Does high fat or protein require any insulin?

It seems that whenever I have a high fat or high protein meal, my blood sugars go high hours after my meal. I found that if I give some insulin spread out over a longer duration using the square wave on my pump, my blood sugars seem to be better.
It is difficult to know how much insulin to give for the high fat or protein.
I only seem to read about insulin dosages for carbohydrate intake, but I don’t hear anything about giving some insulin for fat or protein. I can say with pretty good certainty that I get high blood sugars from high fat or protein meals.

Yes! You definitely ought to be squaring out some extra for high-fat/protein meals. My educator gave me this chart that I found helpful. If a meal has 10 or more grams of fat, I definitely see its effects later. I think you have to play with the amounts to find your personal solution, but you’re doing the right thing.

Hi Melissa BL,

Thank you for that great information and graph about fats and protein. I have a few questions.

How much insulin do you square for fats and protein? For example, if you have 4 ounces of protein, 2 ounces of that will convert to glucose according to the chart. How much insulin would you give for that 2 ounces of protein that converts to glucose?

And what about fat? If you have 20g of fat, 2g of that would convert to glucose according to the chart. How much insulin would you give for that 2 grams of fat that converts to glucose?

Also do you find that you need a different insulin/protein or insulin/fat ratio? For carbohydrates, my insulin/carb ratio is 1unit to 14g or 1unit to 18g, depending on the time of day. Do you use the same ratio?

Also, I take a shot of symlin before each meal. This medication slows the absorption of my food and is supposed to help me avoid large highs. Therefore for every meal I use the dual wave function on my pump (Medtronic Paradigm 512). I’m sure I can’t do a square wave for the fat/protein while my dual is running. Do you have any suggestions?
Using the dual wave function, I first enter my carb intake on my pump, and then spread out the insulin dosage over 90 minutes; 50% now and 50% later. I don’t think I should falsely increase the amount of carbs that I enter for the dual wave because of the high fat and protein that I eat. What have you found works for you?

Thanks so much for your ideas.

Normally for protein you don’t have to bolus unless it has high fat content, like chicken skin. If you eat meats that are coated with flour you should bolus for that. Get more specifics from your educator.

Aaron,
When I eat ice cream my educator sayes that the fat and protien also slow down the obsorbtion of carbs also that. I have expermented a little and found that .6 to .7 units an hour over 8 hrs workd well for me. still ironing out all issues.

I would add that these are “general” guidelines … in my own experience, most protein (e.g. meat) is metabolized into glucose in about 6-8 hours … not the 50% figure indicated, by comparison, fish, eggs, and cheese do next to nothing, so this is very much an example where your own mileage may vary. However, these guidelines are good for people to try and estimate, then use your own experiences to refine them.

I agree that it’s very general, Scott. For instance, I find that fat hits me earlier than indicated in the chart I was given. But I do hope it helps to get you started, Aaron!

Hi Andy,

Is that a square with 4.2 units over 8 hours (.6 an hour for 8 hours) or do you change your basel rate?

Thanks, Scott,

So in your experience, if you ate 5 oz of hamburger, how much insulin might you give and how would you deliver it? I will experiement on my own, but I would appreciate a starting place to consider.

It does help. I really appreciate discussing this.

The standard way to estimate insulin for protein is to figure 58% of protein grams turns to carb over 4-7 hours.
There are 6 grams of protein in an ounce of meat. For other foods read the label and if in doubt use a food scale to find out exactly how much you are eating. Portion size is very important in figuring insulin needs

For fat the percentage is 10% of fat grams can turn into carb.

People who still have some insulin secretion left don’t usually have to worry about fat and protein raising blood sugar, but if your beta cells are all gone, you will.

Hope this helps.

from my experience with my patients,high fat meals raise posprandial blood glucose,so i ask mothers to increase insulin dose premeal.I do not have kids on pump yet because they have to pay for it,but parents and children learn with trial and experience how much rapid acting insulin to give.

your discussion is very useful to us

Sohair

I agree with you Mike it is a good case for the CGM…if only the powers to be understood that.