[Diabetes-Talk] G5 question

[TALey at ups.com]

Bridgit, 

As you know, even the fast acting insulin analogs such as Novalog and Humalog still take 20 minutes or so to begin lowering your blood sugar, so the idea is take the insulin 20 minutes before you start eating. If you wait to take the insulin until after you start eating or not until you've finished eating, typically the carbohydrates in the meal digest quickly and start to raise your blood sugar before the insulin can start working. In an ideal situation, you would like the insulin to begin working at the same time the carbs begin to raise your blood sugar. 

For most people, the blood sugar rise after the meal is much much higher when taking fast acting insulin at meal time or after meal time than it is compared to when you take the insulin 20 minutes before you start eating. By the way, medical professionals sometimes refer to the after-meal blood sugar as the postprandial blood sugar. 

For people who've been taking their fast acting insulin at the start of, or at the end of a meal, studies have shown they can get a fairly nice drop in their A1C simply by following the 20 minutes before eating rule. Of course, the 20 minute rule wouldn't apply if you are already low! And, check with your doctor before making any changes to the plan your doctor has set out for you. 

If you are eating a low carb meal and lots of fiber and protein which will slow the digestion of any carbohydrates you eat, then the 20 minutes before eating rule probably doesn't make sense. Bridgit, you've worked that out with your doctors and it seems to be working great, which is the most important thing. 

I usually don't follow the 20-minute before rule because I have Diabetic gastroperesis, which slows down the digestion of everything, including carbs. . 

Hope this helps.

Tom



-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Bridgit Kuenning-Pollpeter via Diabetes-Talk
Sent: Monday, February 13, 2017 9:35 AM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Bridgit Kuenning-Pollpeter <bkpollpeter at gmail.com>
Subject: Re: [Diabetes-Talk] G5 question

Funny, but it's been years since I've bolused before eating my meal. Even before I switched to a pump, my doctor recommended bolusing after a meal.
One of the problems with bolusing before eating is what happens if you don't want to finish your food? But if the insulin is already injected, you kind of have to finish. Or if you want a little more after eating a first helping, but you've already bolused, again, if you don't take more insulin, you will likely go high. And we found I didn't drop so much when bolusing after eating. But I see a lot of insulin independent diabetics still bolus before eating. Curious.

Bridgit

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Tom Ley via Diabetes-Talk
Sent: Sunday, February 12, 2017 9:10 PM
To: diabetes-talk at nfbnet.org
Cc: TALey at ups.com
Subject: Re: [Diabetes-Talk] G5 question

Veronica, 

Your accounts of the daily real world experiences with a CGM are similar to mine. 

I wonder if a better way to produce healthier outcomes for the high alert on a CGM like the Dexcom would be to let you set a number for your high threshold, but instead of alarming once you reach that number, only alarm if you go above and remain above that number for some period, like an hour. I know exactly what you mean about seeing your number start to rise toward your alert level, and in an attempt to keep it from getting there, you take too much insulin. Timing your insulin with your food is not always straight forward. 

For me, my food doesn't always digest at the same speed, due to Diabetes gastroperesis. If I bolus my short acting insulin 20 minutes ahead of eating, like everyone recommends, I sometimes go too low before the meal begins to digest. 

So I usually wait until I've started my meal to bolus my short acting insulin on my pump, but if the food digest normally, not slowly as usual, then my blood sugar goes up quickly before the insulin starts to take effect. 

With my CGM, I watch it climb toward the high alert level I've set, and to try to avoid that alert it is tempting to take more insulin. The trouble is many times I don't really need more insulin, I just need to wait for the insulin I've already taken to begin to work. 

That's why I'd like to set a high number, but only have it alert me if I've gone over it and stayed over it for an hour. 

Tom






















-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of Veronica Elsea via Diabetes-Talk
Sent: Sunday, February 12, 2017 8:29 PM
To: 'Diabetes Talk for the Blind' <diabetes-talk at nfbnet.org>
Cc: Veronica Elsea <veronica at laurelcreekmusic.com>
Subject: Re: [Diabetes-Talk] G5 question

Good idea about the ear buds, Tom. But as I said I just turned mine off. I had trouble living in fear of that high alarm. I also noticed, especially during the first few months, I tended to over treat when I'd get near that high number. Yeah I saw a better A1C but I had more lows. So I'd say I'm still kind of learning how and when to react to what that Dexcom says and does. I've had a few occasions during this last update where the app accepted my calibration and then seemed to forget that it had calibrated. So there I'd be on a bus or something and up would come the calibration alert.
But it's like any device. It just takes some time to make it mine. <grin> Veronica


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