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When to take Bolus on lchf

bellabella

bellabella

Well-Known Member
Messages
135
Type of diabetes
Type 1
Treatment type
Insulin
I've just started lchf as of yesterday! I was wondering, when to take my Bolus insulin on this plan, as I've noticed that when I take it with my meals like I used to before, that I go hypo fairly soon after, but then my bg's go up later in the day, presumably because the protein is being converted to glucose more slowly than carbs would? Should I wait an hour or two after eating, and then Bolus? I'd just be worried that id forget to take the Bolus this way, so would it be better to just increase my basal and take really small Bolus units at mealtimes? Thanks!
 
The only way I can safely bolus for low-carb meals is to split-dose (I'm on MDI) to avoid a postprandial hypo but also to avoid a high 3-5 hours after eating.
 
For my Bolus, it varies according to the meal. As I'm newly diagnosed I haven't done any official carb counting self education yet, so I choose a dose according to the Meter, and roughly using a 1 unit pet 10g of carb ratio. So today for example, I had 5 units each for breakfast & lunch, and 8 for dinner
 
bellabella said:
For my Bolus, it varies according to the meal. As I'm newly diagnosed I haven't done any official carb counting self education yet, so I choose a dose according to the Meter, and roughly using a 1 unit pet 10g of carb ratio. So today for example, I had 5 units each for breakfast & lunch, and 8 for dinner
Click to expand...

I meant what type, eg. Novorapid or something else ? They work slightly differently:)

Signy
 
Being new I'd get the nurse to help you check your basal dose first, because 180g of carb a day may not mean that protein will affect your BG as much as someone on 50g a day
this has been suggested to give a background to basal testing
Basal testing
http://www.diabetes-support.org.uk/info/?page_id=120

and there is also a free online course and workbooks till you can do your course for a background info, always put any changes through your nurse

Free to register
http://www.bdec-e-learning.com/

This set of workbooks are worth reading and practising working examples only of carbs and doses
Don't change dose without nurse approval
http://www.diabetesinscotland.org.uk/Publications/9224 Overview

Workbook 1
http://www.diabetesinscotland.org.uk/Publications/9225 Carbohydrate Counting.pdf
Workbook 2
http://www.diabetesinscotland.org.uk/Publications/9226 Carbohydrate Counting the Next Steps.pdf

Carb list
http://www.diabetesinscotland.org.uk/Publications/9227 Carbohydrate Tables A6.pdf

Diary
http://www.diabetesinscotland.org.uk/Publications/9228 Free Diary Portrait A4.pdf



Sick day rules
http://www.diabetes-healthnet.ac.uk...flet_-_Sick_Day_Rules_for_Type_1_-_Nov_13.pdf
Sick day rules flowchart
http://www.leicestershirediabetes.org.uk/uploads//documents/Type1 Sick_day_rules_InsulinV3.pdf


A workbook with USA BG numbers if you're not uk numbers
http://www.bd.com/us/diabetes/download/insulin_adjustment_workbook_complete.pdf
 
bellabella said:
@noblehead: when you say you split your dose, how long after your meal do you wait to take the 2nd dose?
Click to expand...

I don't often have a meal without any visible carbs, however for a 4 egg omelette or bacon & eggs I would need 4 units of Novorapid insulin, I'd take 2 units immediately before eating then take another 2 units around the 2 hour mark postprandial, the second dose would deal with the slow breakdown of the protein and fat.

But like most things with diabetes we are all different and this might not work for you, anything you've learnt to date about carb counting and injecting insulin (insulin-to-carb-ratio's) may well go out the window when if you LCHF, it will be a case of trial & error until you find a way of bolusing for these type of meals yourself, perhaps by keeping a diary of the meals you eat, the blous doses you give and your postprandial bg readings afterwards may give you a better idea on how best to bolus.

Sorry it's bit vague but there's not much more to add, both Sam JB and Robert72 follow a LCHF diet and they would be best placed to advise on insulin dosing. If I were ever to try low-carbing again I'd probably want to do so using an insulin pump or go back to when I was using human insulin and would ask to use an insulin called Actrapid, it's profile (IMHO) would better suit LCHF meals.
 
Thanks, @noblehead, you explained this far better than I could have :)
I personally didn't get on with Novorapid, especially after changing to LCHF . Even splitting the dose missed the mark, That's why I've changed to HumulinS which suits me completely, though I'm aware it wouldn't suit everyone. I'm just a person who gets on better with the "old" human insulins :rolleyes:

Signy
 
Hey again! So today pre lunch my bg's were 4.9. I had lunch ( salmon and cheese salad) and took 2 units with it. 2 hours post prandial my bg's were 5.9, so I didn't take any more QA insulin ( was at work and didn't wanna go hypo, just being extra cautious ATM) 3 hours pre dinner was 5.1. Pretty happy with that so took 2 units with dinner again and will check in two hours to see if I need more. I'm really enjoying the food on lchf so far, so am hoping it'll be beneficial for bg's and losing the insulin induced belly bulge! Also, just wanna add that this forum is providing a wealth of info and support since I've been diagnosed, it's great to hear other type 1 diabetics experience as it can be such an isolating condition sometimes
 
Just to briefly reiterate what @jack412, @noblehead and others have said, in order to do LCHF safely you have to be sure that the balance between your basal dose/rate and your carb ratio is correct. Going on to LCHF will often reveal that basal and bolus seemed OK on a high carb diet, but were actually wrong. This is easily done, if you were eating roughly the same amount of carbs each day / each meal (today's breakfast same carbs as yesterday's breakfast, etc).

However you are paying attention to your BG and adapting your insulin doses, so I think you will be fine, particularly as you are enjoying the LCHF food. Well done, and good luck!
 
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