Pre-Bolusing and Still Spiking? Check Your Carb Count | Type 1 Diabetes
You pre-bolus. You give it the 15 minutes. You watch the arrow. And you're still spiking. Don't throw out the challenge, that spike is a clue. Neil puts on the detective hat, because timing is huge, but it isn't the only dial on the...
The episode, word for word
So let's say you've been a straight-A student. You pre-bolus. You give it the 15 minutes. You watch the arrow like a hawk. You've done everything I've asked for six weeks, you've practically been taking notes.
And you're still spiking.
First of all, I'm sorry, that's genuinely maddening. Second of all, do not chuck the whole challenge in the trash, because that spike is actually trying to hand you a clue. Let's put on our little detective hats and listen to it. We're going full Only Murders in the Building on this spike. Three suspects, one nosy podcast, and a prime suspect nobody really wants to accuse.
I'm Neil Greathouse, this is Your Best T1D Year, and today we troubleshoot, because timing is huge, but timing is not the only dial on the dashboard.
Here's the thing. Pre-bolusing fixes a timing problem. But if you're timing it perfectly and still climbing, the problem might not be timing anymore. It might be the amount. And the most common culprit, the one nobody wants to hear, the one I'm going to say gently, is the carb count.
Carb counting is hard. It is a lifelong pop quiz that you never got to study for, in a class you didn't sign up for, with a professor who is your own pancreas and frankly checked out years ago. And most of us are guessing way more than we'd ever admit out loud. That bowl of pasta you confidently called "about 60 carbs"? My friend. That bowl was 95. That bowl was a personal attack. Restaurant portions especially are out here lying to all of us with a straight face. So if your timing's dialed and you're still spiking, the next question isn't "did I pre-bolus right," it's "did I actually count that right, or did I do diabetes math the way I do tip math, vibes and hope."
And again, this is measured, not me guessing. There's a study by a researcher named Brazeau that had 50 adults with type 1, people who had lived with this an average of 21 years, count the carbs in their real meals. On average, they were off by about 15 grams of carb per meal, roughly 21% of what was actually on the plate, and they underestimated 63% of the time. So these are seasoned veterans, two decades in, missing by a fifth. You and I are not better than that. I promise we're not. So if your timing is dialed and you're still climbing, your carb count is the first suspect you bring in for questioning.
The other usual suspects. The fat-and-protein second wave from Wednesday, that's an insulin-timing thing, not a you thing. Stress, which dumps glucose into your blood whether you ate or not, because your body is dramatic. Illness. Hormones. A workout from earlier in the day that's still echoing. Type 1 has roughly nine hundred variables, and timing is one big one, but it was never the only one.
So just to recap. You spent six weeks mastering the timing, only to discover there was a whole second boss fight you didn't know about. Welcome to type 1. The game never ends and there are no cheat codes, only us.
But that's not bad news, I promise. That's you leveling up. It's giving "the timing was never the final boss." There were more levels. There are always more levels. You just got good enough to see the next one.
So the move isn't to panic or quit. The move is to get curious, like a detective who's annoyingly calm at the crime scene. "My timing's good. So what else is going on here?" Maybe you tweak your carb count. Maybe you talk to your care team about your ratios, the math behind your doses. Maybe it's a stress thing and the fix isn't insulin at all, it's a walk and a deep breath. The pre-bolus did its job. It put you in a position to finally see the rest of the puzzle.
Your challenge this week. If you're pre-bolusing well and still spiking, play detective on one meal. Weigh the carbs, or eyeball them with brutal honesty, and see if the count was off. Just gather the clue. Don't go changing your doses solo, bring what you find to your care team. You know your body. They've got the math. Great partnership.
This is exactly the kind of thing the newsletter digs into, and it's free at yourbestt1dyear.com along with all the challenge resources. Sign up, follow along, and lean on the 1,500 people troubleshooting their own mystery dinners right there with you.
Here's the honest encouragement. If you're still spiking after all this work, you are not failing. You're advancing. You got good enough at timing that you can now see the next thing, and that is exactly, precisely how this is supposed to go. One dial at a time. You're doing great.
I'm Neil. Monday, we've got a guest, and we pull up a chair to the hardest table in the whole house. The kids' table. See you then.
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.