Why You Don't Pre-Bolus (you know you should)
You already know you should pre-bolus. Your endocrinologist has told you. Every diabetes educator has told you. And you still dose with your first bite, same as the rest of us. Neil Greathouse, who has lived with type 1 diabetes since...
The episode, word for word
I'm going to come straight at you today, so buckle up.
You already know you should pre-bolus. You've been told. By your endo, by your educator, by every pamphlet in every waiting room with a stock-photo couple jogging into a sunset like type 1 is a fun lifestyle brand. You know you're supposed to take your insulin before you eat, not with the food, before.
And you don't do it.
I know you don't. And here's the thing. I don't either. Not as often as I should. Thirty-four years with type 1 and I still sit down, food in front of me, and dose with the first bite like a man who has learned nothing.
So this is not a lecture. I have no high horse. My horse is in the shop.
I'm Neil Greathouse, I've been living with type 1 since Valentine's Day, 1992, and this is Your Best T1D Year.
Welcome to The Head Start. For the next eight weeks, Monday, Wednesday, Friday, we are going to take on the one thing almost all of us know about and almost none of us actually do. Pre-bolusing. And I want to challenge you on it. Hard. Lovingly, but hard.
Because here's what I've figured out. Pre-bolusing is not a knowledge problem. You don't need me to define it. You've known what it is for years. So the real question, the one this whole challenge is built around, is not "what is pre-bolusing." It's "why don't we do it."
And we are going to sit in that question for a while. Not rush past it. Because I think the reasons we don't do it are way more interesting, and way more human, than the science of why we should. The science is easy. The science is settled. It's the rest of us that's complicated.
So for the first couple weeks, I'm not hitting you with studies and stats. We'll get there, I promise, and when we do, the numbers are going to back all this up. But first I want to talk about the real stuff. The fear. The bad memory from that one time. The reason you tried it for three days and quit. The reason it's easier to just spike and correct and call it a Tuesday.
I want to get all the way in your head. And then, once we've actually named why we've been avoiding this, we're going to do something about it. Together. At dinner.
Quick note on that. The whole challenge runs on dinner. Not breakfast. Half of us don't eat breakfast, we pour a coffee and a vague sense of dread into a travel mug and leave. But dinner, almost everybody eats dinner, you're usually home, and you've had all day to see it coming. So when I say "your meal," I mean dinner.
Here's the thing about starting something you've put off forever. The Knicks just won their first title in 53 years. Fifty-three years of "maybe next season." And they finally got there. So if a franchise can wait half a century and still pull it off, you and I can start paying attention to one habit on a random Wednesday in July.
Your challenge this week is almost insultingly easy. Do nothing different. Keep dosing exactly when you dose now. Just notice one number, two hours after dinner. Don't fix it, don't judge it. Just know it. We're taking a "before" picture before we change a single thing.
And if you want to do this with us for real, not just listen along, head to yourbestt1dyear.com and sign up for the newsletter. That's home base for the whole challenge, and there's a pile of free stuff waiting there to make it easier. About 1,500 people are already in this with you, all over the world. You are not doing it alone.
You're not doing a bad job. You're doing a difficult job. Hang onto that this week.
Eight weeks. Let's go. I'm Neil, I'll see you Friday.
This is the script as read on the mic, lightly tidied for reading. Education, not medical advice. Talk to your care team before you change anything about your insulin.