In the grazing snacking technique, snackers eat small amounts of carbs intermittently over a three-hour interval, resulting in the consumption of a large amount of carbs. Bolusing for these carbs every 15 minutes or so is problematic if using an insulin pen or syringes (without an insuflon or other port). It is tough to manage blood sugars if a grazer employs insulin pens for blousing. A better strategy for a "cow-like grazer" would be to consider insulin pump therapy and bolus as he goes. Even this strategy may not be as effective as one might think due to the complexity of the carbs consumed, accuracy of carb counting, and the "insulin on board" feature. However it is more effective than trying to do a snack recall after one has consumed carbs during the last three hours and giving one bolus by injection or pump.

Another effective strategy, especially for pump users, is to give the correction bolus before the snack or meal. Give the rest of the insulin after they either know what they are eating or have consumed all carbs. It is tough to bolus ahead of time if you do not know what you are going to consume. In small children or toddlers, bolusing after the snack or meal may be the only recourse. Keep in mind, as a result of continuous blood glucose monitor tracings, best blood glucose control has been demonstrated if one boluses before eating (even 15 minutes earlier).

Your eating style may determine the best strategy for insulin management. It is important to be honest with your diabetes team about your eating tendencies so that we may best assist in an eating game plan to improve your quality of life.