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How to: Pre-Bolus with Intuitive Eating

Kelly Six was an intern with me back in December on 2020. She has also lived with type 1 diabetes since she was a child.

When we started taking about posts I’d like for her to write, my first idea was this one. She was quiet for a little bit and said “hmmmm.... how DO you pre-bolus with intuitive eating? What do you tell your clients?” I gave her the 20-second version and she said she’d work on writing a post.


She came back the next day laughing and said “That’s exactly how I do it! I just got so used to it that I didn’t even notice!”


Read on for Kelly’s excellent explanation of how to pre-bolus with intuitive eating:


Well, well, well - you’ve made it to the point where you are questioning if pre-bolusing and intuitive eating can go together. It’s nice to see you here.


My short answer is YES! Absolutely they can. Nothing about diabetes, including taking insulin, should prevent you from practicing intuitive eating. Even when it might feel like a real barrier, it’s possible. Let’s break it down:


What is pre-bolusing?

The thought behind pre-bolusing is that most fast acting (meal time) insulins take about 15 minutes to “kick in” so by taking your meal time insulin before you eat, you allow your insulin to get a head start on your food. Insulin and food are then better “matched.”


This involves deciding how much food you want, calculating how much insulin you need to take, and dosing ~15 minutes before you start eating.


That would work so beautifully…. if we were cars and could calculate exactly how much fuel we need for a drive, no more no less. You fill up, you go, end of story.


But we aren’t cars. We’re people. And maybe we finish eating at realize we need more, or we feel full before we’ve finished what we’ve put on our plate.


What is intuitive eating?

This brings us to intuitive eating; a philosophy built on learning how to listen to what your body wants to eat, how much, and when to stop without a huge reliance on external factors like calories, carbs, how your friend is eating, etc. (It’s a lot more than that but those are the super simplified cliff notes!)


When you first look at it, pre-bolusing and intuitive eating feel like opposites. Like enemies. Like things that really really really can’t go together. How can you learn to eat what will satisfy you if you’ve already pre-bolused for what you plan to eat?


How do we reconcile this? Here are some thoughts:


1️⃣ It’s OK to have more if you want more; just remember to take more insulin


You’ve planned your meal, done your carb counting, pre-bolused, and eaten. But then you realize that you’ve actually still hungry.


What do you do? You get more, and you bolus for it.


It might feel like you’re “breaking the rules.” But reframing that a little might be helpful:

  • You have insulin on board which is going to help a lot in preventing a spike after a meal. You’re already a head of the game.

  • Taking more insulin now to eat what will satisfy you isn’t going to make or break the blood sugar bank.

  • Sure, maybe things won’t look perfect but if you’re taking enough insulin you can trust that your blood sugars will come down. But it’s better to feel satisfied now than starving later.


2️⃣ Don’t come to the table starving.

I recognize this is a lot more challenging than it sounds. We live busy lives, and it’s difficult to eat a meal, especially in the middle of a work day. Sometimes it might feel like we are so caught up in what we are doing that we don’t feel our hunger until it is SCREAMING at us.


But when it’s possible, feeding yourself regularly is a great way to help keep your blood sugar more stable and your body fueled throughout the day.


When you are able to practice eating regular meals, notice if it feels any different to calculate carbohydrates and pre-bolus. Is it more or less stressful? Was it easier to remember to pre-bolus? Were you able to come into the meal more relaxed or was it the same?


3️⃣ Check in with what you DO want in the moment

Ok, so say you do show up to dinner and you’re starving (it happens, not a big deal!), and you pre-bolus and you fill up your plate with everything you could ever want. That’s fine! Nothing wrong with that.


BUT since you’ve been practicing intuitive eating, half way through your plate you realize you’re feeling full and not enjoying the food any more...but you’ve only had part of your carbs.


This is a time to check in- what do I want right now that sounds better than this? Something sweet? Something salty? Does a cookie sound good? Or an apple? It might not be ideal to eat past fullness but really it’s not a big deal. It totally happens. Rather than pushing through a food that you’re no longer enjoying, pick something else. You can switch over to a carb source that sounds more satisfying until you’ve matched your insulin dose.

A million thanks to Kelly Six, #RD2Be for this excellent how-to!


Feel free to leave any questions, comments or your own tips for being an insulin user and intuitive eater below!





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