[Diabetes-Talk] G5 question

Mon Feb 13 17:38:14 UTC 2017

Yeah, I know. I used to do the 20 minutes before a meal when I was younger,
but for years now, my doctor has had me take insulin after eating. I mean,
since my teens, and I'm now 35, and did not go on a pump until I was 23. I
know a lot of diabetics who do the same. So just curious. Thanks.

Bridgit

-----Original Message-----
From: Diabetes-Talk [mailto:diabetes-talk-bounces at nfbnet.org] On Behalf Of
Tom Ley via Diabetes-Talk
Sent: Monday, February 13, 2017 10:53 AM
To: diabetes-talk at nfbnet.org
Cc: TALey at ups.com
Subject: Re: [Diabetes-Talk] G5 question

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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