I was just wondering if anyone else regularly bolused for their protein consumption or if it is just me. Or, for those eating relatively low carb meals, how they calculate their bolus beyond just CHO intake, if they do anything different.
For example, about two weeks ago, I had a large (16 oz) ribeye steak for dinner with no veg and no starch. I bolused some, but still spiked over 150 pts (at 6-7 hours post prandial) and wound up needing as much insulin as if I had eaten 40 g of carbs.
I thought I had posted this video on the site before. Seems like I hadn’t (I recorded it almost three months ago). Anyway… it deals exactly with this same topic.
I also bolus for high protein (and high fat) means, like pizza, steaks or protein shakes (the kind that have, say, 30 gr in a cup). My rule is: calculate 40-50% of the proteins and 10% of the fats, and using the dual wave, give myself that much in 3:30 hours.
Could you have an issue with sensitivity to insulin at times? I try to cover protein and slow acting carbs but quite often go hypo if I do, I think this is due to the fact that I am on fast acting insulin. I am going to ask for some regular insulin next time I am at the Diabetic clininc so that I can do this without the hypos. You should get Dr Bernstein’s book on normalizing blood sugars, it explains all about this subject and many more.
think in these terms…all food is glucose…aka suger, and will jump your BG. Trick is how much depends on how much you eat. I suggest keeping a log for 30 days. You go about eating and bolusing, just right it down. At the end you get a picture of what does what. Oh yea don’t forget about addiing notes on stress and excercize…
God bless,
Joe
Manny’s video was great - but you have to remember that each diabetic reacts a bit differently. This means that the timing/percentages and thus insulin required will vary from person to person. Unfortunately even the same person will react differently on different days. I can only speak from personal experience. So follow the general rule and test and test and try and find a combo bomus that works most of the time and from there make small adjustments for the given day. This doesn’t sound simple and it isn’t! Another different point is that a protein need sugar for digestion. If you just eat a protein meal without carbs what will probably happen is that you will burn fat to produce the carbs necessary to digest the protein. How much fat you burn is extremely difficult to calculate and thus you do not know how much insulin will be necessary. It is the liver that does this. For me even if I eat carbs, my liver ANYHOW tends to burn fat to digest the protein. Different people are affected differently by different protein sources, eggs, meat, white fish, red fish, shall I go on? Some people seem to have no problems with proteins. Other do! I do, even if I eat very small portions. 50g of white chicken meat, not 50g of protein, will definitely raise my bg 6-8 hours later! Furthermore the exact timing and amount of insulin necessary to cover the protein changes, depending partly on what else you have eaten that day or what exercise you have had. I do not want to sound pessimistic, but I want to let you know that if you are having a hard time with proteins, you are not the only one. I have had D for 45 years, but hey I am doing just fine! Often I think people tend to have their insulin for proteins hidden in their basal rates, and they are unaware of this!
I have to. I can eat nothing but a plain bunless hamburger and be at 275 in 3-4 hours. When I did the Atkins Diet induction, I was eating virtually no carbs and my blood sugars would rise to over 300 every night with repeated boluses. (Not rebounds from highs. It would just gradually rise all night long. Stubborn, too.) I don’t understand it. I’ve read that up to 50% of protein can be used to make glucose, but I swear that percent is way higher in me.
I’ve wondered if it has something to do with c-peptide/insulin secretion. I was in a JDRF-sponsored study and the researchers told me that only about half of the long-term type 1’s actually dropped to NO insulin secretion. Of course, in the other half the levels are too low to survive on, but even a bit of c-peptide/insulin generally meant better a1cs. Some folks had had type 1 for 20 years and still could peak out at a c-peptide reading of 3.0 when stimulated with injected arginine. My response wasn’t that good at diagnosis, during my honeymoon period! And it dropped to undetectable/zero less than 2 years from diagnoses. And I’ve never gotten an a1c under 6.8% since. And, as I said, just plain meat raises my bg like I’m eating a candy bar!
I usually figure 50% of the protein as carbs and use my bolus ratio for that over 3-4 hours. Ive done the same many times and woke at 3am with sugars in the high 300’s.
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My best advice? Aggressive investigations. Take a meal or food with a lot of protein that you could eat a few times in one week, and try what everyone is sort of recommending… 50% of the weight to carbs. Now, I often am more aggressive, 60% or so. Also depends on fat and richness. Steaks, my main love, will make me high late into the night, so extended boluses are an excellent choice. Good luck!
I don’t bolus for proteins. If I do, I just go low.
I try to estimate for protein, but I haven’t gotten it down yet. It’s been difficult because you can’t really go by weight of protein with red meat because it’s not all protein (fat, moisture, etc.). I’ve had better luck guesstimating with fish & poultry due to lower fat content. Wish I could find a great site that I’ve lost that explained how to calculate the actual available protein based on weight.
Great topic! I’ve wondered for a while if & how people do this.
Wow. Food for thought. No one ever suggested that I should even consider bolusing for proteins, so I never did. It may explain a lot of unexplained highs. I`ll be watching now!
Here is a quote from Bernstein(I follow Berenstein’s system):
Protein doesn’t raise sugar anywhere near as much as carbohydrate; however it can still raise blood sugar. Protein raises blood sugar by two mechanisms. The first mechanism is gluconeogenesis, which is the conversion of a small percentage of the protein to glucose. It converts to about 2 grams of glucose per ounce of protein, a very small percentage. An ounce is 28.5 grams. If you eat a 12-ounce steak, those grams can add up. The other mechanism by which protein raises blood sugar is the incretin effect, which in my books, I call the “Chinese Restaurant Effect.” Just distending your gut with anything will raise blood sugar, even a handful of pebbles, if you are a severe diabetic like me. So, just the presence of that steak in your gut will distend the gut, causing you to release hormones that will raise blood sugar.
Does anyone use dual boluses with injections to deal with protein (similar to the dual-wave technique with pumps)? I have tried it a couple of times and it does seem to work.
Cheers.
Paul.
Interesting topic, and a bit advanced for me!! I’m a vegetarian and one of my favorite lunches involves nut butter (almond, hazelnut, cashew, etc). I eat it on crackers or even (I know juvenile) with bananas. I have been just bolusing for the carb (crackers or banana) and I am fine at 2 hours, but then by the time for dinner I am high and need to add correction. I thought this was from the fat in the nut butter delaying the absorption. Is it a combination of pure protein and fat? Most of your solutions are for pumps and I’m on MDI. Tuatara, can you gtell me more about how you do the dual bolus with injections? When do you inject?
I do not bolus for protein per my CDE, Endo, and Dietitian - except if the protein is breaded or in some kind of sauce - any sauce. Just have to guess what is in the sauce or breading - this is where testing helps to determine how that menu item reacts in your body.
Zoe,
Tuatara has a pump.
It’s probably from the fat since fat slows digestion more than protein. The protein in nut butters isn’t difficult to digest because it’s already pulverized & also isn’t a large amount of protein.
If you’re typically going high between meals, it could also be that your basal insulin dose isn’t right.
The way to handle this without a pump is to take a second injection to head off the high from fats/protein. Naturally, this takes a lot of testing eating the same food to learn when the spike occurs. If dinner & lunch are 4 hours apart, then test a 2 hours & again at 3 hours.
Nope - tuatara (me) uses injections.
I was wondering if anyone else has tried more than one injection to deal with high protein meals.
What I’ve tried is one shot 15 mins before to catch the carbs and another small one after (say) an hour to manage the protein which is slowly converted to glucose over several hours. It was an experiment I tried a couple of times and seemed to have good results. More testing needed. YMMV.
It seems that dual wave boluses (to simulate first phase/second phase pancreatic response) provide the best post-prandial numbers (see here for example).
Cheers.
Paul
Thanks, Gerri and Paul. No, I don’t typically go high between meals. I think I mentioned on here that I did some adjusting of my basal and I think I finally got it right! Usually the only time that happens is with the nut butter lunch. I was about to give up on that food but will try your recommendations. I eat 5 hours apart and am always fine at 2 hours, so it’s somewhere in the middle that the spike occurs. I’m willing to do some fiddling for nut butter. (Though I worry about gaining weight and it’s not the most weight friendly food…lol).
Update note: the link to the video is broken b/c the video had some issues that someone pointed out to me. I have not been able to redo it, but will as soon as I have a chance.
