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Old 05-04-2013, 10:44 AM   #1
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Anyone bolus for just one meal a day?

My PCP had been treating me as a type 2 diabetic, but basically I still had to starve myself to keep from having BGs in the stratosphere. After more than a year, she finally referred me to an endocrinologist, who diagnosed me as a late onset type 1. (Age 70, yeah, I'd call that late onset!) He put me on Lantus 8 units daily and gave me instructions to start Humalog as a bolus before each of my 4 meals a day. A week later he called with results of my antibody tests, and after hearing my before-meal readings I'd been getting with Lantus only, agreed to let me stay on that only rather than adding the Humalog. He said he was turning me back over to my PCP for further follow-up.

Neither the endo nor my PCP has ever asked me to take any after-meal BG tests and what few I'd taken before that, they basically ignored. But from all my readings on the web, it seems to me that the frequency of my results over 200 is of concern. I've done more tests (and expect to do more yet before seeing my doctor next time) and really think I should be injecting the Humalog for meals. But I'm so darned skinny that I'm just in terror of having to give myself five injections a day!

I lost so much weight in that year+ that I only have a very small area on my abdomen where I can see that I have enough fat to give an injection. At five injections a day, I'd be hitting the same area every few days! I sure don't have any 3/16 of an inch of fat on my arms or thighs. So I'd hoped to be able to gain a little weight before starting the additional injections. But I seem to be in a no-win situation. How can I gain weight when I can still eat so little before my after-meal BG gets into the 200s? At least I can eat a little more than I did while on oral meds only, but as I see all those high after-meal numbers, I'm getting more and more concerned. I'd really like to gain 15 pounds before the fall rains start in October.

The thought occurred to me that perhaps I could have just one meal a day of higher carb and bolus for that, but keep the remaining three meals a day at 20 grams carb or less. Does that sound reasonable? Do you know anyone who has tried that? I want to be able to have specific suggestions I think will work when I see the doctor, as I don't believe she has much experience dealing with a type 1.5.

 
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Old 05-06-2013, 05:09 AM   #2
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Re: Anyone bolus for just one meal a day?

Whether or not you need to bolus after a meal will depend on what your blood sugars are running. Try a low carb meal and then test at the 2 hour mark. If you are high, then you know you needed to bolus. This is all trial and error for all of us.

The "honeymoon" period for late onset type 1 can last for years and years. So you might be able to get away with this regime for a long time. You may still produce enough insulin for a low carb meal. But also remember, try to enjoy your life. If you want some extra carbs, don't be afraid to take a small bolus for it. I'm not saying go whole oink, but given your age, the odds of developing complications and still being alive to do it are relatively small. The trick is to maintain good blood sugars, feel well, and enjoy your life.
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Old 05-06-2013, 09:28 AM   #3
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Re: Anyone bolus for just one meal a day?

Thanks, Cora. Finally yesterday I decided I could stand this battle no longer. I've been having to restrict food for a year and a half now, first on oral meds and trying to increase exercise only. Then for the past five weeks on Lantus plus Metformin and exercise. But I was still getting 2-hour highs near or over 200 on the rare occasions I tested.

So yesterday I took my first Humalog. I decided I'd bolus for two meals a day and try to keep the other meals mostly fat and protein so I could avoid extra bolus for them. Even so, I look at my poor abdomen. I'm already horribly bruised from the Lantus injections. And after you subtract the 2-inch from navel area where you aren't supposed to inject, I have hardly any space left for testing. I'm just so thin!

After injecting Humalog for dinner last night, I went from 147 before dinner to 287 two hours postprandial. I did, however, drop to 96 by 3 am, so I'm inclined to think it might be more a question of the timing of my injections rather than the insulin to carb ratio. Then I had a 9 gram carb snack at 5 am without a bolus and my BG was still 8 points higher than before my snack 3.5 hours later. My snack was high in fat, though, (mostly cheese) so I wouldn't expect it to drop fast plus at that time of day who knows? In the past I've never noticed anything of a dawn phenomenon, but it is possible that I might have a small one.

I can see that this is going to take a lot of testing, recording, and analyzing. But I sure hope I can gain some weight fast so I have more than a couple of square inches in which to inject!

Last edited by Uff-Da!; 05-06-2013 at 12:23 PM.

 
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Old 05-06-2013, 09:37 AM   #4
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Re: Anyone bolus for just one meal a day?

Oh, I forgot to mention. Yesterday for lunch, for which I did NOT bolus, I had 15 grams carbs. I neglected to test at the two-hour mark, but before dinner (which was 4.5 hours later) I was still 20 points higher than before lunch in spite of working in the yard for an hour or two in the afternoon. I'm going to test for 10 grams carb at lunch today, and see if I can handle that much.

 
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Old 05-06-2013, 02:26 PM   #5
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Re: Anyone bolus for just one meal a day?

An excellent book to buy (or borrow from the library) is called "Using Insulin". It is an excellent work that will tell you all the tricks of maintaining good levels. Best of luck and feel free to ask lots of questions.
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Old 05-06-2013, 04:01 PM   #6
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Re: Anyone bolus for just one meal a day?

I'd seen you or someone else recommend "Using Insulin" before and had it in my cart at my favorite online bookseller already. But I wanted to check to see if my local library had it first. I just checked and they don't, so guess I'll go ahead and order. I really do have what seems like a zillion questions and haven't had that good luck finding good explanations online.

Is there a best time of day for one's basal injection? I've been doing mine in the evening after dinner just because that seemed like a good time that I'd never be eating or sleeping or busy cooking. (Otherwise I keep a really weird schedule.) But I'm wondering if that's a poor choice of time if I'm one of those people where the Lantus doesn't last a full 24 hours. Dinner is usually my largest meal and it is normally at 5 or 6:00. How would I even know if my Lantus lasts 24 hours or not?

 
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Old 05-08-2013, 11:03 PM   #7
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Re: Anyone bolus for just one meal a day?

Another thought, Uff-Da -

Since you are actually a T1 and you've been running so high, you're probably producing ketones much of the time, which would explain the weight loss and the inability to regain some of it. If you start bolusing for meals (based on your carb intake), you'll probably be able to gain some of the weight back. You'd have to figure out your insulin-to-carb ratio (and that book might help here), but once you do, you count the carbs you're planning to eat and bolus accordingly.

Also, what areas of your body are you using for injections? You can use the backs of your upper arms and the fronts of your thighs, plus the upper area of your butt (usually we can only manage that on the side of our dominant hand though)...but if you're not already using those areas, it'd help to spread out the shots somewhat.

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Old 05-09-2013, 03:54 AM   #8
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Re: Anyone bolus for just one meal a day?

I'd never thought that I might have a problem with ketones. I don't recall why, but I somehow didn't think I was likely to have a problem with them now that my BG gets back into the normal range several times a day, even though it goes sky high for a few hours after meals. I'll have to look into this ketone possibility more. I'm going into town today and could buy a ketone test kit.

The only place I've been testing is on my abdomen. Seriously that's the only place I see any fat where I could get at it, but in five weeks on Lantus and now four days of Humalog twice a day, what little fat pockets I have there are horribly bruised and have puncture marks about every half inch. I see no fat on my upper arms at all, just skin over bone and a miniscule amount of muscle. At 105 pounds and 5'5", I'm really THIN. I have arthritis, so I'm not very flexible and question my ability to do it myself, but I guess I could get my BF to give me injections in those little fat pockets below the waist in the back. I hate to have to ask, though, but it may come to that.

Last edited by Uff-Da!; 05-09-2013 at 03:56 AM. Reason: duplication of phrase

 
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Old 05-09-2013, 12:39 PM   #9
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Re: Anyone bolus for just one meal a day?

Never having been that thin myself, I'm not sure how it'd work, but when you use either your thighs or the back of your arms, you have to pinch the skin up. Insulin shots are just subcutaneous (under the skin), so they don't even have to go into fat pocikets. Also, you might want to inquire into the shorter-needle syringes.

Ruth

 
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