Even higher protein can spike some people, not just fat. My daughter is one of these…we have to give a small amount of Apidra for grilled chicken for example (plain, no marinade, no bun). The idea behind TAG is that a portion of protein and fat is converted to glucose as your body digests it. I don’t think everyone needs it, but it does help us. Basically we dose for all the carbs up front, just as we usually would, and then do a second extended bolus for a portion of the fat and protein. Everyone is a little different so you have to tweak it to fit your needs. We run our extended out 2 hours, but it’s very individual.
Nuts definitely send my daughter soaring, but not right away. The thing about high fat and high protein spikes is that for us they come way after the meal – like 1 1/2 to 2 hours after you ate, so you don’t associate it with the food necessarily. If my daughter eats nuts and only doses for the carbs in them, she’ll remain flat for a long time, and then it will spike up (what I call the fat spike) and be very resistant to corrections. TAG dosing does help us.
