While I love most of what my son gained at diabetic camp, one thing I do not like is that at camp, they would have everyone insulin (inject or bolus) AFTER they ate. This was a unique environment, though, where camp life was active, active, active. My son has taken this as a way of life now. Everytime I ask him to insulin before he eats, he says he doesn't know how much he's going to eat. The days of estimating intake are way out that window. He's a growing boy and I'm trying not to get into major power struggles with him about diabetes and food, but now he NEVER insulins before he eats. He just wants to eat. Even after learning at a pump class that researches have found that blood sugar rises earlier than the injected insulin kicks in, even if you inject RIGHT before eating.
I guess, now that I'm writing, this is really a discussion for the non-pumpers. BTW, we went to a pump class in October and it just solidified my son's feeling that for now, the pump is not for him. He's bothered by the idea of something being constantly attached to him. He likes being to the inject and then forget about it for a while. He really didn't like hearing about all the times he could disconnect (intense dance classes, ultimate frisbee, showers, etc.). He said if he was going to be doing all this disconnecting, what was the point in the first place. Mind you, he understands that generally pumpers have better control. But right now he is 16 and I'm not going to force a pump on him. I wish he felt differently, but that's how he feels.
Have you talked to gone to his endo or diabetic team and discussed the insulin after the meal problem? i never went to camp so im not sure why they would do that..but maybe having an conversation that includes his endo in a more "adult" style will help or peer-to-peer..i donno what the word for it is haha. instead of talking to him as a parent telling their child what to do, give him a chance to express why he thinks it's a good idea, etc etc and then his endo can go into more detail about when it might be appropriate, why it's not most of the time and maybe why the camp did it.
i do sometimes, but usually when i've forgotten to before hand haha or like he's said, when im not sure how much i'm actually going to eat. usually, though that's mostly when im sick and not sure how much im going to be able to eat and keep down =/
im glad you're not forcing the pump on him :) i felt the same way when i was his age, tried it last year, and decided it still isn't right for me. he's the one who has to live with it attached to him 24/7, so it's important you respect his decision/wishes.:)
My Doctor has me bolusing after I eat and that's all I know. ( I was just Diagnosed in August 2010) but, they say they'll switch me to before eating after (insert amount of time here). I'm hoping to get a pump sometime in the near future. (I;m keeping my fingers crossed!)
I've learned, and feel that it makes the most sense to bolus before you eat.
However, I worked a diabetes camp this past summer and the RNs did bolius the kids towards the end of their meal/after they were finished. Their procedure was to test the kids, then while they were eating they would get the shots ready. Once the shots were ready, they would start giving them. I think this was done for two reasons, the first was that it takes time to calculate each individual's dosage, and also, we needed to make sure they ate all of their snack, and so wouldn't go low. Now I worked with the 4 and 5 year olds, and I believe the oldest kids in my camp were 10 or 11. With your son being older, and doing his own shots, it might have worked differently. But I do know that nobody was taught to bolus after the meal in my camp, it just made the most sense to do it this way because of the number of kids.
My endo yells at me for bolusing (or injecting when I go back to them) after eating. I have found that it is also easier to forget the insulin after eating.
I went to camp once the summer after my diagnosis, and we all took insulin before eating.
I guess it depends on what your endo thinks is good for your son. What's good for him is not always what is right for everyone else.
I'm not on a pump, and the only times I bolus after I eat is when I start off the meal too low. Otherwise, I find I need the insulin in my system to avoid spiking afterwards (although I do sometimes anyways, sigh). I agree that it would be easier to forget if you did it after too.
I can see that at a camp it would be easier to shoot everyone up after the meal, but I remember being SO MUCH more active at diabetes camp than real life, so I was running low anyways.
I think you could go about this two ways:
1. Ask him to bolus after the meal for 3 days and track his BG 2 hours post for each meal. Then, for 3 days, bolus before his meals and then track his 2 hour post BG's. Are they the same, or are they better if he injects before? Maybe this will help him figure out what works best for his body on his own.
2. Pick your battles and hope he grows out of this phase. Is he consistently taking his insulin, testing his BG's, etc? If so, it may not be a battle you can win with a teenager right now and you should count your blessings that he's otherwise compliant. Maybe the endo will change his mind down the road.
Let us know what happens! I'm curious! (And glad I have quite a few more years until I'm Mom to a teenager, lolol)
I'm guilty! But definitely not all of the time and not because I was told to do so. I am a pumper (not CGM), so when I check my BG, the number is transmitted to my pump and it kind of prompts me to correct and/or bolus for a meal before hand so I am getting better. If he needs some persuading to consider a pump send him on over to Juvenation, I bet there's a ton of us (myself included) that would agree a pump is better than MDIs in several ways. I ski, wear dresses, bikinis, etc without any pump issues!
I've always been told to bolus 15 minutes or so before starting to eat, and I've noticed that that's definitely the most effective. At the camp I went to, insulin was also given after/during meals, probably because it was easier for the staff to record everyone's doses and such then.
Maybe he's resistant to bolus before eating because he doesn't understand why it's important and why he has to change what he's learned to do by habit. My endo and parents are always annoyed with me because I don't recheck 15 minutes after treating a low, and I never really understood why that was important so I didn't want to bother changing what I'd always done. I'm still bad at remembering/motivating myself to do it, but a lot of the battle is realizing that it's important. If somebody outside his family explained why bolusing before eating is important, maybe he'd be more willing to listen.
Also, about pumping...let him get used to and accept the idea of pumping. If he's forced to try it, he'll probably view it more negatively than if he were to try it willingly. Although I wish I started on the pump earlier, I know that if my parents/endo had forced me to do it, I would have been very stressed.
I know that for toddlers, who don’t always eat what’s in front of them, that it is common to take the insulin only after eating. Maybe that’s why the camp does it too. But you’re son is old enough that he should have some idea what he is going to eat. I wouldn’t worry about it too much - taking insulin after eating is better than not taking it at all. There have been times I’ve forgotton to bolus before eating, and it really hasn’t made that much difference on my post-meal numbers by taking the insulin afterwards.
I have a tendency to do both. I was never told to give insulin 15 minutes before I eat until a year ago, so I routinely did it afterwards prior to that. It never fails that when I bolus before I eat, I'm no longer hungry for all the carbs on my plate.
I also agree with Spaghettio - taking the insulin after the meal is much better than not taking it at all. While it can be more beneficial on the post-prandials to take insulin beforehand, at least he's not rebelling against insulin in general. As a teenager, you will probably have bigger battles to fight. If you think you can, you might consider letting this one slide. :o)
We do a pre- and post-eating dose for my 8 year old daughter since we are never sure how much she will eat. We'll usually start with 20-25 carbs since we know she will normally eat at least that much - and then we finish up at the end to cover what she actually eats.
This works well for us right now since we are pumping and Mom and Dad are "hellicoptering" over her all the time. As she gets older and takes on more responsibility for her D - this may not work as well since I'm guessing it would be hard to remember to go in and finish up the dose.
But for now it's working for us and keeping the peace since before we did this we had lots of wars trying to get her to finish what we dosed for. ;)
I know dosing before is ideal, but think the benefit it creates is pretty small and not worth fighting over with your kid. It is important to make sure you're using one of the faster insulins (Novolog, Humalog) since that will hit his blood stream quicker.
Like others mentioned, at camp they probably dose after the meal because then it's clear how much was eaten. Also, meals don't usually start right on time, so it would be a mess to dose everyone in advance and then have lunch delayed.
Tell your son I was worried about being "attached to something" and put off getting a pump for 10 years. When I finally got one I felt comfortable with it about a day later. Wish I hadn't wasted so much time! He might consider just trying it; think most companies let you return a pump after 30 days of trial.
I do pre post and combo depending on BG fat in a meal and well once in a while forgetfulness. I think for a lot of high fat meals its better to do it after because she doesnt end up high and needing a correction as often.
The only time when I'd really wait until after is when I'm not sure I'll be able to eat much at all. Like if I'm feeling sick, and am not sure how I'll handle food. Otherwise, if I'm not sure how much I'll eat, I use my pump to give myself the minimum I think I'll need, then give myself the rest when I'm done. I also did this a couple times even before the pump.
My CDE advised me on my first business luncheon that would be served in courses: I can wait if the food isn't too carby, but I needed to give myself some insulin ahead of time otherwise. (So I stuck with salad, veggies, and chicken until I actually saw the last course, and could then inject for a better estimate of my total carbs.)
That said, I have a friend (in her early 30s) who has had D since she was 7, and she always injects after eating. She sheepishly told me "you're not really supposed to do it," while I was first learning about all this stuff... but she really feels like it works for her, and it sounds to me like she has pretty good control. (Of course, I generally see her eating fairly low carb meals.)
I bet that your son totally understands why it's good to bolus before eating, and doesn't care. What does twenty more minutes being higher really matter? Isn't that preferable to going low because you didn't eat as much as you thought you were going to, being forced to eat more, or being forced to do another injection because you're still hungry?
If I were you, I would not fight this particular battle. If he's taking insulin with every meal, and he's testing his blood sugar, let him take the insulin later. Yes, sometime in the non-teenaged future, he will probably care more about not spiking high after eating, but right now, that's not important to him, and fighting with him is probably not going to help.
Make sure he understands the benefit, and then let him decide whether the benefit is worth the lows, extra food, or extra injections, and know that sometimes it will be, and sometimes it won't.
I went to camp when I was younger and had 3 different endos before anyone ever even MENTIONED the before possibility. But my eyes also usually tend to be much larger than my stomach. I started bolusing before if I'm eating a bowl of cereal, granola bar, or lean cuisine or something along those lines, but for bigger meals, I always wait to see what I eat.
I would really encourage you to reconsider the pump before your son leaves for college though. I was on shots from 3-18 and then I got the pump before I left for college and it changed everything. Personally, I really only disconnect when I shower. I use a temp basal when I exercise (I also wrap it up in a paper towel so I don't sweat on it) and now with the continous glucose monitoring I am to control everything better!! I was absolutely terrified to get it and my mom really pushed me and I am so glad she did. In the eight years I have had it, it's only been accidently disconnected twice, once on a door handle and once on a drawer. And aside from my husband calling me the bionic woman, I constantly forget there is something attached to me.
I don't know if I would have made it through college so easily and happily without the pump. If you have an insurance company that will pay for it, I suggest taking advantage, you can always go back!!!!!
2. Pick your battles and hope he grows out of this phase. Is he consistently taking his insulin, testing his BG's, etc? If so, it may not be a battle you can win with a teenager right now and you should count your blessings that he's otherwise compliant. Maybe the endo will change his mind down the road.
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A lot of people find "compliance" to be an ugly word. Personally, I think it's not just paternalistic (which makes sense with one's children I suppose) but, even worse, condescending. I greatly prefer "adherent".
I would have to agree with the reply earlier about 2 reasons for giving shots after meals at camp. Just an administrative procedure to keep "chaos in order". I would not recommend it though. I have to be a hypocrite though, because there have, and still are times that I would bolus after. Must routine has been quite hectic for the last couple of years and I don't have much time to portion out my meals accurately enough to bolus before hand, but again for strongly recommend it.
I have been on the pump for probably a little over 5 or so years, and do agree that control is much better. The only reason for my general health care on diabetes is off is because of the freedom you can get with a pump. I am lacking a little bit of discipline to take care of it the right way, but it is possible to do so. The pump is probably more friendly when unsure about the amount of food, or atleast guessing on the amount to take. i would normal figure it out while eating and dial in the dosage during the meal, and the plus comes with square and dual bolus features.