Need to learn TAGGing on MDIs

Okay so I eat low carb high fat high protein. About 35 carbs per day, 100g fat, and 90g of protein. Seems like I can eat a ton of fat and protein until lunch time and then starting about 3pm it spikes me. I have great blood sugars until after dinnertime and it’s so frustrating! I’m assuming its due to fat and protein at dinner. For example last night I had an asian vinegarette salad containing: 4 cups Romaine, 1 oz almonds, and 6 ozs of grilled chicken, and a vinegarette=5carbs,15g fat, and 36g protein.For dessert had my usual Carbsmartice cream bar=9carbs and has 15g of fat. So I bolused 2 units for 14 carbs. And I biked 25 minutes after dinner as well. My 2 hour bg=112 and my 4 hour bg=175!? I cannot figure this out!I never eat after 4 or 5pm so I do not have any protein/fat digesting at night. I was thinking it may have to do with my basal not lasting 24 hours but my bg is up before my last bolus is even out of my system so I’m assuming it is from protein and fat in my dinner. So I either have to cut back on my fat and protein which is impossible while eating so low carb OR try and figure out how to bolus correctly. Anyone ever tried bolusing AFTER eating a meal with only fat and protein? For example in the morning I eat 3/4 cup of eggbeaters with 3 tbsp of salsa and 2 ozs. of almonds=16 carbs, 28 g protein, and 30 grams of fat. I do not bolus until 30 minutes AFTER eating and then ride bike for 20 minutes it works very well usually am around 100 at 2.5 hours.

I used to always bolus 30 minutes before eating even though I eat so little carbs but after seeing a spike after a few hours I have decided to try and bolus right before I eat or even after since I mainly eat only protein and fat. Advice?

I wouldn’t entirely rule out basal. It could be that even though it’s not “run out” it has become less effective. Or that your basal requirements are higher in the late afternoon/evening. It’s hard to say w/o knowing your current regime.

As you know from being in this group, some of the protein to a lesser extent fat is converted to glucose (not the entire amount and at a steadier rate than carbs), so some of the spike could be due to the protein to glucose (TAG).

I currently use MDI. I bolus anywhere from 30-60 minutes before eating meals with carbs because for me, it can take up to 2 hours for the bolus to be effective (or so I’ve observed on dexcom) and my food especially carbs is absorbed much faster than the insulin. If I eat just slow acting carbs (like legumes) and protein/fat, then I’ll inject at the start of the meal since the food is absorbed more slowly. If your bolus insulin works faster than you will want to wait longer (like waiting 30 minutes up to an hour after a meal). I’ve sometimes done a split bolus with MDI for mixed meals- small portion to cover the first wave of carbs and then an hour later a second portion to cover slower carbs/protein.

Did you test at 4 hours when you injected your bolus 30 minutes later?

General advice is play with timing and ignore the rules. Insulin absorption both for the same individual and across people seems to vary a lot, so if you’re not spiking within the first hour or so, when you delay your bolus, then delaying it delays the tail end to hopefully better cover the lagging protein/fat.
I don’t see much of an effect at all with fat so I personally don’t consider it (except for timing since it can slow absorption).

Fat metabolizes very slowly. Protein is next slowest, and carbs are fastest.

Eating a fatty pepperoni pizza one night can elevate blood sugars for DAYS because of the fat.

Oh, be careful with the almonds - they contain arsenic which is cumulative in your system. Some are ok, but not a lot of them.

Try eating a real cheeseburger without the bread. Do the 2hr PP then the 4hr PP. You will see things elevate slowly.

Dreamfields Pasta is horrible. It can spike you 12 hours after eating it!

About your bolus. Ever try cutting back the bolus a bit and injecting before eating?

If you consistently spike 3-4 hours after eating your specified meal, then try using NPH insulin. It usually kicks in about 3-5 hours after using it. Most places will sell it without a prescription. Wal-Mart brand is the cheapest (about $25 per bottle).

The task is to control blood sugars as they begin to increase, not treat them after they are high.

If I remember correctly, Lantus lasts between 18 and 22 hours.

If you split your dose, and time it correctly, you should be able to use a fast acting insulin right at the end of the 22 hour mark, just in time for breakfast.

Thanks Aimee, I’m pretty sure my Levemir does not last 24 hours but everyday is so crazy and different and now throw in a pregnancy and I am just all confused haha
I’ve been taking an additional unit of humalog with my last meal of the day.

generally, if you need 5 or less units per day, your diet can fix the problem.

Eat more meat, less carbs. And walk 1-3 miles at a time.

Carbs are hidden everywhere too. Even a simple glass of milk has carbs.

Just remember, the more insulin you take, the faster you can gain weight. The key is to eat less carbs but maintain your basal metabolic rate of calories in the form of protein and some fat.

A chart I uploaded was featured on this site. Maybe take a look?

Before pregnancy I ate about 30 carbs per day but now that I am trying to stay at from more than small ketones I am eating about 50-65 carbs per day so I think I am doing pretty well.

Thanks, I’m tryin! Did you have diabetes when you were pregnant with yours or did you develop it after?