Tricky Timing and the Power of the Pre-Bolus

Pre-bolusing: It’s the term that describes taking insulin before eating food. The “before” part in the definition is key, because the amount of time that “before” is can and will vary among people with diabetes. It depends on a few factors, including the amount and type of insulin being used, the amount and type of food to be consumed, current blood sugar levels, and so forth.

It’s one of those things that’s tricky to nail the timing of, but boy, when it works it’s so worth it.

Pre-bolusing works well, but only when the timing of it is perfect.

I have two examples to complement that belief, one in which pre-bolusing almost lead to a disastrous outcome and the other in which everything turned out ideally. I’ll start with the more chaotic scenario first.

In this situation, my boyfriend and I spent the night in New Hampshire to attend a friends’ wedding and had a pretty late night, which meant we slept in a little later than we had intended the next day…actually, a lot later. We only had about 20 minutes to race around our room, pack up our belongings, and get ourselves looking presentable before we had to check out of the hotel. Luckily, our scrambling paid off and we made it out in time, but sleeping in cost us the opportunity to enjoy a complimentary hotel breakfast. We decided that it made sense to stop for brunch on our drive back home to Massachusetts, so we Googled a diner that was on our route home and stopped there for a meal.

When we got there, the restaurant was pretty crowded, but we were seated and able to place our brunch orders almost immediately – a good sign. I assumed this meant we wouldn’t have to wait more than 20 minutes or so (that feels like a restaurant standard) for our food to be ready, so I went ahead and pre-bolused my mealtime insulin. After all, I’d ordered a hearty omelet that would come with breakfast potatoes and toast, so I wanted to be proactive about avoiding high blood sugar and get my insulin in system sooner rather than later.

Unfortunately for me, our food ended up coming out later rather than sooner. In fact, we waited nearly 45 minutes for our dishes to finally come out. In that period of waiting, I was getting more and more anxious about my decision to pre-bolus with each minute that passed without food in front of me. By the 30-minute mark, I was close to full-on panic. Even though my Dexcom wasn’t indicating that my blood sugar was low (it held out steady the whole time), I was worried that the system delay in reporting my blood sugars would fail to catch a serious low in a timely manner. I told my boyfriend what was going on, and without hesitating he went to his car to grab some packs of honey that he’d stored in his glove compartment in case of emergency. We talked it over, and decided that it was probably best for me to consume at least one pack of honey because we couldn’t possibly know when our food was going to come out, and at this rate, we wanted to play it safe rather than be sorry. That didn’t exactly lessen the sorrow and stupidity that I felt for taking a pre-bolus (even though I couldn’t have possibly known that our food would be so delayed, I still felt badly about the whole thing), but it was what it was. And ultimately, I felt like I paid the price several hours later, when I was dealing with the very same high blood sugars that I’d hoped my pre-bolus would prevent. So much for making the pre-bolus grade that time…

But that doesn’t mean pre-bolusing always fails! This brings me to my other example. My mom and I had a nice lunch together last week. Before we left to go to the restaurant, I noticed my blood sugar was a little high. I decided to give myself a correction dose, plus one extra unit of insulin, because I knew we’d be eating foods that aren’t typical for me to consume at lunchtime that could result in highs later in the day. So again, I was aiming to be proactive and prevent prolonged high blood sugar.

And this time, the strategy worked great! At the restaurant, I stacked that pre-bolus with my actual meal bolus (not always a recommended tactic, but it was useful here) and rounded out my afternoon with a blood sugar in the 120s – a win in my book. Thanks to my pre-bolus, I didn’t experience any pesky blood sugar spikes and still landed in range, which in turn showcases the power of the pre-bolus perfectly.

So just like anything in life with diabetes, when pre-bolusing works, it’s wonderful…but it definitely requires a little finesse to learn exactly when/how/where to use it.

My Top 10 Tips for Managing T1D at Family Gatherings

A version of this blog post originally appeared on Hugging the Cactus on November 23, 2017. I’ve decided to share it again today (with some slight updates) because I felt like I needed a reminder as to what a successful game plan looks like heading into a food-centric holiday! Read on for more…

Holidays that are centered around gratitude and eating…what’s not to love? As much as I enjoy the holidays, though, I can’t quite say that my diabetes feels the same about them. Fortunately, I’ve developed a bit of a game plan as to how to handle diabetes when family feasts come rolling around – here are my top 10 tips for making the most of eating-centric holidays with diabetes!

The only thing missing from this picture is the massive pre-bolus that I’ll likely be taking before sitting down at a major meal.

10) Don’t skip breakfast in the morning. This helps me avoid over-eating when dinner is served later in the day. Breakfast doesn’t have to be a huge thing, maybe just a bowl of oatmeal or a piece of fresh fruit – anything that will sate me for a few hours.

9) Volunteer to prepare a couple of dishes. If I’m going somewhere for the feast, I like to know what my host needs me to bring. If I have creative control over the dish, I prefer to make it something that I know won’t be too hard on my blood sugars, such as a side of veggies or a sugar-free dessert.

8) Familiarize yourself with what’s being served prior to sitting down for the meal. Before my family sits down to eat, I like to know what exactly we’re being served so I can plan accordingly. I can usually get away with strolling around the kitchen to get an idea, but sometimes the chef (my aunts or my mom) kick me out while they finish cooking dinner!

7) Don’t feel pressured to try everything. It all looks and smells so good, but I have to remind myself to use some restraint when piling my plate with food. I’ll add staples like turkey and green beans (both of which are low-carb!) and take smaller portions of the heavy things, such as stuffing and potatoes.

6) If it’s necessary, extend my bolus. This all depends on what my blood sugar is before the meal, but sometimes, I’ll extend it in order to prevent lows or highs post-feast.

5) Check my blood sugar often. I’d rather have an idea of where my blood sugar is headed than leave it to chance and guess incorrectly.

4) Go for a walk or organize another outdoor activity. The weather doesn’t always cooperate with this idea, but I’ve found that dragging my cousins on a 20-minute walk after eating helps my blood sugar and provides us all a chance to hang out while our uncles take control of the TV and our aunts chitchat over cups of coffee.

3) Wait a bit before having seconds or starting on desserts. I try to indulge a bit on the sweets, but I know that it never works out for me if I help myself to desserts too soon after consuming the main course. So I avoid the temptation by staying busy after eating dinner – my mom and aunts always appreciate an extra set of hands to assist with clean up!

2) Look up carb counts if I’m struggling to come up with them on my own. Sometimes, I can’t quite determine how many carbs are in a serving of pumpkin pie – I’ll guess too low and end up high, as a result! But I know that there are tons of carb counting resources at the tip of my fingers, thanks to my smartphone.

1) Remember what the holiday’s all about: being thankful! Enjoy the day and time with loved ones! Whether you’re part of a large family like mine, a small one, or choose to spend the day with friends or a partner, just relish it for what you want it to be.