Protein and fat is usually lumped together when discussing pre bolusing so I know how to account for things like pizza.
But I was wondering if we get rid of the fat and just have protein, eg chicken breast with veggies or tofu, is any prebolusing required? And if we put some carbs into the mix like 3 tablespoons of cooked basmati rice with chicken, do we need to factor in a prebolus?
The short answer is yes. Up to 50% of I:C ratio. Google TAG, total available glucose
I understand we need to bolus. My question is do we need to PRE bolus ahead of eating.
I’m not experienced but from your other post, your CGM and/or finger pricks will tell you when the protein kicks in. Have just a large protein meal and see how long it takes. I don’t think there is a set time, it would depend on your digestive system. Perhaps you will need to Square wave the protein and do a combination with the rice.
I use the Tandem Control IQ. If I have a no carb or very low carb meal such as a meat protein and a very small green salad with a full fat dressing, I don’t pre-bolus. I don’t even bolus sometimes because Control IQ will take care of the very small rise in BG. But what I do is an extended small bolus for the protein/fat. Most times a 1.5 unit or 2 unit extended bolus will do the job. CIQ extended boluses are limited to 2 hours. That works for me.
For a low carb meal regardless of weather it’s high fat or high protein or both I don’t usually pre-bolus unless my BG is higher than I want it to be. I do however estimate a carb amount for the protein/fat and dose that as I am about to start eating.
I use my I:C ratio and total up the grams of protein and divide by 2. Same for fat except divide by 4. So 30 grams of protein would get 15 carbs worth of bolus and 30 grams of fat would get about 7.5 carbs worth of bolus. I also extend my bolus, 75% upfront and 25% over an hour or two depending on my previous experience with that meal.
I am used to doing extended bolus of three or four hours. This CIQ allowance of only a two hour extension doesn’t do it for me. So, I turn off the CIQ and do a real extended bolus.
If I’m eating a meal like that, I do not pre-bolus. Usually taking insulin after eating works really well. I honestly just go by gut instinct/many years of experience for dosing (smaller bolus than for a carby meal, but still take some), and I’m on MDI so I take a single shot of humalog, but it tends to work well. Super high fat meals I actually tend to need a delayed shot, since the rise comes considerably later.
my endo once said Protein takes about an hour or two to begin kicking in and takes a couple of hours, while fat can take up to 3 hours to begin and stay in the system from 5 to 8 hours.