Bolus for Protein

Type 1 and LADA
1

Does anyone bolus for protein? I need to do this now. My endo told me, basically, the only thing a type 1 can eat without an increase in blood sugars is an egg yolk and oils (olive oil, etc..). Protein seems to increase my numbers quite a bit, depending on how much I eat. I discussed with my nurse and she gave me some info which stated the below:

1 oz. protein = 7 grams

But seriously, who eats 1 ounce of protein, that's like a bite. So, using that figure, a 3 ounce piece of chicken - fish would be equal to 21 grams of carbs? Does that seem right?

thanks!

2

I count half of the grams of protein as carbs. This 1 oz protein = 28 grams gets counted as though it were 14 g of carbs. A 3 oz piece of chicken breast contains about 25 g of protein.

3

OK, thanks. So, let's say you're using a 1:10, you'd take (say) another 1.5 units for that 14 grams, correct? That sounds about right as I end up having to correct about 1.5 units when I don't calculate the protein. thanks! Does everyone bolus for protein?

4

I usually bolus a little bit for protein. Not that the protein is worth anything, but the fat that goes along with it usually complicates my blood sugar readings. If I take a little bit of insulin with cheese, meat, cottage cheese, peanut butter, etc., I can keep a better control line during the day. I don't really have a schedule for bolus, I usually just bolus 2-6 units, depending upon what I am eating and how much.

Crazy, isn't it!

5

6

Eggs, small amounts of sunflower seeds, lettuce and cheese never seem to have much of an effect on my blood sugars. I dunno

7

Protein seems to raise my BG up to 8 hours after eating if the meal contains a large amout of protein. For best results I have to measure and correct several times in that period, although many times the effect can be predicted to some extent.
I bolus only for the carbs before the meal as the fast acting insulin does not work long enough for anything else.

8

I'm T2, but I just got similar advice. My hemoglobin and Red Blood Cell counts are low. I need to add protein, but I've been trying and noticed my BGs are up. As I understand it, if you add protein, your liver turns it to glucose, so higher BG. Since I'm not on insulin, I can't compensate for the increase. Dr. Bernstein's book might be helpful for someone on insulin.

9

There's a group here on TuD for those who are interested in bolusing for fats and proteins according the the old-school TAG method (Total Available Glucose). You might find it helpful :)

10

I agree with everybody that 50% is a good figure to use. A lot of times I sort of wing it by just adding 5-10G of carbs depending on what the hunk of protein is.

11

I started bolusing for Total Available Glucose (TAG, see Kate's comment for TuD link) about a year ago. That's when I went on a lowered carbohydrate diet, about 50-70 grams/day. After reading about other's experience at the TAG group I experimented with my insulin dosing.

What I do is add up the fat and protein amount in my food. Some percentage of that nutritional content is converted to glucose by the body, especially when carbs are limited. The process is called gluconeogenesis.

For example, if I plan to eat two hard boiled eggs that contain 10.6 grams of fat and 12.6 grams of protein, I add the two together ( 10.6 + 12.6 = 23.2). Only a portion of the fat and protein nutrients can be converted to glucose. That amount varies in each person. Some TAG group members reported that 0.4 is a reasonable factor to use to start your own experiment. I found that the factor, 0.35, works for me.

So I take the 23.2 grams of fat plus protein and multiply that by 0.35 and get 8.12. I then divide 8.12 by my insulin:carb ratio. In the morning I need 1 unit of insulin for every 4 grams of carbs. In this example, I use 8.12/4 = about 2.

Since fat and protein metabolize slower than carbs, it's best to deliver the fat/protein bolus over time. The TAG group reported that a maximum rate of 1.2 units/hour worked best. So I would deliver 2 units over 2 hours in an extended (square wave, combination) bolus. If I had any other carbs with my eggs I would bolus for them up front in immediate bolus.

This is what works well for me, but I encourage others that might be interested in this method to conduct their own personal testing to determine what may work for them. Your diabetes will vary!

Using this dosing regime and sticking to a low carb diet, I've been able to cut my total daily insulin in half, reduce my A1c from 6.8% to 6.1%, and markedly reduce my BG variability. The number of hypos I experience now are few.

I know that this looks complicated at first glance. Once you start to think in these terms, however, it becomes second nature.

Adopting this way of dosing insulin has had as much of a positive impact on my BG control and quality of life as using an insulin pump, the advent of rapid acting insulin, using a CGM, and eating a lowered carb diet. It may not be a good method for everyone but it's been a big deal for me. I would never go back to just bolusing for carbs.

12

How about skippng the so called 'healthy' protein in favor of a steak?

Yes, protein and fat can raise your blood sugars. Fish and chicken do not have enough fat content to slow the spikes.

Also, it take large amounts of water to metabolize protein.
Be sure to drink at least 32 ounces (1L) of water with each meal.

Not only will the water help metabolize the protein it also dilutes the concentration of blood sugars that result from eating.

Fish, pork, and chicken nail me hard, just like bread. But beef doesn't.

It take 40% of the calories consumed in the form of protein to metabolize the other 60%. Just a tidbit for everyone.

13

thanks for the replies. my endo also told me, because I low carb, about 50/day that my body will convert everything, basically, into glucose faster. he also said, and this makes sense to me, the short acting bolus (novolog, etc..) we take are designed to work on carbs, not really protein. So, kinda wonder why i'm low carbing if I have to bolus for protein anyway and I DON'T need to lose weight. I seem to do better if I throw some real carbs in there and let the bolus do the trick. I just ate 5 oz of protein - i guess 35 grams of protein = 17.5 carbs and bolused for it with a huge plate of veggies, hope I don't go low after last night of injecting basically air for my basal insulin, talking to my endo at 10:40pm and having to wake up every two hours for checks and small boluses. fun stuff!

14

Sarah,

Fast-acting insulins such as Novolog and Apidra do indeed handle carbs best. Protein digests much more slowly, so a longer-acting insulin such as Regular tends to cover it better. That's why I use both.

Although each individual's response is specific to themself, the general rule of thumb is that about 7.5% of consumed protein ends up being converted to carb.

These are the metrics I use to calculate boluses and they work for me. Your diabetes may vary, of course.

David

15

HMM my post disappeared

16

I do not know that your Endo is 100% correct, but yes i bolus about 20% of the grams of protein in a meal. One thing that I have found is that protein takes longer to absorb so it can be difficult to gauge when is appropriate. I suggest starting out slow lest you force a low.

17

I bolus for protein...10g same as 5g of carbs. In the old days most indaviduls diet was only around 20% protein so the the powers to be said it would be more convenient to just skip calculations for anything but carbs...they can live with a 20% error. Here is a old PWD cook book...look at the cover...the book is full of meals just like the cover photo.


18

Eactly. But remember everything is YMMV.

19

Instead of using R, you can also time your meal bolus of fast to after your meal and another strategy is to actually split the meal injection half at the meal and half 2 hours or so after.

The hallmark of an insulin mismatch is going low after a meal (like 2 hrs) and then still going high 3-5 hours after. This is why David's recommendation for R works well for very low carb meals.

20

Spagetti?!
I am convinced I need to start insulin AND I need start adding protein because
i am becoming anemic just avoiding catbs without adjusting with more protein.