3 Secret Insulin Strategies That Have Transformed My T1 Diabetes Management, Stabilized My Blood Glucose And Make Me Feel I Am In Control (Which My Endo Never Told Me About)
The "Rule of 15" was one of the first things they taught me when I was diagnosed with T1 Diabetes: inject your insulin, wait 15 minutes, then eat.
Many (me included) sticked to this strategy for years irrespective of the situation. I felt somehow protected by the halo of Science, and regardless of the impact of this strategy on my blood sugars, I was religiously committed to it because the "doctor said so", and I was nobody to contradict my doctor. Luckily, I’ve grown out of that false belief, and recognized that the Rule of 15 is nothing more than a fine rule of thumb which only really applies to a handful of very linear, predictable life situations.
Sure, I am no doctor. But let’s be honest, I live with diabetes 24 hours a day, 7 days a week, 365 days a year, every year of my life.
And my real life experience is much more insightful than a bland formula.
Everyone with diabetes knows that the unpredictable nature of life calls for adaptable diabetes management strategies.
And when it comes to insulin timing, learning to be adaptable is crucial for survival.
One bad insulin timing decision (such as applying the Rule Of 15 when blood glucose is already trending low) and the life threatening hypoglycemia is just around the corner. Two bad insulin timing decisions and your day becomes enslaved by the blood sugar rollercoaster. A lifetime of bad insulin timing decision and you get to suffer the long term complications of T1 Diabetes.
Luckily for us all life is a great teacher. My personal experience revealed to me 3 Insulin Strategies that are far more effective and adaptable than the Rule of 15. I have learned them and refined them "in the trenches" of life with diabetes, and they helped me improve the intentionality and the quality of my life with T1 diabetes.
Here they are:
Split Bolus
In Split Bolus, you give part of your insulin before, and part of the insulin after eating.
Here are some circumstances where I have applied it:
Unsure about hunger level / portion size: After a long day of train travels, I was not that hungry for dinner. I had to eat because I had a big run the morning after, but I wasn’t sure I would go for a big meal. My thinking was: “all right, I’ll take half the insulin because I’m going to eat half my normal portion. If I eat more than that, I’ll adjust the dose after my meal accordingly.
Eating carbs with proteins: proteins metabolize as glucose hours after the meal, so when I have meals rich in proteins, I take into account that there’s going to be a small spike later. My usual lunch is richer in proteins, so I lower my meal bolus and add the remaining amount of insulin a couple of hours after my meal. Flat blood glucose!
Eating carbs with fats: Fats delay the absorption of glucose. So, in order to avoid hypo right after and hyper hours after the meal, I split my bolus tactically. If thee fats amount is particularly high, I might even take 40% at meal time and 60% one or two hours after the meal (I know it sounds crazy, but there are cases when more aggressive strategies work great).
Planning to move after the meal: I always walk after my meals, and since walking increases the effectiveness of insulin, I must make sure I am not going into hypoglycemia. I usually reduce my meal bolus by 20% and take the remaining part after my walk only if I see my blood glucose on the rise.
Post Bolus
Post bolus means giving your insulin only after eating. If this sounds crazy, there are great use cases for this strategy too:
When you’re already low: if I am already low, I ALWAYS eat something and THEN inject insulin only when blood glucose is in a safe zone (around 100). I never want to put myself in dangerous situations, especially if I am not home. So: hypoglycemia = first eat, then inject.
After intense exercise: after every one of my marathons, I literally ate 5 or 6 pieces of fruits right after crossing the finish line without any impact on my blood sugars. After my Rome Marathon, I finished with blood sugars at 160, ate three apples and two bananas without insulin and one hour after I was at 80. Sometimes insulin is not needed: had I taken my usual dose I would have probably spent hours in hypoglycemia. I only had to inject a couple of units around 6 hours after the end of the race.
At restaurants: I don’t eat out very often, but when I do I always have no idea about the portion size, the carb content or how long I will have to wait for the meal to be served. Unless I am very high in blood sugars (rare, but in that case I’ll take a corrective unit anyway), I wait for the meal to be served and then decide how to dose.
When sick: I have experienced situations where I would eat and, because I was sick, the chances I would be able to keep the food down were very low. Injecting, eating and throwing out all the food means that you have insulin on board and no glucose for it at all. Which means: hypoglycemia. And since you can’t really eat, that means if you go low you can’t even take sugars because you won’t digest them. When I am sick, I always take the shot ONLY after the meal, when I am sure that the food is staying in the body.
Eating fats / proteins / fibers only: Some of my preferred snacks include carrots, olives and unsweetened soy milk. None of these might will rise blood glucose immediately, but they all could have some impact some hours later, if at all. So only take insulin when you see that blood glucose starts to rise.
Pre Bolus
Pre bolus is the closest one to the Rule Of 15, and it is nothing but an attempt to match food timing with insulin timing. I have learned that the timing of injection varies greatly depending on the context of my day.
Specifically, it varies on a day to day basis, and even on a meal to meal basis.
For instance (for the sake of the example, let’s consider perfect blood sugars, standard meals from day to day and the same carb to insulin ratios):
When I am more stressed I know I am more insulin resistant, so I am going to wait more than the 15 minutes I waited yesterday.
When I haven’t moved much, such as on long travel days (on plains or trains), or when work gets a bit busier and I am glued to the chair, I know that it is going to take longer for insulin to enter into circulation properly. So I wait 20, even 30 minutes if needed.
When I haven’t slept well, I know I’ll be more insulin resistant all day long. This means: insulin will be slower at operating, and I must respect that slower pace by increasing the time between my injection and my meal.
When I haven’t drank enough water, because the more hydrated we are, the easier it is for insulin to travel around our body. So, dehydrated? Wait longer (and drink water!)
These are some examples of how I (and we all) can make our insulin timing mach real life situations in a much more flexible way, keeping our blood sugars much more stable and helping us ENJOY our life more.
It is all a matter of balancing different variables of the diabetes equation, considering many of the variables that come into play (a topic we have covered in a recent article).
I’ll always respect the doctors effort to help us, but sometimes we need to learn from our real, hard earned experience living with the disease daily.
And experience tells me these insulin strategies are game changers and far more adaptable than the Rule of 15 to manage blood glucose while enjoying life.
