For teens with diabetes, is dinner the most important bolus of the day?

For teens, dinner may be the most important bolus of the day.

In a recent study following 90 kids, ages 13-17, over a 2 month period researchers in the Netherlands found that teens who checked blood sugar one more time a day than their peers shows a 56 point improvement in their average blood glucose! These improvements were greatest among young people for whom the additional bolus was at dinner time.

Dinner is a HUGE opportunity for diabetes management! I often have patients tell me “breakfast sets the tone for the day” but dinner sets the tone for our NIGHT! When daytime blood sugars are off, or we miss an opportunity to bolus, we are awake, we are physically active, and another meal is coming with a chance to get back on track. Dinner is different. There is not another meal coming after dinner to allow for another blood sugar check before bed. When we do have a snack or other food after dinner it tends to be close to dinner time so we are unlikely to add correction. So if blood sugars are high after dinner they end to stay high all night! If we miss a dinner bolus that is a full 1/3 of our life with high blood sugar! Not only does that mean a serious hit to A1C and complication risks, our sleep suffers! When blood sugars are high we do not spend as much time in REM (rapid eye movement, the deepest part of our sleep cycle) sleep. REM sleep is when our brain converts short term memory to long-term memory. So when teens don’t get enough REM sleep their memory and attention spans suffer! This is also the time when our bodies repair most effectively. By honing in on that diner bolus we can improve academic and athletic performance!!! When we are not at our best, and when we aren’t getting great sleep we are also not socially very savvy. We are more stressed, more irritable, and more prone to depression. So getting a handle on diabetes management can literally make you more popular (ok it probably won’t make you home coming court popular, but it will make  dealing with the rigors of high school social interactions less of a mystery!)

Some potential barriers to dinner blousing:

• I meant to bolus, but then I forgot
• Pre-bolus before the meal: you are less likely to forget the bolus, the insulin will more closely match the food action reducing highs and lows, and if you end up eating more than you bolused for ahead of the meal you can always take additional insulin after!
• I barely checked blood sugar all day, why start now?!
• Check blood sugars before dinner bolus: This is your last big time to make a course change on your day before the night, so check blood sugars and factor that into your bolus!
• Dinner boluses never seem to work right!!!

Tips for improving dinner bolus habits:

• Look for opportunities to fine tune dinner blousing: Dinner tends to be our most complicated meal of the day, from high carb, to high fat, to eating out, it can be a tough one. So rather than just doing a standard bolus up front like the rest of the day, take an opportunity to think about dinner a little more. Is this a big meal or slow digesting that would benefit form a split or extended bolus? Is this a high fat meal that would benefit from additional basal insulin? If you’re going to give it a little extra thought, dinner is the place to do it!
• Dinner is social time, I don’t want to stop the fun!!
• Insulin pumping is a great way to make bolusing stealthy! Just a covert press of a few buttons and you’re ready to go.  I would also encourage meal time to be a time of empowerment. We do a lot of this diabetes thing solo, letting your friends in on this piece of your world can actually help make it a source of strength! Prebolusing also helps not disrupt the meal itself. Get an eye on what you’re going to have for dinner and bolus 10-15 minutes or more ahead of the meal (If blood sugars are at or above target) This way you’re not getting up from the table to disrupting a dinner conversation to bolus! And remember, your friends and family care deeply for you. I think they would be really hurt to know that their fun is keeping you from being healthy.

Being a teen with diabetes is already rough enough! Super charge your athletic performance, academic prowess and social maneuverability! Give a little more focus and care to dinner and reap rewards all day, and all LIFE long!