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Prebolusing the Sh*t Out of Things.

Now, at the halfway mark of my pregnancy, insulin resistance is becoming a bit of a thing, and is going to progress into an Actual Thing as the weeks go on, which happened last time and I’m prepared for but it still a bit whoa and this sentence is a run-on.

Which means that basal rates are creeping up ever-so-slightly (my pre-pregnancy basal total was around 13u and I’m now up to 16.2u) and my insulin:carb ratios starting to dance (pre-pregnacy was 1:10, am now 1:9 … except lunch is 1:12 because why would things be consistent?).  When I first found out I was pregnant, my endocrinologist told me that post-prandials contribute most to macrosomia, so keeping my post-meal blood sugars as in-range as possible would help mitigate that risk.  (But let’s take a look at the risk list … pre-existing diabetes?  Check.  Over 35?  Check.  Previous pregnancies?  Check.  Having a boy?  Check.  Cool.)

The plan?  Actively and aggressively pre-bolusing the shit out of my meals.

This sounds like an excellent plan, in a perfect world.  Pre-bolusing works well for me when the bolus is delivered at least 20 minutes before eating, the meal is properly carb-counted, and nothing delays the process of eating.  But one monkey wrench in that process can muck the whole mess up.

Pre-bolusing can feel spooky, like I’m tempting fate and inviting a low.  Not doing it is like opening the door for a high.  The middle ground could use some xanax.

Over the last few weeks, my pre-boluses have been executed with precision.  A few fistfuls of jellybeans have worked their way into rotation when I’ve bolused too early, but that’s to be expected.  The temp basal option on the t:slim is stupidly easy to employ, so sometimes I use a temp basal to help back me out of a mild low, but overall, I’ve seen my post-prandials come down nicely and hopefully my ultrasounds continue to show a very boring, predictable pregnancy progression.

Makes meals interesting, though.  They’ve become a game of roulette.

“Do you think we’ll get seated right away?”  Or, “I forgot to pre-heat the oven and now dinner is going to be 15 minutes later than I thought.”  Or, “Fuck.  I forgot to eat!”

I’m pre-bolusing all over the place.  Usually it works fine.  Sometimes I end up wicked low.  But every time, it’s in effort to keep my post-prandials from causing chaos in my kid.

14 Comments Post a comment
  1. I’ve read about using temp baseless to avoid lows before. How much do you reduce by, and for how long? I’m trying to perfect that myself.

    Congrats on a healthy pregnancy so far! You make it seem not so scary. Thank you for sharing.

    04/22/16; 1:34 pm
    • I lean on the Dexcom information to help build a temp basal strategy. For me, a temp basal only works if I am falling very slowly or if I’m steadily low (like a 60 mg/dL with a straight arrow or something). I usually turn my basal down 50% at least for 20 min at least. But if I’m falling (double arrows), I head for the glucose tabs. These days, I fall faster than a temp basal can pick up the slack for.

      04/22/16; 1:36 pm
  2. Tim Steienrt #

    I’m like an old jalopy. Everything will be fine as long as I don’t let the tank get below 1/4 full. If I do, I stall out and have to spend a while getting myself restarted.

    04/22/16; 2:23 pm
  3. Matthias Granberry #

    1U(or even just enough to correct down to 75 or so) so an hour before eating helps a lot. You can then subtract that amount from your bolus and eat with food. Give it a try and see how it works for you.

    04/22/16; 2:53 pm
  4. As a Dad of two, I leaned one thing a long time ago. Do not comment on anything a mom says about her pregnancy :).

    I referred your blog to the TUDiabetes web page for the week of April 18, 2016.

    04/22/16; 10:04 pm
  5. Beth Baskett #

    The past few years, I have had a serious problem with not being able to eat what I thought I would be able to eat, or getting sick shortly after I eat. Pre-bolusing has definitely become a thing of the past for me. Having a low and having to force myself to eat when I’m sick is really difficult.

    04/22/16; 10:59 pm
  6. I just got a t-slim in August, and pre-bolusing is so much easier now! When I was on MDI I would post-bolus and my blood sugars were crazy. Usually due to being at work or in school and not being able to pause to pre-bolus. Sometimes (a lot of times?) due to sheer laziness. For me the pre-bolusing usually works, as long as I don’t get customers at work, or completely forget to eat like I did once…. yay diabetes.

    04/22/16; 11:14 pm
  7. I recently had the pleasure of telling a young friend of mine right in front of his mom, how much work she had to do while she was pregnant with him (2nd baby, 2nd boy!) for her to be healthy and him to be healthy, and that many adult Type 1’s are “one and done” and she must have really wanted him like crazy. The kid couldn’t believe it, looking at her like, “Whoa, Mom.” That was a sweet moment I’ll never forget!

    Sounds like you’re rocking it! Thanks for the post and for expanding my awareness for when/if my kiddo decides to have a babe.

    04/23/16; 9:53 am
    • Martha #

      My boys are 15 and 18 and on days when they’re really kicking my ass, I’ve been known to let them know how hard it was to be pregnant with them with T1D. As of yet, they don’t appreciate it and I’m not holding my breath, but it would be nice if they ever got it at least a tiny bit. Oh wait, I’m not supposed to want them to feel guilty. But let’s all agree that there really should be a special place in heaven for moms with T1D!

      04/25/16; 5:42 pm
  8. Andy #

    Typically I bolus right before I eat unless I’m over 200 or so then I bolus and wait 15-20 minutes. Bottoming out before your food digests just sucks and treating lows adds weight. Glad things hear you and baby are well.

    04/23/16; 12:57 pm
  9. Dan #

    Hi kerri,
    You are doing a great job. Keep on keeping on. I know that you can do this and you are taking the necessary steps to succeed.
    As always have a great day.

    04/23/16; 1:08 pm
  10. Jim #

    Wow, what a challenge! I have to admit, pre-bolusing scares the crap out of me after having tried it in the first year following dx with all the challenges you mentioned in your post. But that was pre-CGM, so maybe I should give it another go. As for now, I chase stubborn postprandial highs with a correction+Symlin cocktail, which brings things into line fairly quickly as long as I follow some basic rules that seem to work for me.

    Sounds like you are putting in the maximum effort to tame the beast. Insulin resistance sucks, but I am fairly confident that the reward at the end of the term will be oh so worth it! I’m very happy for you and wish you the best!!

    – Jim

    04/25/16; 8:03 pm
  11. Hi Keri. I just read your post about being pregnant again. I am so excited for you and your beautiful family. My daughter is 15 months old now and reading you, brought me there…during pregnancy…Hard work. Very little room for error. I feel you. Thank you for sharing with us Keri!

    04/28/16; 5:36 pm
  12. So. Much. Fun. Even when non-pregnant, I find pre-bolusing (or pre-blousing like my computer wants me to write) feels so risky, and spooky, with a 1 year old running around who determines my schedule. It’s so easy to forget to eat altogether! I’ve definitely slacked off on pre-bolusing as a mama because it’s just scurrrrrrrry! :p

    You’re doing great, mama!

    04/28/16; 10:23 pm

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