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When do you prebolus?

Discussion in 'Parents of Children with Type 1' started by MelissaAL, Jan 8, 2013.

  1. MelissaAL

    MelissaAL Approved members

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    The prebolus a thing of the past thread has me thinking- when do you prebolus? I will admit that we very rarely prebolused before DD got her pump. In our defense, we were taught at the hospital at dx, to postbolus, I think that makes it less overwhelming at first. Later, her endo encouraged us to prebolus, but DD's eyes are often bigger than her stomach, or smaller so on MDI we were reluctant to force prebolusing and maybe need a second shot per meal.

    That being said, since she's started pumping at the beginning of Dec, she preboluses 90% of the time (and then sometimes does a 2nd bolus for a 2nd serving or desert.) Usually, we plate our food, carb count, bolus, pray :)) )and eat. So usually her prebolus is just a minute or two before she starts eating. Is this how it works for other families?
     
  2. Beach bum

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    Depending on how the day is going, it can be anywhere from 1 minute to 10.
    We try hard, but aren't always good at it. But, in general it's 10 minutes.
     
  3. StacyMM

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    We prebolus every time, or at least we try. We're MDI. The only consistent exception is lunch at school as our school does recess then lunch and I don't want to dose before recess.

    I follow the guideline I read in the pink panther book (I think that's where it came from, at least) - we drop the last number off their bg and prebolus by that amount of time. So a 220 is a 22 minute preblous; 380 would be 38; 140 would be 14. For breakfast, they pick out what they are having, we calculate the carbs, then determine when they can eat. We dose, set the oven timer and they head off to get ready. For dinner, they check bg about 30 minutes before it will be ready and we count carbs and then set a timer to remind us to dose them that much early. If they decide to eat more, we do a second shot after the meal. It seems to be working for us. Getting into the habit was hard but DD's a1cs really improved when we did it. It's second nature now so we don't even think about it and the timing seems completely normal.
     
  4. mom24grlz

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    We hardly ever remember to pre-bolus. Most time Ashleigh boluses right as she's sitting down to her meal or snack. The few times that we have prebolused it's always been at breakfast time, since that's the time of the day where she's most likely to spike. The breakfast prebolus is done 15-20 minutes before she eats.
     
  5. 3kidlets

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    Hana Always preboluses breakfast to head off disaster. I usually do it when I get her up for school. About 15-25 min before she eats.
    She doesn't pre bolus for school lunch but she usually has salad. Sometimes pizza, which we've found doesn't need prebolusing.
    Dinner I try to prebolus at least 10 min. But not quite as necessary as breakfast.
     
  6. JamieP

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    We prebolus everything we can. Tyler inhales his food and seems to metabolize it very quickly. Breakfast during the week is about 15min, but on the weekend it is as much as 30min if he is having cereal with his breakfast. Other meals are 10-25min depending upon the GI of the meal and his BG. As others have mentioned, no time for it before school lunches.
     
  7. Amy C.

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    I encourage my son to bolus around the time he eats. Prebolusing is not a priority, but staying in range is. It helps the closer he is to the meal.
     
  8. khannen

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    For breakfast, I try to make it about 20 minutes. I just keep her busy with doing other tasks she needs to do to get ready for school. ;) Lunch and dinner, we shoot for 10-15 minutes. Lunch is easy as she just does it in her classroom. By the time the class walks to the cafeteria and she gets her tray, a good ten minutes has passed.

    Prebolusing is one of the main things I like about her being on a pump. It's easy for us to just give a certain amount up front and then bolus for the rest once she has started or is finished with her second (or third!) helping. We tend to bolus for a set amount automatically and then complete the rest a little later. I can pretty much guarantee she will eat 40 carbs for breakfast and lunch. We use 20 for dinner.
     
  9. TheFormerLantusFiend

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    I've used two different bolus insulins (Novolog and Novolin R), with and without CGM, and with three different injections systems- pens, syringes, and jet injector. I also start meals with different blood sugar patterns. So all of those things have made a difference.

    I most often prebolus by a long time if I'm high- that's my method of getting a high down fast. You know- to get out of the 200s, with a correction of 2 units needed, I'll inject 12 units and then eat half an hour later. Works a whole lot better with CGM.

    I was prebolusing by fifteen minutes for most of the time using Regular. But since switching to a jet injector, that's been too far ahead, unless I start out high. I inject when I have less that five minutes before eating, or soon after starting to eat.

    With Regular, I often inject, eat a meal right away- but don't eat all that I injected for. I wait another hour or two and then eat the remainder of my meal. I've found that this lets me eat more without stomach pain (a bit issue for me- I have GI problems) and allows me to avoid spikes.

    With Novolog I sometimes prebolused ahead of time, especially if high, but generally injected right before eating. I very often went low while I was eating from the Novolog kicking in too fast- I felt Novolog was less predictable and that it made me scared to eat. If I'd had a lot of lows lately, I would split the dose, half before the meal and half after.

    I sometimes post bolus if I start the meal low. I also frequently do a second shot if it turns out that I'm rising as the meal goes on, or if I'm eating more than I planned for.
     
  10. cm4kelly

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    Always for breakfast

    We always prebolus for breakfast to keep from going high. I allow for 30 carbs - he eats at least that. Then I add more carbs afterward if he eats more - which he usually does. I usually only do about 10 minutes because that is all the time we have . I would do more time if it was possible.

    Sometimes we prebolus for other things - for instance when he has a specific snack or something he wants, I usually put it in first, but not necessarily a long time in advance.

    I also think it is a good thing.
     
  11. nebby3

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    I'd say we prebolus for at least part of the meal most times. We take into account her bg and the glycemic index of the meal. My dd is on MDI but she never minds extra shots doing she eats more we just give her more insulin.
     
  12. virgo39

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    At home, we routinely pre bolus 30 g. Our breakfast pre bolus is generally 20-30 minutes before eating and dinner varies more, but we shoot for 15 minutes. At school, she pre boluses only 20 g., and that is just a few minutes before lunch.
     
  13. Heather(CA)

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    Almost never, my son is on shots and being a growing teenage boy never nows how much he's going to eat. Based on his A1c's it doesn't matter enough to make it worth two shots. IMO certain foods such as pizza actually work better when the insulin is given after. He does pre bolus at the movies but a lot besides that.
     
  14. hawkeyegirl

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    We do it as often as practicable. There is some evidence that glycemic variability plays a role in liklihood of complications, so the more you can avoid the spikes that come with post-bolusing, the better.
     

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