Conflict of Interest?

I am often frustrated by the absorption times of the insulins we use these days.

Don’t get me wrong! They are much faster than what we had back when Regular was the best tool for the job.

Back then we were told to take our insulin something like 30 – 40 minutes before we started eating. Talk about impossible!! I don’t know about you – but I simply could not follow that rule, and accepted settling for just getting it into my system as soon as possible.

Now that I’m using Humalog, the “lead time” is much, much easier to follow. But it’s still something like 10 – 15 minutes right?

There are many times that I dish up a meal, carefully counting all of the carbohydrates, and punching the information into my pump and allowing it to calculate my insulin delivery down to 0.01 units accuracy.

I’ll do my best to get the bolus in my system and working ahead of my meal – but I’m still not very good at it. When I start splitting things up (bolus, wait, eat), I’m just begging to screw something up (getting sidetracked after taking my insulin or something like that).

Once I start delivering my insulin, I have a five minute window for which I can stop the delivery (assuming I am using a standard bolus, rather than an extended or combination).

But what do you do when you have reached the point of being content with what you have eaten, and you still have a bunch of food on your plate?

What do you do when you’ve bolused for 65g carbs, but have only eaten 25 or 30?

You have kind of put yourself in a shitty spot – but you were only trying to do what you’ve been told you are supposed to do!

There are a few approaches you can take to this scenario, but none of them are really ideal.

1. You can bolus for your food as you eat it, or shortly after eating it. The problem with this approach is the timing of the absorption. The carbs you are eating will spike your BG faster than the insulin you are taking can counter that spike.

2. You can stuff your content stomach to the point of being uncomfortably full, because you bolused for more carbs than it took to satisfy you. This just plain sucks. Having to eat when you don’t want to is just crappy.

3. Work to balance meals to satisfy you, but with a much lower total number of carbs. Hmmm. Now this one has a lot of potential – but I’m not there yet. The idea behind this is that designing a meal to satisfy you with fewer carbs, your potential risk is not very great. It’s much easier to cover 20g of carb bolus than it is to cover 40g or 60g of carb bolus. Even if you don’t want to, you can pretty easily find something you can get down that has 20g of carbs.

Chess board with opposing pawns facing offThe point I’m after here, is that to stop eating when you are no longer hungry, and to pre-bolus in time for the insulin absorption and digestion curve to match up, is a conflict of interest.

I don’t much like conflicts of interest. They make life a little too confusing and complicated. I’m a simple guy – I don’t do confusing and complicated well.

I manage to pull it off somehow, most of the time, but that doesn’t mean I like it, and that doesn’t mean I do it well. There’s a lot of room for improvement with this one for me.

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Scott K. Johnson

Patient voice, speaker, writer, advocate, and Senior Community Manager at Blue Circle Health. Living life with diabetes and telling my story. All opinions expressed are my own and do not necessarily represent my employer’s position. Read more…

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