Sarah Howard
Sarah Howard has worked in the diabetes research field ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
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How often do you bolus before you start eating? Cancel reply
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Often was my answer as many of my meals have carbs.
“Before” would be by at most a minute or two. Digestion is not wonderful but still good enough to bolus when I start a meal, not afterwards.
This question did not have good answers to choose.
I said “Often.” The only times that I would bolus after a meal are when my blood sugar’s low or if I’m at a restaurant or party and I don’t know what or how much exactly I’ll be eating.
I said “always” but it’s really just as I’m ready to pick up my fork.
“Often” = “It depends”. It depends on where my premeal blood glucose is. If it is below 80, I’ll eat first and watch for it to start rising and then I’ll bolus.
I take my bolus as I finish up making the meal, around the time I set the table, unless I have gone low while cooking, in which case I bolus right before we sit down.
Pre-bolusing (avg 30 mins but up to 1 hour while pregnant) changed my A1c dramatically – much more impactful than any technology change.
Said ‘often’. Depends on pre-meal BG and content of meal. With a mostly LC/HF diet and well controlled BG, it often makes since to bolus about 10 minutes into the meal to avoid the insulin taking effect before the carbs kick in.
I find if I do not bolus before I ea, it will elevate my bloods sugars greatly.
Always 15 minutes to 1 hour in advance to avoid post meal/snack hyperglycemia.
Depends upon what my BG reading is prior to meal. Ranges from immediately to an hour wait…
Always
I answered “Always.” But, in reality, I sometimes forget to take my insulin before I eat. I try to take my bolus 20-30 minutes before my meal, depending upon what my blood sugar is.
I go by my cgm numbers. If the numbers are low, I go ahead and eat food and bolus mid-meal or after meal. If they are high, I bolus and wait for numbers to come down before eating. You do whatever works and you become your own medical scientist. The body is so complex and it is impossible to be perfect with numbers, so don’t ever quit or give up, just press on and remind yourself that Insulin is celebrating the 100th birthday this year.
I need to pre-bolus well before a meal, since the insulin doesn’t kick in for at least 1.5 to 2 hours.
As the questioner, OBVIOUSLY doesn’t know much about diabetes, I’d hasten to add that there ought to be an ‘Other’ option.
To clarify, I’d state that in the main I often begin the infusion of my insulin dose prior to starting to eat, but this REALLY depends on what my blood glucose level is prior to that meal.
If my blood glucose level is on the lower side, I wait until I begin eating, or even infuse insulin after I’ve eaten my meal. This is because I use Apidra insulin, which is very rapid acting, so it starts to work before the carbohydrates of my food intake is broken down and glucose is released into the bloodstream. (I’ve had MANY occasions when my blood glucose level has fallen so dramatically that I’ve lost consciousness … sometimes before I’ve even got to finish my meal. This is compounded by the fact that I have gastroparesis, which results in a delayed emptying of the stomach contents.)
You are so right. My digestion is sometimes very slow, and my insulin sensitivity rarely allows pre-bolusing. I answered rarely as this is my life.
I routinely pre-bolus for at least part of what I think I’ll need, before breakfast. But, later in the day, I so often take so long to digest that I routinely don’t prebolus, and even sometimes wait for the dexcom curve to start up before bolusing if it’s a period when the slow digestion is being a particular problem. When I wait for the curve, I often go higher than I want to be before the insulin works, but I tend to get a worse high if I have had to treat a low caused by the insulin working before the food hits, and then digest the food originally bolused for at some unpredictable time. And I’ve also had a low that is difficult to treat, because I’m not digesting. Still manage low 5 A1cs and usually over 90% TIR, and at age 75, dx at 8, I don’t worry about it too much, but do try to eat more of my food earlier in the day.
I have to look at all the variables just like everyone else and make that decision every meal/snack. The only difference is a few people say they sometimes bolus and wait to eat, and I don’t have enough willpower for that when I am hungry. 🙂
I use DIY FreeAPS X and there’s a lot of meals that it can handle but it always looks better with a bolus
Not always, but Almost Always wasn’t given as an option so I said “Often”.
My answer is “almost always,” with rare exception (e.g., I am distracted somehow) or if I am eating to counter a low bg. So I answered “often,” despite it being an understatement.
Exactly! Almost always should’ve been in there. I’m sure not gonna bolus at 3 am when I’m eating to counter a low! 🙂
Unless I forget………,
Or don’t find out there are carbs until it’s already being served, yup.
I **always** intend to, but I only **often** mange to. Sometimes you don’t know there are carbs coming until the meal is served, especially when you’re eating out. I almost always feel awkward about quizzing someone who’s cooked dinner for a full ingredients list, and frequently they don’t know if there are carbs or not, because they don’t know things like pasta, beans, bread, and fruit are carbs. “It’s full of honey but it’s locally sourced organic honey!” Sigh….
Got a laugh out of this. My friends always says cooked this especially for you as my sugar rises. Most people just have no idea what a carb is.
Now that I am on faster acting Lyumjev I can bolus when meal arrives. So much easier to remember. Also easier to estimate carbs in a restaurant.
I pre-bolus if I’m the cook and know exactly what and how much I’ll be eating. If my bg is low I bolus just before I start.
Another trick question. If I’m going to exercise and am eating to fuel, I don’t bonus at all. If it’sa regular meal and my bg is in range or above, I try to bonus before with the time depending on where my bg is, if my bg is below my target I don’t bonus until right before I put food in my mouth, if I’m more I’ll usually wait until after I’ve started eating.
I usually bolus 15 to 30 mins before eating, depending on starting blood sugars.
Always. Most times I bolus as I’m about to eat but it depends on my BG. If it’s high or high normal I will pre-bolus. If it’s under 100 I usually bolus right as I go to eat, or maybe just a couple of minutes before. If I’m low I will bolus as I’m about to eat but I will do a dual or extended bolus.
I bolus almost always before starting to eat…. unless I am out and not confident of the timing of the food arriving at the table, then it has to be delayed. Once food arrives the bolus goes in before starting to eat.
If I haven’t given my bolus before starting to eat, it can sometimes be because my BG is already low, and rarely (but it does happen) it can be due to being so busy or involved in conversations with friends at the table with me that I forget.
As soon as I remember, the bolus will go in! Luckily, as said, this is only a rare occurrence.
I never prebolus anymore with my inhaled Insulin. I use it at the same time I eat. If it’s a higher fat meal, I may wait 20-30 minutes after I eat to bolus.
In 1945, Frank Notestein, the founding director of the Office of Population Research at Princeton, estimated in Food for the World that about 3.3 billion humans would be on planet earth by the year 2000.
He was only about 3 billion off.
Now if the best and the brightest are in error by that huge amount for a 50-year projection . . . I think most of the rest of us mere mortals can be forgiven for being in error on a mere 50-minute projection. Nes pas? ✍️
Virtually always, usually 20-30 minutes ahead of 1st bite. Only on rare occasions when I have no idea of the carb count will I wait until I see what I’m eating.
It depends on my numbers before I eat and the carb count of the meal. I would say 95% I bolus
I said “Always” but truly “Almost always” would have been the more correct answer for me to cover for when I’m correcting a low but eating enough carbohydrates to require a small dose.
Usually, but not always. Depends on factors like what, when & where I am going to eat, what I am doing in everyday life, what my BG level is doing, and whether or not my attention is focused or distracted before I eat something.
Thanks and kudos to all of you who gave real life honest answers to this question. Truth be told, for most of us – whether a T1D long hauler or a T1D newbie – remembering to take a bolus of insulin before you start eating is a crap shoot. You win some and you loose some and nobody’s perfect!
I always bolus, but if BG/SG is low, then I choose a square/extended bolus with 0% at the current time. That ensures I don’t forget to bolus and better matches the projected BG after eating with a low BG.
It takes forever for my food to digest that I bolus after eating with a delay delivery