Well, today, I did it again. First off, I succumbed to a bowl of noodles, which was bad enough, but I figured I should pre-bolus for it, in order to head off a high spike. So I gave myself a 10-minute head start, and enjoyed the noodles. And just after I finished, I started feeling a bit weird, so I checked, and I was down to 52. NOT really where I wanted to be.

So my question for my friends is, if you're going to pre-bolus, how much time do you give yourself? Ten minutes was too long for me, but I've tried 5 minutes, and that's too short. Or does it vary according to the phase of the moon?

I also didn't know whether I should try to treat the low, because my stomach was full, but I decided to just wait it out -- I knew the carbs would kick in reasonably soon, and they did, but not until I had made several panic calls to friends, of which no one was home! So the next question is, if your stomach is full, and you're low and dropping, what do you usually do? Like, there shouldn't be a next time, haha!

I thank you for your continuing support!

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I'm almost positive I have delayed stomach emptying, at least for solid food, but not for liquids. I drink tea with milk in the morning and it hits quick. But in the past, I've mostly observed it when I eat too much (who me????), and this was a smallish bowl of noodles -- not enough to make me feel overfull.

I think it's the hiatal hernia -- my stomach is shaped like an hourglass, and the stuff in the top part, above the diaphragm, has to squeeze through a small opening to get to the bottom part, and then into my intestines. So, just like the sand in the hourglass, it takes time.

I should probably study up on the techniques for gastroparesis, because the effect seems to be much the same, even though the cause is different. The things that really get me are eating a big meal, because the insulin runs out far sooner than the food gets through, and I see a flat line for the first 3 hours, and then a rise after that. And maybe pre-bolusing for liquids is a good idea, but not for solid food.

I wish I had a double bolus on the pump, and not a dual wave, because I've tried the square wave, and it doesn't work, and what I really want is a delayed bolus I can set for 3 hours after the first one!

Oh yes, your hiatal hernia. That would certainly do it. I can't eat large meals without suffering discomfort & consequences. I've never liked feeling full & stuffed even before diabetes.

I take split doses. We've talked about that before. I take a small bolus right after eating & another 1.5-2 hours after eating, which is really crazy inconvenient.

Gastroparesis techniques: Small meals, chew well, low fiber, food cooked well, no raw food (I eat salads anyway), no heavy dinner meals because gastroparesis is worse in the evening. Protein sources that are faster to digest are fish, poultry, eggs. Red meat takes a lot longer. If I eat red meat, it's chopped meat, roasted slow or in stews & soups. I also take digestive enzymes & walk after meals.

Update: so I hung right around 100 for 3 hours (partly the carbs, partly a glycogen response?), and then spiked up to 174. Aaarrggghhhh. I really do think I need to get serious about the dual bolus thing -- I've been sort of resisting it -- because you're right -- it's crazy inconvenient. But the pump does have an alarm I can set to remind me, so no excuses.

I pre-bolus with Humalog. Bernstein (who recommends R) actually tells people to pre-bolus 40-45 minutes before a meal. I pre-bolus 10-15 minutes before my meal when my blood sugar is normal (80s). If I am lower, I wait until right before the meal and if I am higher I might even bolus 15-30 minutes before.

Bernstein recommends stomach exercises to facilitate stomach emptying. These are like the classic stomach vacuums. They might help.

ps. Bernstein also recommends chewing gum.

Thanks for the link, bsc. I printed that page. You can do that *bending while sitting* exercise as a break from the computer...

I don't pre-bolus for foods such as pasta and pizza -they are slow to digest for me (and many) and then the insulin works before the food has had a chance to kick in.

Pre-bolusing is tricky for me just like flatlining is. I think the appropriate answer for pre-bolusing is...It depends. Of course you want to pre-bolus if you pre-meal BG is above target, but the rest seams variable. I would like to pre-bolus everymeal by 10-15 minutes if my BG is at 100.

I have days where I have trouble getting my BG up into the 100s and I have other days where I have trouble getting my BG below the 130s. This may be related to different insulin sensitivites based on the moon? In any event, if I know the insulin has a little more kick that day I may not pre-bolus at all and if I know I have been running high I will pre-bolus maybe 20+ minutes before the meal.

If I test after a meal and see a 52 I treat with a small correction. My rationale is that if I drop into the 40s my brain gets foggy and I want to avoid that. If I test in the 60s then I guess and follow my CGM.

Chew gum! Seriously helps to get the stomach going. I have done that a few times, I usually pre bolus at least 10 to 15 minutes and I don't typically have any problems. When we had italian food the other day, I bolused when we were waiting to be seated, it worked perfectly, it was like a 30 minute window though before I ate. YMMV

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