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Bolus?

SueJB

Well-Known Member
Messages
3,336
Location
Heaven
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
cold weather
I'm still struggling with this T1 and thought I'd got the idea of insulin : carb ratio sorted, now I'm confused.
Diagnosed in Aug last year and put on levemir 5units morning and evening (this hasn't changed) and novorapid for bolus ratio 1:10
Since I eat very little carb (around 30g per day) I very rarely bolus and then it'll only be 1 unit.
Now I've read on another thread that people bolus for protein, is this correct and how can you work out how much?

The other bolus question is, do people bolus in the morning if their fbg is high. Mine was 7.4 this morning and I'm sitting here wondering if I should.
Any ideas welcome and sorry if this is a repeat question.
 
The answer for this question depends on your situation. How are you sugars during the day? If your numbers are fine then you don't need to worry. You are still very new as a diabetic and it takes time to learn about not only your body but diabetes.

Yes you would bolus. For example, my blood glucose I wish to achieve is 6.0 mmol/L so if I woke up with 7.4 mmol/L I would do a bolus to lower my blood glucose.
 
Hi SueJB, I'm like you on low carb diet. I'm on Levemir 4.5 units twice daily and novorapid usually 2 units for meal. Protein doesn't seem to raise my bs level so I don't bolus for protein.

1 unit of Novorapid will reduce my bs by 3.0 mmol/L so if my fbs is 7.4mmol/L I would do 1.0 unit correction or 0.5 unit to be on a safe side.
 
On the other thread @Brendon.Dean I'm sure you said bolus for protein too
 
I don't bolus for protein, but then I have a moderate carb intake that obviously needs insulin, myself with a waking blood of 7 would start to rise with my 'feet on the floor', a unit at that point would allow me to delay breakfast for an hour but I'd need another couple of u to eat.

As far as injecting for protein, my advice would be simply to eat it and test, if you get a rise/spike then you needed insulin, if you're eligible for libre it will show you what's happening, or use blood tests as a 'dot to dot' drawing of your day, remembering it's not just food and insulin affecting your BG readings.
 
To me, there are two reasons for taking bolus
- to work with the food I am about to eat. Usually, this is just carbs but when I eat a no carb/very low carb meal such as omelette, I need a small bolus
- to correct a high when above my target BG. If I was about to go for a run, my target may be higher so, I may not correct a pre-run 7.4, but I would correct a pre-run 9.4. Whereas, if there was no run in sight, I would definitely correct a 7.4.
 
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SueJB said:
On the other thread @Brendon.Dean I'm sure you said bolus for protein too
Click to expand...

I think you missed my reply to you on the other thread because I explained it but here it is again @SueJB

What I mean is, if you are on an extremely low carb intake then you will have a higher dose of basal insulin if you are not going to bolus with fast acting insulin. If you have your basal insulin set to just cover your daily expenditure of energy then you will 100% have to bolus with fast acting insulin when having carbohydrates ( the IC ratio depends on the kind of carb). As for the protein to carb ratio this I cannot tell you because it could be different for you, but general rule of thumbs for me are if I am having more than 10g of carbs I will not bolus for protein, and I will only bolus for protein if its been more than 2 hours or more after my last meal and 15g+ of protein.

So to simplify it, you would not bolus for protein if any carbohydrates are involved during the meal. If the body does not have carbohydrates all day for example, and all you consume is protein and fat then bodies blood sugar would spike if you are not taking fast acting insulin. This is the same reason why a type 1 diabetic cannot live without insulin, because no matter what food we intake, at the end of the day it will all turn to sugar and spike our blood glucose.
 
@Brendon.Dean Thanks for this but can you explain why I would need a higher basal if I'm eating very low carbs. So far this morning I've had some cheese and a coffee with cream. Today's basal dose on waking was 5 units
 
My basal requirement has halved since switching to very low carb, and I rarely need to bolus either. Only really for white fish and prawns, and not for eggs or vegetable proteins. The only time I use Novorapid now is for morning corrections or if I’m ill.
 
Thanks @Mel dCP that's really reassuring. I've gone from 5 units twice a day to 3 and actually think I could go to 2 which is what I might try next week.A quick question, I'm assuming you don't eat meat so did you test to see if you needed to bolus for fish/prawns?
And, if it's not an intrusive question, what does your fbg have to be for you to bolus? To you have a sort of preferrred morning bg? Really appreciate any input, thanks
 
You’re right, I don’t eat mammal or bird meat (horribly allergic to it, sadly), so I get most of my protein from eggs, tofu, vegan pea protein powder and seafood when I can afford it (ie when it’s reduced!). Fatty fish such as salmon doesn’t affect my levels at all, but I found if I was having a very low carb meal containing king prawns, usually a salad, curry or with avocado that my levels would rise by 2-3mmol a few hours after eating. Basically lean protein has that effect on me, even when eaten with plenty of fat. It does seem to follow the same sort of time scale as Novorapid, handily. I’ve found a ratio of 1u:20g works well to keep things stable, which is half my “fast carbs” ratio. I don’t need to bolus for eggs at all, even my much reduced basal (17-18u a day compared to the 36u I was taking on a “standard” diet) covers that. Plant proteins aren’t utilised nearly as efficiently by the body as animal proteins, so even quite large quantities of stuff like tofu and pea protein have no effect on my BG levels.

As for my FBG, I aim to be between 5-6.5mmol. I wake up any time between 3-8am by my sugars just starting to rise, and I have a massive dump of cortisol and adrenaline to go with it. So I scan my Libre, and depending what the score is, inject according to a scale I’ve worked out. That nips the rise in the bud, six days out of seven, on the whole. Took me a few weeks and a fair few packs of dextrose to nail down exactly how much I need, but it works for me. So even if I’m in the 4s when I wake, I’ll need a little to prevent it shooting up into double figures - felt a bit wrong (and I’m sure my team would have a conniption fit if I told them) at first, injecting when I was in the lower end of my range, but it’s my personal solution to beating the dawn rise. Means I start the day with a good level, which makes things an awful lot more stable for the rest of the day. If I just let it rise naturally (or sleep through my liver’s wake-up call) it’s quite hard to bring down, and stays high despite later corrections for a good few hours, whether I eat or not. However, I really wouldn’t recommend doing this as your doses are so tiny, and you may still be honeymooning. Dawn phenomenon aside, I usually start correcting when I hit the high sixes, usually just half a unit to bring me down by 1.5mmol.

PM me if you want to chat about it x
 
Hi! Thanks for this post... I'm about 3 weeks into my diagnosis as T1 and have switched to a ketogenic diet. My docs are totally supportive but I have a couple weeks until my week-long T1 course in June. I've been just generally taking 1.5-2 units of my Fiasp with every meal, plus any corrections as needed, unless I'm going walking (which works well, almost too well, to get my sugars down). Can you recommend any reading on this topic? Thanks!
 
I bolus for eggs. 1 egg = 4g.

If you wake at 7.8.... you need to know if your levels rose and what time during the night, and is this everynight.

And if you dont correct do your levels continue to rise or do they remailn the same or drop on average....

There are so many different factors to waling up and should you bolus for a 7.8... but many answers will depend on basal testing from 3am to midday....
 
donnellysdogs said:
I bolus for eggs. 1 egg = 4g.
...
There are so many different factors to waling up and should you bolus for a 7.8... but many answers will depend on basal testing from 3am to midday....
Click to expand...
Thanks! I've done a fair amount of reading lately but sometimes I feel lazy about testing what does what to my sugars. At the moment, i'm waiting on the delivery of my Libre sensors. I figure once they arrive it will be easier to know what's what.
 
Jo Bodensee said:
Thanks! I've done a fair amount of reading lately but sometimes I feel lazy about testing what does what to my sugars. At the moment, i'm waiting on the delivery of my Libre sensors. I figure once they arrive it will be easier to know what's what.
Click to expand...

Totally agree libre makes it so much easier.. dont forget though for your first sensor going in, it takes time to settle-dont make any adjustments to anything from your first day of putting libre in. When you put your next one in, put it in 24 hours before the old one ends and it will be settled pretty well so you dont have the 1st day of it "warming up".....
 
Jo Bodensee said:
Can you recommend any reading on this topic?
Click to expand...

Think Like a Pancreas by Gary Scheiner is an often recommended book for those of us new to this.

I note from your later post you're getting libre. Sugar Surfing by Stephen Ponder and Beyond Fingersticks by William Lee Dubois are pretty good for getting the most out of cgm.

WLD's book is a bit dated now, written about 10 years ago, but still makes some good points about what to expect and what not to expect from cgm that hold true today. There's an amusing bit where he looks into the future and imagines us having bg readings on our phones!

The authors are all T1, the first two are endos, the third is a diabetes educator, so they've all lived this both personally and professionaly.
 
Thanks, @Mel dCP you've clearly got it sorted and I'm envious. I'm just guessing intelligently on what to do. My pancreas is still bashing out some insulin otherwise the basal stuff would be much higher or the pancreas is still pushing out at the same rate as before and my weight gain is because of unnecessary insulin. BUT and this is and incredibly big but, I still think the diagnosis is wrong. I was in ketosis (4.8) for sure and was intentionally managing to lose weight because of it when I was diagnosed. I didn't feel ill, didn't pee hugely but still drank a lot.
Thanks for confirming the idea of a good level to start the day. Anything under 6 is what I like. I've only been over 9 twice this month so I think from what you've said, I think I'm sort of doing OK.Thanks for the PM offer, I'll take you up on it if I get another conundrum. Going to try and get a half unit pen.
 
Hi @donnellysdogs I only count eggs as 2g and don't bolus for them. I generally haven't corrected a fbg because they're usually under 7 and sometimes just a tadge over. As today woke with 7.4, and a couple of hours later 5.7. I'd rather have a good nigh sleeping that start testing during the night
 
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