Pre bolus or post bolus

Since my daughter was diagnosed the docs have said check her sugar allow her to eat then give her insulin. She has 30 minutes to eat but I notice a lot of parents do it before they eat. Which way is better? Is there a difference? Do you wait a certain amount of minutes before your child eats after administering insulin?

Hi @stixxs512, with young children it is often “safer” to count the carbs eaten and to then give the shot of fast acting insulin. Doctors say to do this because a low blood sugar is more dangerous than a high blood sugar. You wait until your daughter has eaten all the carbs she is going to eat and then you give the shot. No need to wait.

“Better” is a funny thing. Your goal is for reasonable blood sugar control without severe low blood sugar. By giving the insulin first (pre bolus) you can reduce the “peaking” blood sugar after a meal. As the carbohydrates absorb from a meal, if the insulin isn’t working at the same time then a low or a high will happen. Once you get some experience and once you can safely predict the amount of carbohydrates she is going to eat BEFORE she eats a meal then you can pre bolus to help reduce that temporary spike due to eating.

I’ve been taking insulin for 41 years so I pre bolus unless I am eating pizza or ice cream. Then I never pre bolus.

Hope you have a good CDE and Endo and don’t be afraid to ask anything. Cheers!

Hi @stixxs512. I’ve been on insulin since 1963 and on a pump for 20+. I’ve learned how my body responds, so sometimes I do bolus a little in advance of a meal of I’m on the high side of normal, to avoid rising too much afterwards. Some people - adults as well as kids - wait until they’ve tasted their food to see if they can eat it; or wait when eating out just in case their meal is delayed. Kids can be picky so bolusing with the meal could be safer.

. Let me clarify a little bit my daughter is 8 shes been a type 1 since she was 3. So we definitely have a routine she always eats every amount of food shes given so making sure she ate all her food and counting the carbs afterwards was done in the beginning. Now that shes older she always finishes her food , she did it even at 3 but to be on the safe side I followed the doctor’s orders to the t. I’ve just noticed over time a lot of people pre bolus and I questioned it because when she is high before a meal I dont like to feed her and she go even higher before the insulin starts to kick in so I wondered if pre bolusing is a good option

@stixxs512. It sounds like you can give her insulin before she eats. If she’s a little higher than target then you can give fast insulin 15 minutes before eating a non mixed carb meal. If she’s way above target then a correction can be given with no food as long as you know her sensitivity factor, and you’re less likely to be super high right before a meal. Of course you should have a new talk with her doctor. Cheers!

@stixxs512, as has been pointed out, for a child it is often “better” to bolus after seeing what the child is actually eating or has finished eating.

As for me, and I’ve been using insulin since the 1950’s, my hard & fast rule is “it depends”. If my BGL is in a normal range and I know the exact content of a meal, I will bolus 5 to 15 minutes prior to eating, “pre-bolus”, to minimize the spike of my BGL. If I’m running “low”, I will at least begin eating before I bolus, and in extreme situations finish eating and then bolus.

I fully agree with a pre-bolus well before she begins eating when her glucose levels is high before the meal. I sometimes will administer a correction bolus an hour or more before a planed meal and then bolus for the meal when I begin eating - after double-checking BG and allowing for still-active insulin.

Thank you so much all of the suggestions I will definitely try as well as speak with her endo

What I didn’t say, Ndidi, be sure to take into consideration her activity before doing any correction bolus. Activity includes everything she does.

For instance, I try to keep my BGL a little higher when at the gym and bike-riding; I would NOT do a correction at that time because I’m fairly certain that my glucose will be dropping.

I have been T1D for 50 years and on the pump for 18 years. I solved this issue by taking 2 doses of insulin with my pump for each meal. A pre- dose before I eat - of about 1/2 the estimated units I will need. This keep my BS from spiking. After I finish, I calculate what I actually did eat and adjust the second dose - up or down- to handle the rest of the meal. For example: I think I will need 4 units for dinner. I take 2 units as I sit down to eat. Afterwards, I see I left some food on my plate that I chose not to eat. So I adjust my second bolus to 1.6 units (not the 2 units I thought I would need). Or - I decide a need a bit of dessert - andneed to add alittle more insulin - the second dose becomes 2.4 units. My son, who was diagnosed at 11 years old (in 2003) and went on a pump uses this method (from day one) and does great on it also.

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@TJC Hi Terri and a warm welcome to the JDRF TypeOneNation Forum! Happy to see you here.

Us “old-timers” [I was diagnosed 1957] have had to figure many innovative ways to manage diabetes and I’m happy that you shared this method. Your method is somewhat similar to what I do, only I ‘usually’ only split the dose like that when I’m “high”, eating something like pizza which hits me a few hours later or in a restaurant when I figure out that extra corn syrup sweetener was added to what I carb-counted as just plain vegetables.

Please continue contributing your tips here - especially with the “newbies” who are struggling.

if you can provide info on how old the girl is, how insulin is administered, if she has a CGM unit to help control the glucose level, it will be easier to answer.

Another option is Fiasp insulin. It was only recently FDA approved, but it hits the system faster. We started on it recently, and it works GREAT!

It would be really great if the pump makers would adapt the pumps to Fiasp.