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So Maybe Don’t ALWAYS Pre-Bolus.

I like to pre-bolus.  It helps keep my post-meal blood sugar spikes from rocketing out of range and taking a sizable bite out of my overall diabetes control.  (… I’m sorry.  I laugh every time I type the word “control.”  It’s not a word I toss around lightly when it comes to diabetes.  I’m not Janet Jackson.)

The art of pre-bolusing has been instrumental in keeping diabetes shit in line.

But it only works when it works.

Last night, we ordered pizza to go along with our birthday cake for Birdzone (we rounded out the meal by eating a stick of butter each and guzzling soda – healthy! – only the butter part is a lie) and the promise was “delivery in 30 minutes.”  Since pizza can be insulin’s kryptonite, I thought it wise to pre-bolus so that the initial carb influx of the pizza would be headed off by the first bolus, and then I’d chase my meal with more insulin to grab the fat-induced-blood-sugar-bump that hits about two hours later.  (I don’t have a #DIYPS, so when my food choices edge towards pizza party, I have to improvise a touch.)

Basic gist?  I took my insulin way too freaking early because the pizza arrived an hour later.

My Dexcom was freaking out by the time the pizza delivery man left – “Kerri, your Dexcom is vibrating like crazy over here, and says you’re low.”  “Like how low?”  “Like spelled out as LOW low.” – so the first piece of pizza was inhaled in a matter of seconds.  The second piece went just as quickly, and then I chased my dinner with a handful of glucose tabs.  (Wildberry – the perfect palette cleanser.)  Pre-bolusing doesn’t always work – its success leans on timing.  My pre-bolus was working right on schedule … if the pizza had arrived on time.  But due to tardy carb arrival, my blood sugar was in the trenches and covered in pepperoni.

“Mawm, is this good pizza?”

“The best!”  I answered her, through a mouthful of glucose tabs.

9 Comments Post a comment
  1. Shannon #

    I had frozen pizza last night and it jacked me all up. I was 41 an hour later and then shot up to 288. Forgot to dual wave bolus but still … And you’re right – pizza IS insulin’s kryptonite. :)

    04/16/14; 9:57 am
  2. Pizza is the 5 letter curse word that’s safe around children.

    04/16/14; 10:22 am
  3. Thanks for sharing! I have definitely noticed the same thing: preboluses work great when they’re timed properly, but it’s not always possible to guess when exactly you’ll be eating, so it turns into quite a balancing act.

    What we’ve found using #DIYPS is that we can safely do a *partial* prebolus an hour before a meal, followed by a bolus for the first ~30g of the meal (once you can see the whites of the pizza cheese’s eyes).

    Here’s how #DIYPS currently calculates the partial prebolus:

    – Determine how much you can safely drop your BGs before the meal carbs hit. For example, if you’re at 140 mg/dl and planning to eat within an hour, and are comfortable going as low as 80 mg/dl, then you can safely drop by 60 mg/dl.
    – Assuming that, at worst, 3/4 of your insulin might take effect before your carb absorption catches up, calculate a safe meal-correction partial prebolus. For example, if your insulin sensitivity ratio is 40 mg/dl per unit, then your partial prebolus would be 60/(40*3/4), or 2 U.

    By implementing such partial preboluses, we’ve found that we can usually either get BGs down to be safely in-range before meals (which means that a 50 mg/dl rise from your meal might result in a BG of 140 mg/dl instead of 180 mg/dl), *or* get enough insulin active before the meal to allow the liver to absorb most of the incoming carbs and avoid a big post-meal BG spike. Either way, implementing such partial preboluses seems to result in much lower post-prandial BG, with less risk of mealtime low BG, than trying to time a single large prebolus for right before the meal.

    The other thing that #DIYPS does, of course, is monitor BG values and suggest corrective action (suspending insulin delivery with a temp basal, or eating carbs early) if you drop too fast before the meal. Getting even a small amount of carbs on board (5 grams for every 10 minutes until you eat) is generally enough to head off a pre-meal low.

    Hope that helps!
    Scott

    04/16/14; 11:21 am
  4. Speaking of tasting good….why is it that when you eat something on a low blood sugar, it seems to taste SO MUCH BETTER??? I hated eggs for years since I was a kid and was forced to eat them cold on occasion.
    Had a low fairly soon after diagnosis (read: I was clueless to a lot of things about carbs/protein/fat/etc) and I downed some juice, but before it started working, a friend had made me an omelet. I was still ravenous, so I ate the omelet, and ever since = LOVE EGGS.

    04/16/14; 2:31 pm
  5. Danielle #

    Maybe it’s a pizza thing ; )

    My family still laughs about the time I pre-bolused, the pizza was late – and after eating one slice in a normal fashion – I suddenly attempted to eat a napkin – and then fell over onto the floor! Nothing like a sudden onset hypo episode to spice up weekday dinner at mom’s!

    I am definitely forwarding today’s post to the family to give them a good laugh. Glad I am not the only one making that particular error!

    04/16/14; 5:05 pm
  6. Guess you’re more trusting that I am. We’re always told 45 minutes to an hour with our order delivery. The restaurant is about 3 miles from us, so if I take half of my dose approximately a half hour later I don’t go too low or spike too high by the time we’re actually eating the pizza. Only once was there a problem with a late delivery when a new delivery guy got lost.

    04/16/14; 8:47 pm
  7. Susan #

    Happy Birthday, Birdy! My girl turned 4 last night and we made pizza too. I was okay 2 hours later and woke up with a 245. Maybe I should have taken your prebolus.

    04/17/14; 1:19 pm
  8. Pizza still messes me up the most to this day, sometimes I am in the 300′s for hours (maybe they use sugar in the dough as well as the sauce?) Other times I never reach 200 after the meal…

    05/5/14; 10:37 am

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  1. #DIYPS findings help people with type 1 diabetes better manage post-meal blood glucose levels | Scott Leibrand's Blog

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