Updated: Aug 31, 2021
If you’ve been following me on instagram for a while, you know that pre-bolusing is my FAVORITE tool for more stable sugars. While there is some planning that needs to be involved, it’s relatively simple and accessible, whether you’re on shots or a pump!
That being said, I know there are factors that stand in the way of nailing a pre-bolus every time, or even doing it at all. This blog will walk you through my experience with pre-bolusing, tricks I use to navigate certain situations (like eating out and pre-bolusing with unpredictability during work), and how I find the insulin timing that works for what I’m eating!
I don't think I ever really learned about the importance of pre-bolusing until I was 18 years into my diagnosis with t1d. However, I do remember the first time I heard the term. When I was in 4th grade, I went over to my friend’s house for a sleepover. My friend’s older sister had t1d, so my mom was super comfortable with it! In the morning, her mom made us pancakes. She helped my friend’s sister and I do our boluses, then set a 15 minute timer on the kitchen counter. We did not do this in my house. As we waited, I was entirely confused but way too shy to ask about why we were waiting.
When my mom picked me up, I asked her about the timer and remembered her saying, “Oh yeah. We should definitely be doing that.” But for whatever reason (most likely because t1d as it is requires more planning that anyone can manage), we never did.
Now, it’s not my mom’s fault that we didn’t incorporate pre-bolusing into my daily routine. In fact, I don’t think my endo placed any emphasis on its practice or importance. But after my rebellious phase with t1d when I finally started to crave stable numbers and more control, I finally sought out the magic of that 15 minute timer.
I’m no medical professional, but I can pretty much say with absolute certainty that stable blood sugars are a good thing. Pre-bolusing takes some of that after-eating bump out of the equation by allowing insulin to get moving in the body before the glucose hits. The result is more time in range and a better feeling me!
It’s important to note that not all increases in glucose are bad-- after all, even non-diabetics have fluctuations to their blood sugar. It’s a natural response to eating carbohydrates. I aim for a spike that does not go above 150 and comes back down to about 100 after the insulin has done its work.
There is not one thing alone that helped me get to a 5.7% a1c with 88% time in range, but this was definitely part of the equation.
Consistency over perfection
As a recovering perfectionist, I know that the fear of failure can prevent me from even starting a lot of initiatives. If I had one piece of advice to give around pre-bolusing, it would be to not let the fact that you may fail or may not do it every time stop you from trying.
There are some days for me that pre-bolusing is not in the cards and I just have to shrug it off. Or maybe I only successfully pre-bolus for one meal that day. No biggie! I know that I am still doing myself a huge service to my body and health.
General pre-bolus best practices
TRIAL AND ERROR: If you haven’t realized it by now, diabetes is not a one-size-fits-all disease. What works for me may not work for you. Understanding how your body reacts to certain foods and quantities of food can help you get a grasp on the ideal timing.
DISREGARD PERFECTION: I don’t keep a long list of my pre-bolusing times for each food, but I do have a general idea for how long I need to wait for things that I eat often. If I’m trying a new food, I will do a generic 15-30 minute pre-bolus. Based on the results from that, I alter the timing for next time.
KNOW WHERE YOU’RE STARTING: If I’m starting with a slightly higher blood sugar, I will give myself a little bit more time (and insulin) added to what I would traditionally pre-bolus for. As a rule of thumb, I like to be trending downward or below 120 when I start to eat. If I’m starting on the lower side, I will either lessen the pre-bolus or not do one at all.
SOMETHING IS BETTER THAN NOTHING: Even if I wanted a 45-minute pre-bolus, I’ll still take a 10-minute pre-bolus. Anything helps. Again, don’t let perfection stand in the way of progress.
ALL FOODS ARE DIFFERENT: The macronutrient composition of a meal will have a direct impact on pre-bolus timing. Generally speaking, more fat and protein will delay the absorption of carbohydrates, thus delaying the impact on blood glucose. So eating one item with added sides or sauces can change the overall pre-bolus timing.
This can cause a lot of frustration. But you don’t need to be a mathematician or have spreadsheets full of scenarios to get it right most of the time. I like to focus on general versus specific, and overall patterns versus exact numbers. It makes the pre-bolus equation more sustainable for me. More on that below.
KNOW THE FACTORS THAT IMPACT PATTERNS: There are so many. Physical activity, last meal time, macronutrient composition of meal (and the previous meal), quality and quantity of sleep, sickness/stress, time of day, water intake, muscle tone, and more can all play a role. Like I said earlier, I like to know how these generally affect the absorption and rate of the insulin working. From there I make an educated guess, usually adding or taking away 15-30 minutes of the pre-bolus in order to get it about right.
USE A TIMER: It’s really difficult for me to actually conceptualize what 15 minutes feels like. Sometimes, I way underestimate it. Other times, I pre-bolus, get distracted, and then totally forget that I was planning to eat until I hear that low alarm. A great way to combat both of these problems is by setting a timer! I have an apple watch, but you could also use your phone or any timer that will alert you when it’s time to eat!
Fear of lows can be a major obstacle that prevents people from pre-bolusing. After a bad low, I can find myself hesitating pre-bolusing because I don’t want to drop again. When this happens, I like to just work my way back slowly. Meaning, if I am eating a food I would usually do a 30 minute pre-bolus for, maybe I’ll just do 10 minutes. Once I trust my body and the patterns again, it’s easier to get back into the confidence that I had before.
Eating out at restaurants
This one can be tricky. Not only is it difficult to predict exactly when your food will come out, but it can also be tough to know exactly what the portion size is if you haven’t eaten there before or ordered that specific dish. Not to mention, snacking on appetizers, buffets, and drinking alcohol can impact the equation.
Here's what I do:
Immediately after I order, (whether it be an appetizer or meal or drink) I give myself a conservative bolus. Meaning, if I know at minimum something will be 40 carbs, then I pre-bolus for that. Once the dish comes and I see how much is actually there (or I realize how much I want to eat), I add more to the bolus (or not). This allows me to at least have some insulin working.
If the meal is taking longer than expected and I start to drop, I’ll ask the waitress for a lemonade or juice (or order a sweet cocktail hehe). This doesn’t happen too often. I find that most restaurants get food out around 15-30 minutes after ordering.
There are some situations that are just impossible to navigate with pre-bolusing. In those situations, like if I’m at a work event and there is no set time for lunch on the agenda, or if I’m not sure a place we’re going to has gluten-free options, I just wait until I know for sure. In other words, I just disregard the pre-bolus. Like I said earlier, I do it when I can, and I don’t stress when I can’t.
I hope this can act as a good base as you start to incorporate more pre-bolusing into your routine! Let me know if you have any questions in the comments or DM me on instagram!
*this blog is NOT medical advice nor am I medical professional! I'm just a girl who has t1d. Please always chat with your endo or diabetes educator about this stuff first.