When To Give Pre-Meal Insulin

Dr. Bill Quick Health Pro February 03, 2013
  • Another diabetes myth just bit the dust: the idea that pre-meal (bolus) injections of regular human insulin should be given thirty minutes before eating. This is a myth that I grew up with, and one that I had religiously taught my insulin-using patients back in the days before insulin analogs became ...

4 Comments
  • Anonymous
    Bennet
    Feb. 03, 2013

    I think this is one of those things where A1C is not the ideal measure. I would be curious to see if a measure of variability within the day would show an advantage to the pre meal shot. The real issues would be if complications are a function of variability within similar long term averags A1cs. 

    • Gretchen Becker
      Health Guide
      Feb. 03, 2013

      I agree with Bennet. You can have a good A1c but fluctuating BG that I don't think is healthy.

       

      What was the "blood glucose profile?" How often did they measure?

    • Deafmack
      Feb. 04, 2013

      I agreee that using an A1C is not a good test as it only measures averages of the hemoglobin over a 2 to 3 month period. I think a better test would be to measure the post prandial glucose at one hour and two hour intervals to see if injecting regular insulin at 30 minutes preprandial or at the time one starts eating makes a difference. To me using the A1C...

      RHMLucky777

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      I agreee that using an A1C is not a good test as it only measures averages of the hemoglobin over a 2 to 3 month period. I think a better test would be to measure the post prandial glucose at one hour and two hour intervals to see if injecting regular insulin at 30 minutes preprandial or at the time one starts eating makes a difference. To me using the A1C is flawed.

      On one note not having to wait or having to time the injection so it is 30 minutes before a meal could be a hug plus especially if one is eating out or eating at a friend's house and has to wait to eat.

    • Gretchen Becker
      Health Guide
      Feb. 04, 2013
      When I had a CGM (a kind friend gave me one because he didn't like it) and was trying bolus insulin, I did a lot of tests, taking Humalog, Novolog, and Apidra (not all at once) at different times before eating a piece of bread. It took a long time after injecting (I think up to 45 minutes) before the BG started going down, at which point I quickly ate the bread....
      RHMLucky777
      Read More
      When I had a CGM (a kind friend gave me one because he didn't like it) and was trying bolus insulin, I did a lot of tests, taking Humalog, Novolog, and Apidra (not all at once) at different times before eating a piece of bread. It took a long time after injecting (I think up to 45 minutes) before the BG started going down, at which point I quickly ate the bread. I was able to reduce the peak, but when I injected enough so that the peak wasn't very high, I went low at 3 to 4 hours. The curves in different tests were amazingly similar; I could superimpose one on the other, and this way of testing sure beat pricking my finger 10 or 20 times. But my main conclusions from all this testing were that (1) no insulin will keep BG from going up after a fast-acting carb and (2) bread really doesn't taste good enough to warrant all that calculating and waiting, so I returned to my low-carb diet, which works for me along with a basal insulin.