Overbolus Leads to Overeating

Patient Expert

My efforts to manage my blood sugar and be a good parent collided last night. Here's what happened:

First of all, some background information. Yesterday Sienna received her six month immunizations. The check-up went well; she's growing perfectly and developing normally. Getting shots always puts her in a little bit of a funk. So, by around 7:00 p.m. she was getting fussy and tired. I'd just enjoyed a delicious bran muffin after going for a walk with my mom and Sienna.

I knew my blood sugar was on the high side, so I tested in anticipation of dinner. My blood sugar was 233 mg/dl. Oops I bolused 2 ½ units of insulin as we were planning a low carb dinner of homemade cheeseburgers. Dennis and I attempted to feed Sienna some milk and then some oatmeal, both of which she mostly refused. She was getting more tired and fussy by the minute.

"Okay," I announced. "Let's just get her in bed and then make our dinner."

The memory of the recent bolus hit me, but then I figured, since I was high previously I shouldn't drop too low before we got dinner made.

You can see where this is going...

As we finally sat down to eat dinner, I started to feel low. Testing confirmed that my blood sugar was 48 mg/dl. Darn! The cheeseburger on half a slice of whole wheat bread wasn't going to raise my blood sugar very efficiently. So, I had an appetizer of Honey Nut Cheerios and milk (I take the opportunity to eat cereal when I can!)

After my cereal and cheeseburger dinner, I started to feel really low. The turnaround time of trending blood sugars can be so frustrating. When I tested at 48 mg/dl, I didn't feel that low. Even though I'd eaten sufficiently to raise my blood sugar, I still had to sit with that low feeling for several more minutes. To pass the time, I had a couple graham crackers and several mini brownie cookies with milk.

The regret soon followed. I bolused for my overcorrection and tested a couple more times before bed. My blood sugar didn't crest 150 mg/dl for several hours. Those in-range blood glucose results lured me into thinking that I'd bolused appropriately. When Sienna woke us at 4:45 a.m. this morning, I tested at 306 mg/dl. Agh!

There are many places where I could have changed my behavior and thus avoided these rollercoaster blood sugars. However, I think the most critical place to focus is on the catalyst: the severe low blood sugar before dinner. By bolusing for dinner in addition to giving myself a correction bolus for my high blood sugar at 7:00 p.m., I set myself up for failure. Since my eating schedule is now dependent on the activities of my growing family, I can't always predict when and what I'll be eating.

The moral of the story is to bolus independently for corrections and meals, rather than attempting to "superbolus" my way out of a high blood sugar. Sure, I may have slightly higher postprandial spikes if I avoid bolusing ahead of time for meals. However, that's a small price to pay for the piece of mind knowing I'm not going to have very low lows when my eating schedule goes awry.

Read more from Kelsey on related topics:

[The "Bare Minimum Method" of Diabetes Management](http://www.healthcentral.com/diabetes/c/5868/35426/minimum-management "The "Bare Minimum Method" of Diabetes Management")

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