Beware the Forgotten Bolus...

On my iPod Diabetes Pilot app, my glucose readings are color-coded so I can immediately tell how I am doing. Black readings are in the desired range, blue are lows and reds are for those infernal highs. I was in the black all of yesterday (even with Mexican for lunch!) then ended the evening and early morning in the red. Why?

I was a victim of the forgotten bolus.

What is the forgotten bolus, you ask? Actually, if you ask that you probably aren't a diabetic. All real diabetics have experienced the forgotten bolus, when they get so caught up in the moment that they actually forget that they have diabetes and neglect to bolus.* Believe it or not, it actually sometimes happens. In my case it occurred at my daughter's birthday party at her favorite restaurant, Famous Dave's BBQ.

Here's how I was attacked by the forgotten bolus. We sat down at the restaurant and I decided what to eat. I decided upon the BBQ pork sandwich, a diet Coke and some baked beans. I knew the baked beans were going to throw a complication into the mix, but I was ready for the challenge. I dutifully input all my info into my trusty little iPod app and it calculated the total to be 94 carbs. I input that into my pump and pushed the magic ACT button and it told me that I needed 13.4 units of insulin.

Because of prior experience, I knew that sometimes the food took a bit longer than expected to arrive, so I refrained from giving myself the bolus at that time. Then she opened her birthday gifts and suddenly the food arrived, we hurried to clear the table and set about enjoying a nice meal, complete with a birthday sundae for the girl.

Things went so well I didn't even notice that I had forgotten to bolus. A few hours later, about 8:30pm, I tested at a whopping 311! I figured that I had woefully underestimated the amount of BBQ sauce I had used--that or perhaps that diet Coke wasn't really a diet Coke--and gave myself the recommended 9.5 units of insulin. Two hours later: 345. 345? how could my blood sugar have gone up in two hours? Unless....

That was when I checked and realized that I had become a victim of the forgotten bolus. The insulin units I gave myself at 10:30pm wasn't enough, which prompted another round at 2:40am (238, 5.9 units) until the morning arrived at a cool blue 70. A bit lower than I would have liked, but I wasn't going to complain and could certainly use the difference to offset twelve hours or so of being too high.

Gee, if I'm already forgetting stuff at this age, what will I be like when I am really old? Like at, say, 50?!

:-)


* Not to be confused with the neglected bolus, which occurs when you know you really should bolus for something and you decline to do so out of laziness.

Random thought at 2:30 am

When I was young, from as early as I can recall up to high school, I would often spend a Saturday night at my grandmother's house. Each night before bed she would give me a bowl of cereal "so I wouldn't feel hungry during the night." There was little chance of that actually happening since hunger and an Italian grandmother are two words seldom used in the same sentence, but it meant a lot to her and I certainly wasn't complaining. No doubt that is one of the reasons why I was always a bit overweight. Nothing like a bowl full of Frosted Flakes before bed.

I was reminded of this at 2:30am this morning, as I write this entry. I just woke up with a low of 60 and decided I needed to treat it with more than some glucose tabs. So now I'm enjoying a bowl of Life cereal in the middle of the night. Why? At 11:30 pm I was at 68 and had taken 3 tabs and dropped my basal rate to 0.5 for an hour. But that evidently wasn't enough to bring my BG back up. It must have been those damn homemade coconut macaroons I had earlier in the evening; I must have over covered for them. Anyone have any idea how many carbs in a homemade chocolate covered coconut macaroon?!