Pre bolus or post

When my daughter was first diagnosed doctors said to bolus 30 min after she eats which was ok back then but it’s been 5 years and I’m questioning if that’s the right way especially if she checks her BG and is already high

Our insulin needs change from time to time and it sounds like you need to check with her doctor. Hopefully she sees her endo on a regular basis, and if her needs have been steady up to now that’s great. But with diabetes we must learn to adjust our insulin to match our body’s needs, and that should become second nature with practice and experience. Work with her endo and diabetes nurse educator to learn how and when to make adjustments.
If she is already high before eating she may need more basal insulin as well. Show her doctor your records and they will advise you on what to do.

Hi @stixxs512 it is really common to bolus after eating for very young children, especially because they don’t always eat as predicted. When you get a little older it’s common to bolus before eating or even 10 minutes before eating to help prevent a huge sugar spike in that first hour after a meal.

When I am high (over 140mg/dl) before a meal I bolus 10-30 minutes before and Let the insulin start to work and then eat. It’s more dangerous because if I get distracted I could get very low.

I suggest you work with the doctor but your instincts are, in my opinion, very good.

1 Like

Exactly what you said is the reason why I asked. Initially they said bolus afterwards in the hospital during her initial diagnosis because she was 3 and didnt knowing she would eat everything but at 8 my daughter eats everything. So whether she is high or normal range before a meal I dont understand why i shouldnt allow the insulin to work a little before a meal or during her eating as opposed to waiting until after she eats which she will then spike probably before the insulin fully kicks in . I do work closely with her endo and because I’m with her everyday and monitor her very closely hes open to me trying different options with her

@stixxs512. Type 1 is one disease where you are the primary care provider and the endo becomes your consultant. Just remember that at some point your doctors will always default to the more conservative and safe option, not that your proposal is unsafe it just requires a certain skill set with insulin, which I am pretty sure you have.

My friends daughter was diagnosed quite young and they were told the same thing. I’ve had Diabetes for almost 40 years now and so much had changed! I’m not sure the age of your child, but I know they do that initially because they are unsure how much the child will eat and they don’t want you to have to worry about having too much insulin and not enough food to cover it. It is hard to make a young child eat when they don’t want to. If you can guesstimate approximately what your daughter is going to eat and you know what her blood sugar levels are at, you should be injecting (syringe) or dialing in (pump) to allow for both prior to her meals so the insulin has time to work (is what I have always been taught). Of course, everyone’s body is different. I would definitely be at least giving insulin to balance out her high blood sugar. Running high does not feel good on our bodies - no energy, cranky, thirsty…but, long term it is so bad for us so that needs to be fixed and if this is a pattern, then giving insulin after meals is not working anymore. I’m surprised that your doctor has you doing this after 5 years. Of course, I am no doctor!! :slight_smile: But good to get some insight so you can go to your docs with some questions and a little bit of understanding. Make an appointment…and if you are ever uncomfortable or unsure of your doctor or the information that you are getting, come back and ask us! And remember, there are lots of endocrinologists out there, second opinions are a great thing!! Good luck! And welcome! You’re doing amazing :slight_smile: :slight_smile:

@stixxs512, your thinking sounds very good to me. I’m really happy to see that you are leading your growing daughter to the path where she will soon be able to manage her diabetes.

Something that I have learned about this “wonderful” diabetes thing, is that the only constant over time is change; what I mean by that, just because a certain dose of insulin worked very well last year, or last week, doesn’t mean that will work today - for exactly the same meal. Five years ago, waiting a half hour to see what your daughter ate and kept down, was a conservative approach attempting to prevent her from experience hypoglycemic [low] events. Now that she has grown and become more predictable in her eating habits, it would appear that a time for changing her insulin timing has arrived.

Your thinking about eliminating spikes in her glucose level following a meal while waiting for her insulin is important. Our major goal in diabetes management is reducing times when we go low, and when we go high, and taking her insulin near the start of a meal may help accomplish this. I’m assuming that she is using Rapid-Acting insulin, such as Humalog or Novolog, so be careful, and stay alert as you make any adjustment in dose timing or amount; and YES, speak first with her doctor.

Yes I’m definitely learning how much things change with diabetes now that shes getting older. Shes always been a kid that loves to eat so even when she was 3 at initial diagnosis she would eat all her food but I followed the doctors orders and bolus after meals. The older shes gotten her eating habits are still the same in that she eats everything on her plate but I’ve been more concerned about the post bolus because she always goes up after a meal then goes down which has happened the entire 5 years. The more I read on the forum pre bolus kept being mentioned and now that we have a new endo who is also a pediatrician I love him and how he works WITH me instead of telling me what to do. She is on novolog and lantus right now. I know I can’t control the disease entirely but what I can do i try to do to give her relief . I try my best to figure out why she is low or high and fix it as much as possible as we go along.

1 Like

I know what you are saying @stixxs512 about going high after a meal - like right now, I’m going higher after eating my supper about 90 minutes ago. I took my bolus just as I began eating; I would have preferred to bolus before I began eating, but i wasn’t sure what the meal was going to be.

I like the sound your new endocrinologist/pediatrician who is working WITH you. Great, it must be a team effort with the doctor providing guidance as you and your daughter learn all that is possible.

Another thing, I believe that autoimmune / TypeOne diabetes is a condition that we can never control, so my thought is to manage diabetes as best as possible. There are so many factors that are beyond our control that affect how our bodies react to glucose - there are lists of close to 100 factors - we do best by our keen observation and reacting.

Some doctors but familiar with diabetes go with “textbook treatment.” Having an endo works with you and your specific needs makes all the difference.

I solve this problem by taking my bolus in 2 doses. I take about half before I begin eating and then take the other half after I finish. This allows me to also check the carbs I actually ate (versus my pre-meal assumption of what I would eat) and make any adjustments. Sometimes I split my after meal dosage into 2 parts - some fast and some over time, if I feel I may go low, if my insulin kicks in before the cars do.

1 Like

Terri @TJC, your suggestion to split a meal-time bolus is excellent - especially Ndidi’s @stixxs512 daughter during this change in practice.

When eating at a restaurant [will they ever reopen?] I frequently split my meal bolus, especially when tring a new menu selection - looks can be deceiving.

Hi Dennis,

I guess you and me are "old timers’ (as you said previously) Been doing this stuff for 50 years - picked up a few things along the way. By the way - I’m east coast - NJ. Where are you?

Tomorrow, I switch from Medtronic CGM (nothing but tons of issues - you know this if you’ve read my earlier posts). My Dexcom 6 just arrived and I will try it tomorrow. I’m hoping it will be much more hassle free. Crazy thing though (and I don’t remember what you use…) I plan to use their receiver, as my phone battery doesn’t last very long now. They sent along a charger for the receiver. - but nowhere - nowhere - not int the literature, not on the website - does it say how often/when you need to charge it! Every week? month? 3 months? will it tell me when? Can’t search for this answer either.

Anyway, hopefully it will go in smoothly and work well.

Hi @TJC. I upgraded from the G5 to the G6 so I have the same receiver and can use it as well. Use my pump as my receiver but when I did use the handheld I believe the receiver lasted at least a few days.
I’ve pretty much gotten in the habit of plugging in my pump and my phone when I’m watching TV or in the car, so they stay pretty well topped off. You can do the same with your receiver. I also have some “charging bricks” and those work well too.

Hi Terri @TJC, there are quite a few “long-timers” on here who post quite often.

The Dexcom Receiver will operate for several days between charging, just keep your eye on the battery gauge at the top left. When I used the receiver, I let it charge as I upload my data to the Dexcom Clarity “cloud”; I strongly recommend the Clarity for its reporting features [access can be shared with your doctor] for making management decisions - like tweaking basal rates.

As Dorie @wadawabbit, another long-timer, said, you can not use both a phone and the Receiver simultaneously [some hackers claim to have figured a way around]; I use my Tandem t-Slim as my primary receiver and just recently began using a phone as my secondary data device - both work well together.

For me, the DexCom G6, and before that, the G5, have been hassle-free. By hassle-free, I mean that they only harass me when my glucose gets out of line and I don’t respond - a really good hassling. There aren’t any repeated requests for calibration.

Mentioning calibration, the Dexcom G6 only requires manual calibration if you fail to correctly enter the Sensor Code when starting a new sensor. The Sensor Code is on one of the lift-off protectors of the adhesive; keep this code, write it on a calendar - just in case. I began using the G5 with my old MiniMed [Medtronic] pump, I change to a Tandem pump 18 months ago and this past January began using the Control IQ [CIQ] integrated AIDs [Automated Insulin Delivery system] which for 6 months has kept me constantly above 90% time-in-range.

I too live on the ‘east coast’, well actually the West Coast of Florida; southern Manatee County, just north of the Sarasota - Bradenton airport. Warm weather guy now for 20 years after enjoying the more chilly Boston area for 60.

Hi @TJC. Hey I’m in Morristown NJ I grew up in Bergen Co. Can always spot Jersey grit!

Hi Joe,

I grew up in Monmouth county, lived near Asbury Park, much later (after married) lived in Wayne, Bergen county (plus a short stint in Long island) and I have lived in Linwood, outside Atlantic City for about 30 years now. Definitely a Jersey Girl.


1 Like

Thanks for the tips Dennis. I finished “warm up” 5 minutes ago and so far - so good. Particularly thanks for the tip about keeping the code - good idea!

I’ve been on the Medtronic pump for 16 years - 2 years ago went to cgm and tried the auto setting. I lasted 9 months - hated it . Kept my average way too high. Much happier on manual . Like having more control. Don’t mind putting in the time and constantly checking it. Sadly, I have 2 more years on the Medtronic pump before I can switch. to the T-Slim. But if I really like the Dexcom 6 I may change before that, if the cost doesn’t scare me away. The T-slim looks like a good idea - and you said you are very happy with it. So have others. I will even give the Control CIQ a try.

Thanks for the feed back.


1 Like

@TJC That’s awesome Terri

I just want to add my agreement to the thoughts that have already been shared. When I was diagnosed, they said the same thing – wait till after I ate to bolus. As soon as I got my Dexcom CGM, I saw that my BG spiked every time I ate. Now I always bolus before, unless I’m low. If my BG is steady or high, I bolus about 15-20 minutes before if I can. Interestingly, for breakfast, I have to bolus at least 30 minutes before, and often I can wait a whole hour before I eat without dropping low (but only in the morning, not lunch or supper – this disease is so weird!).