I originally thought PWD only had to count carbs, and if they are taking insulin, know their insulin to carb ratio. But reading through this site, i often see people saying that protein and fat with raise blood sugar too. So do you have to count protein and fat in addition to carbs to get your insulin dosing correct? how do you do that? thanks.
I don't accurately count protein or fat, but there are some foods that I KNOW will cause issues. If pizza was just 30g carbs/slice I wouldn't have a problem eating it. But it has a lot of fat and protein that changes how your body absorbs the carbs and you may have to change your doses to compensate.
A few foods are trouble foods for me (examples: pizza, Atkins bars, plain Greek yogurt, some restaurant foods).
With those foods, if they're high-carb and high-fat, I program a wave bolus on my pump based on my total carbs; the wave bolus gives me a certain percentage of insulin right away, and the rest of the insulin is gradually given to me for a selected length of time. I have also experimented with giving myself an extra unit of insulin for some strange-acting foods (like a particular restaurant chain that always has me spiking 3-5 hours after eating, despite the overall meal being low fat) and programming my wave bolus so that I receive all of the carb-counted insulin right away and have the one extra unit given to me over three hours.
If they're low-carb but high-protein, I might take a fraction of the protein amount (typically 25%) and administer that with my bolus insulin.
A lot of times, it is experimentation though. I like to write down what foods cause issues, analyze how my BG reacted to the meal, and then determine if it is from too little insulin being given or the insulin being metabolized before the meal has a chance to be fully digested.
I'm no expert but if I'm having vegetables and meat (just the carbs in the veggies.) I count 50% protein.
If I have some other sort of slower carb included in the meal ( a little pasta or beans, etc) I usually don't count the protein.
That doesn't sound very scientific! haha
You should look at the group Taggers Unlimited, TAG stands for total available glucose, there is a lot of advice on how to count carbs for protein & fat.
I find that when I consistently low-carbbing (<60-80g a day) I have to account for protein, usually adding 50% by weight to my calculations. However, I always do a dual bolus -- the actual carb insulin delivered immediately, the extra protein over a 3-hour square-wave bolus. I don't usually pay attention to the fat.
This seems to work pretty well.
I think that the medical diabetes professionals decided to not overwhelm us, especially when first diagnosed, with "complicated" insulin dosing regimens. They figured if they could just get us to count carbs, do some simple arithmetic, dose our insulin and return to our normal life, then that would be good enough. I suspect that the insulin to carb ratios many of us use incorporate enough insulin to metabolize the protein and fat in a typical meal.
We've all experienced the high blood glucose numbers, however, when we eat a meal like pizza that includes a good deal of fat and protein. Many of us have also had the pizza experience of going low in the first few hours only to go to 200+ five to six hours later. That's the fat and protein grams metabolizing.
The simple answer is to experiment with some form of combination dosing, delivering an immediate bolus for the carbs and an extended bolus for the fat/protein. I've never tried it but I think old-fashioned Regular could be added to cover the fat/protein in pizza.
A more complicated answer
I dose for all three macronutrients, carbs, protein and fat. I learned a great deal by reading through the TAGgers United group here a TuD.
I typically limit my daily carb consumption to less than 75 grams per day, sometimes to less than 50 grams per day. It's my understanding that the body prefers carbs for energy but it can convert a portion of protein to glucose, if needed. The body can also use directly a portion of the fat content, too.
Here's the system that works for me. I count carbs first and use my insulin to carb ratio to calculate an immediate bolus. Then I count 50% of protein grams and 10% of fat grams, add them together and divide by my insulin to carb ratio. For this insulin, I deliver it over time as an extended bolus with my pump. I limit the protein/fat bolus to a maximum of 1.2 units/hour and adjust the duration of that bolus to make that happen.
I arrived at the 50% of protein grams and 10% of fat grams through personal experimentation, so these numbers will not work for everyone!
This may be way more complicated than you want to do on a daily basis but this system works well for me. I use an Excel spreadsheet to calculate my favorite meals so this makes it easier. I also use a digital gram scale to actually weigh my food to eliminate "guesstimating."
Like many things with diabetes, habits can reduce much of the effort. I've been doing this for two and one half years now and it's second nature to me.
My results have been excellent. My A1c is in the low 6% to high 5% range and I use only half the insulin as before. This reduction in insulin permits the "law of small numbers" to work in my favor. That law (credit Bernstein) says that fewer carbs = less insulin = smaller mistakes.
By making fat and protein a larger portion of my nutrition, my glucose variability is relatively low and the number of hypos is way down. Sorry if I've run on with my answer but I think my system reduced my exposure to hypos while it enhanced my quality of life.
If I eat a 0 carb breakfast, like bacon and eggs or ham and eggs, I need to bolus as if I had eaten 7 grams of carbs.
Otherwise, I ignore protein and fat.
-Lloyd
Excellent answer, Terry, and pretty close to what I do (although I've been ignoring the fat).
I'm going to start experimenting with accounting for fat some too... Enough times I don't wind up all the way back where I started 4 hours PP.
One other "variation" that is of interest to T2's and any LADA's pumping: Be sure and account for the residual insulin production by your pancreas in extended boluses. I've found that a portion of the extended bolus simply replaces basal output by the pancreas (i.e. the pancreas see the exogenous insulin and says "Great! I'm taking a break!"), so it doesn't cover the extra glucose coming from protein/fat metabolism.
In my case, my beta cells are able to just barely cover my basal needs most of the day, amounting to about 1U/hr. In order to reduce my exogenous insulin use, I let my pancreas handle basal for most of the day. Therefore, when I calculate an extended bolus for protein/fat, I have to add in an extra 1U/hr to cover the insulin my pancreas is NOT making because of the extended bolus.
It significantly complicates things, so anyone that's not up to the care and math necessary not to screw it up should just set a proper basal rate on their pump and forget it.
However, taking advantage of my weakly functioning beta cells saves me about 14U a day, which for an insulin resistant T2 pumping, is a huge benefit with a 200U reservoir Omnipod. In fact, it usually gets me from two days to three on a pod, which is a huge plus.
I'm Type 1 - I've never known protein to have an effect on carb absorption, but those with chronic kidney disease often have to watch their protein levels, so maybe that's what they're referring to? Fat can have a big effect on BG's though, because although it doesn't change the overall carb count, the carbs can take a long time to absorb. Chinese, Mexican, and Italian foods, as well as deep-fried stuff, and pizza, sometimes take several hours to absorb. When I eat pizza (not often because it wreaks havoc with my BG), I program my pump to give myself half the insulin up front, and the other half over 4 hours. If you don't take insulin, you can work with your diabetes educator to see what they'd recommend.
thanks, everyone. i am controlling my tendency to high bg with diet and exercise at present. the problem is, i can see the numbers slowly deteriorating, so i am preparing for the possibility of a future with insulin by trying to become exposed to as many of the concepts surrounding its safe use as i can. especially since i am one of those people who doesn't even balance their check book. my approach is just to always have a big amount in my checking account. if i do reach the day i will need insulin (as my mother did), i will probably test eating several standard meals carefully measured, and record the info for later reference. i will just keep doing more meals every once in a while so i don't get bored with eating the same food all the time.
right now i am at a weird point where even a lot of exercise won't get my bg down like it used to. i'm not in an organ damaging zone right now, but i'm going to be ready if it comes to that.
Here's a link to the TAG Group here
http://www.tudiabetes.org/group/tagers
Unless you're eating a TON of protein and fat, they won't jack your blood sugar. That's why we have "free" foods. Technically, all food breaks down into a carbohydrate to be digested. Protein and fat can slow the absorption of carbohydrates into your body, which is why you might see a high blood sugar after eating pizza even if you took the right amount of insulin. I usually correct 2-3 hours after eating a meal with the magic combo (think pizza, chinese food, etc) which I don't normally do.
Hi Leah and Angivan,
Do you eat low carb? How many carbs a day? I eat from 25 to 40 carbs a day from vegetables, dairy products and a few other low carb options. From what I understand, this means my body is changing protein and fat to glucose for energy. (See "Dr Bernstein's Diabetes Solution" also Ginger Vieira's "Your Diabetes Science Experiment").
This solution keeps my BS pretty stable most of the time and keeps me from spiking. I must admit that I haven't started counting fat yet and the protein I do not count over a longer time like in TAG but I do count it.
For example: today a green salad with some cherry tomatoes and raw cauliflower (4 grams carb) and 3 oz roasted chicken (27g X 50%). = 17g "carbs"
Everyone's diabetes is different but I'm much better since I've changed over to this method.