch she pre-boluses for only 2/3rds of the carbs so that she doesn't drop low and has some food spike left for PE later in the day. (We tried different lunch I:C or extended boluses but never quite got it right.)

I have been amazed at how she has figured out a "plan" that works for her.

She pre-boluses supper - IF she remembers. She is also in that forgetful teen stage.

Puberty, metabolism, activity and so many more factors play a role in the outcome.

 

If my daughter doesn't prebolus, it's disaster for the next two hours. Even 15 minutes makes a huge difference for her. It makes no sense to me that an endo would say it doesn't help. The insulin doesn't kick in immediately! Depending on the food consumed, the sugar/carbs kick in a lot faster.

 

This is definitely a YDMV situation. We have to prebolus breakfast, otherwise it's high city for the rest of the day and then a tank after she corrects for any afternoon high. No pre-bolus for lunch on PE days, but other days a portion of the meal, pre-bolus for dinner, except on dance days. Pre-bolus all snacks or it bites us in the butt.

It's all about learning to dance with your pancreas

 

The data supporting the importance of pre-bolusing is rock solid.

Here's a great study:

http://www.ncbi.nlm.nih.gov/pubmed/20151766

And this graph illustrates clearly the impact of pre-bolusing on post-prandial blood glucose levels.

 

I can only assume that there is new evidence that the spikes don't matter as long as the numbers come back into line with the insulin's action. Our endos are excellent, so I cannot discount what he is saying (honestly, there is almost nothing in the "Things your endo did not tell you" thread that they did not tell me). I should have pressed him more, but I was trying really hard to keep my mouth shut during this appointment and let him "work his magic" on DD.

 

Ok, so let's say post meal spikes don't impact A1C numbers, I can buy that. But post meal spikes CAN affect emotions, hunger, concentration, a whole slew of things actually, and can lead to some stubborn highs.

Scientific evidence is not always an indicator of best practice. A1C isn't thought by some to be the most valid indicator of good management anymore, standard deviation is being looked at, etc. (and I would think SD would be hugely affected by prebolusing).

I guess my question would have been if prebolusing is a BAD idea, as it clearly does help for many foods, to prevent spikes.

 

My daughter did this as a science report last year and got almost identical results. It was pretty interesting actually.

 

Breakfast is the meal that Hana consistently preboluses for. If she doesn't, she feels like absolute garbage. She can feel the spike and it doesn't go well with having to sit in a classroom and learn. She will go in to the 300s if she doesnt pre bolus, whereas, if she preboluses by about 20 min., she never hits 200 and is back to a good number by 2 hours. It makes a huge difference in how she feels, performs, and I'm certain has something to do with her a1c being in the mid 6s. If she rides out 200 and 300s for several hours every day, that's just not good.

 

Completely a YDMV issue, and these types of endos annoy me.

To me, it's irrelevant whether it does anything for or against my A1C. I don't live my life based on my A1C. Rather, I focus on keeping my BGs in range as much as possible. Insulin doesn't work instantaneously, while food can start kicking BGs up very quickly depending on what you eat or drink. So, logically, to avoid spikes, I pre-bolus accordingly. And as everyone says: CGM data shows this happening. If I choose not to pre-bolus, I live with the temporary spikes.