It’s different for all of us, of course, but for me, the more protein/fat, the longer the bolus time. For very high fat (say hot wings) or very concentrated high protein (say protein powder drink), I spread it over 2.5 to 3 hrs because that’s about how long it takes to convert to glucose in my system. If there’s not too much protein or fat, usually I just bolus for 1 to 1.5 hrs.
As for the percentages (my pump is Ping, so it’s a combo bolus and I assign % now and % over the time chosen), I try to make sure my carbs are covered up front and I extend the rest.
If you read through the discussions, I think you’ll be confident about trying it out. Please let us know if you have any questions!
I’ve had to calc for the protein and fat in my meals since starting symulin therapy. I do rely on the wizard and square sets for control. My pump nurse first suggested adding 1/2 of the total fat/protein grams to the carb count and using the square set over a one hour period for a high carb mix, or a two to three hour set for a high fat/protein mix. This is my “kiss” calc…the hard part comes when the occassional post meal high temps me to make a correction after the set has completed. Insulin on board is extended by the square set process and the symulin slows down the metabolic response from the liver so I’m usually wrong if I attempt to override the wizzard calculation.
Most ethnic meals such as: Chinese food, Mexican food, and Italian food have their own set of bolus values for each individual. For me, a Chinese meal usually takes 5 hours from the start of the meal until my BG’s begin to stabilize. I use a dual square wave bolus for the first 2 hours and then bolus every hour on the hour until I reach the 5-hour mark.
The method I use for determining what works best for certain types of food for me is to first determine the basic Carb content of the meal, the Carb content is what I will base my Bolus on for the first 2 hours of the dual square wave bolus on the pump. The Protein, Fat, and content of hot spices(peppers etc.) will determine the length of time and dosage I will continue to bolus past the original 2 hour bolus I take before I begin the meal. I personally Bolus with 1 unit on the 3rd, 4th, and 5th hours to maintain control of my numbers.
This is a trial and error technique, but it works for me. The only way I was able to get to this point was by taking a Bolus and then testing myself every hour on the hour to understand just how my body was being affected by the food.
Just to clarify, I’m new to this TAG thing, you bolus for the FULL carb content prior to eating, then extend a bolus for 4 hours to cover around 40% of the fat plus the protein, right?
I’ve been extending boluses with some success for the last few months but my endo wasn’t real helpful about how to do this well so I want to give TAG a try,
Hi CC - take a look through some of the discussions (versus these comments), and you will find forms that help you through. It’s true that we bolus for the entire carb count, but the extended bolus time depends on what you eat (how much fat and/or protein) and what your system is like. For me, I have never extended 4 hours - even for the highest fat content, I only go 3 hrs.
I see that most contributers here are adults. Are any parents using this method for their T1 kids? My daughters are both T1 (9 and 7). To me this discussion sounds like the missing link. My husband and I bang our heads against the wall at dealing with unpredictable highs and I would love to try to incorporate this into the girls’ management.
I will let someone else comment on whether or not they have used this method with their kids, but I want to add that it would probably be a little trickier with kids since you may have difficulty distinguishing highs due to protein and fat metabolism versus highs due to the hormonal changes that kids go through.
@Courtneyv, I like the idea of comparing side by side for a period of time. I’m going to speak with our endo before implementing anything. I’ll use your method for the time before our next appointment and see what she thinks. We already use an extended bolus for high fat meals (pizza!) but we have never done anything about protein before.
As for the hormones, I’m hoping that genetics (women in my family are late bloomers) and our vegetarian diet mitigate the early onset puberty. I do think that this method will help us distinguish between the food and the hormones if we track it long enough.
You’re right, most endos don’t know much about it. When I showed it to mine, she gave me a “that’s nice” kind of look and told me she doesn’t spend much of her time on what she calls her “sophisticated patients” - she says she’s usually just trying to get people monitor their BG!!
Very interesting Courtney - it’s always a trip when science catches up with real people’s experiences.
“Too complex my arse” - if I can learn it, it can be that hard - lol - I’m math-lexic.
I also have to wonder why they didn’t make the mental leap to applying it to adults.
Well, thanks, Mike - but I was a late comer - I give props to Danny and Ricardo for getting me interested enough to try it - the results, they speak for themselves!
Courtney, I got that article in my email and I was laughing my head off. It’s funny how ‘consumers’ tend to drive ‘markets’. This one is no exception! It’ll catch up with my DE one of these days too.
Love the TAG concept! I am the mother of a 13 year old T1 and I too have been banging my head against the wall with problem foods. I’ve been experimenting with TAG but haven’t quite found the right formula for us. I think 58% is too high for protein and 10% for fat is a bit too low. Anyone else trying this with a teenager?
Courtneyv - Yes, I too am amazed at how little this is talked about. I would love to see more detail behind the poster presented at the ADA conference about pizza bolusing, for example.
Here I am, again, Danny!
I think I need to learn about TAG. I’ve never really used square wave boluses, but it’s becoming more apparent that if I occasionally want to eat foods like pizza, I need to learn how. So I’m gonna sit back and do some reading – need to learn how to count protein and fat – so how much protein and fat are there in a slice of pizza?
Natalie, TAG has been a huge help for me. At first, I was worried that I would go low because of the gastroparesis, but it has really helped keep my levels more steady.
Very cool Natalie! Glad to have you over here too. TAGing can seem daunting, but its really super easy. It works of the principal that your body gets 100% of glucose from carbs immediately, 50% from protein over 3-4 hours, and 10% from fats over 10+ hours.
The easiest way I;ve found to look at it is with the calculation worksheet. Seeing that makes it all super easy to understand. My favorite is here.
The only tough part I’ve come across is knowing how long and what % of total TAG to bolus. That part is best determined by trial and error. On my low carb diet, I find that I need a heavy amount upfront to stop the spike, then maybe 1/4 over 1.5 hours to keep it level. But, as they say, YDMV.
Thanks for providing the link to the MelissaBL chart.
I find 2 interesting insights from the chart.
It is noteworthy that our body can use any of the 3 macronutrients as an energy source. As diabetics, we concentrate on carbs, but our metabolisms have evolved to also convert fats and proteins into glucose, which ensures that we would always have an energy source, even in times of famine. While our body can store excess glucose as glycogen, as well as fat, our body cannot store excess protein. Therefore for the first 2 - 4 hours after a meal, our metabolism will use what it needs to maintain or build muscle, as well as replenish blood, tissues and hormones. As the chart shows, 2 - 4 hours post meal, any excess protein is converted to glucose. Any protein that our body needs after the 2 - 4 hour period has to be supplied by an additional meal. I speculate that a physically active or muscular person may be more on the 4 hour end of the window or have a lower TAG % for protein conversion (since their protein needs are greater) and a more sedentary or skinnier person would tend towards the 2 hour end or have a higher TAG %. I must also say, I don’t have any proof of this theory.
What the chart doesn’t show is the synergistic effect of combining macronutrients. Eating a piece of white bread would spike the BG of most diabetics. If you took that same piece of white bread and topped it with tomato sauce and cheese (to make a pizza), the glycemic effect is lowered dramatically. Fat will blunt the glycemic rise of carbs. However, due to the prevalence of obesity in our society, fats have been demonized. Recent research also suggests that saturated fats are not the culprits in cardiovascular disease, as they were once thought to be. Judicious use of fats in the diet may be an additional tool that diabetics can use for good BG control.whereas low fat may leave one vulnerable to excessive BG spikes
