High fat and protien meals

[gillrogers]

Hi all,
Im having trouble getting grips with high protein and fat meals, and the bolusing for it. I understand the calculation but what im not getting is when to give the last bit of insulin. I saw a pattern over xmas where with a homemade chocolate bread and butter pudding made with half milk and half double cream , that i was reducing my bolus by 25% and not seeing that i need to give the 25% later at all. Then came dinner , i bolused for that and ended up with a correction at bed time. Now im.pretty sure this was down to me thinking i didnt need that extra 25% in the meal prior.

So if im right only way i can see if im releasing the protien and fat glucose is to not have the next meal at 6 hours and see if my bg starts to rise?

I am really finding this bit confusing at the moment.

 

[trophywench]

I have never found that I need to bolus for either protein or fat from which I conclude that my average of 70/80g carb a day is enough to keep my body functioning happily without it needing to resort to converting other foodstuffs to glucose.

But if/when someone's body does convert them, protein takes approx 40% of the insulin it would need for the same weight of carb, and 10% of the same, for fat.

 

[Inka]

Are you talking about splitting your bolus to cover more fatty meals @gillrogers ? How far apart were your lunch and dinner? Did you sit down longer than usual? Are you sure your carb count for dinner was correct?

I think Xmas is a time of a few blips in blood glucose, and the cause isn’t always the food. Sometimes it’s the change in routine.

If you want to perfect your chocolate bread and butter pudding bolus, you could just try eating the same again but varying your insulin slightly, or even try a different dinner afterwards. It’s all experimentation really, and do bear in mind that, annoyingly, something that works well one time might not work that well the next. Don’t let it get to you. It sounds like you’re doing well (and your pudding sounds lovely).

 

[gillrogers]

But if/when someone's body does convert them, protein takes approx 40% of the insulin it would need for the same weight of carb, and 10% of the same, for fat.

Thanks @trophywench but thats just gone straight over my head. .

 

[gillrogers]

Are you talking about splitting your bolus to cover more fatty meals @gillrogers ? How far apart were your lunch and dinner? Did you sit down longer than usual? Are you sure your carb count for dinner was correct?

I think Xmas is a time of a few blips in blood glucose, and the cause isn’t always the food. Sometimes it’s the change in routine.

If you want to perfect your chocolate bread and butter pudding bolus, you could just try eating the same again but varying your insulin slightly, or even try a different dinner afterwards. It’s all experimentation really, and do bear in mind that, annoyingly, something that works well one time might not work that well the next. Don’t let it get to you. It sounds like you’re doing well (and your pudding sounds lovely).

Thanks. @Inka , it was wicked! Yes I’m talking about splitting the bolus. I hear a lot about taking into account protein and fat if over 25g in a meal. That’s explained a lot of other times when I’m still rising 3 or 4 hours after a meal. So I put the calculation into practice with my coccyx pudding as it was extreamly high in fat and protein. As it was with that calc taken into account I still took a dive about half hour after dinner. ( which I forgot to mention in my original post ) . I actually did blooming well for me on Xmas day until after dinner when I hit 20 in a huge spike. Yes I’d checked my calcs and now put it down to delayed release from my pudding at lunchtime.

 

[trophywench]

If you need 1u to every 10g of carb, you would need 0.4u to every 10g of protein and 0.1u to every 10g of fat.

That's the main reason I'm glad my body doesn't usually bother to convert it - would make bolus calculations much more difficult to be accurate and I maintain nigh on impossible to deliver to myself without a pump where it's possible to deliver such small increments.

 

[Lucyr]

I would ignore any results that happen over Christmas. If you want to perfect it then try it again and test for a longer period afterwards to work out if/when your bg starts to rise later on.

 

[Finn]

I would ignore any results that happen over Christmas. If you want to perfect it then try it again and test for a longer period afterwards to work out if/when your bg starts to rise later on.

I completely agree with Lucy. Christmas and special one-off meals are tough to carb count and would take practise to get right. That's not really practical for once-a-year meals.

When I find meals that give me a second wave of increased blood sugars, I add them to my mental list of high fat foods that need a split bolus.

So far, I've found burgers, fries, pastries and meals with a lot of cheese tend to give me that second wave an hour and a half after eating them. For those, I give myself a bit of insulin before eating, a second dose an hour later, and then, if needed, a third dose another hour later.

For me, smaller high fat meals or snacks, like a pastry, will only require the first and second dose. Larger high fat meals like burgers, fries, raclette or Christmas dinner will need all three doses. If I see I'm starting to head down (going under 5.5), I have something to nudge my blood sugar up.

 

[gillrogers]

Thanks everyone. Yes I think I will ignore it then. Out of curiosity is this calculation mainly for pumpers? I’m not one although did look into it and I’m now happy that it’s not for me.

 

[helli]

I only find I need to add extra insulin for protein when I eat very low carb meals. Something like your bread pudding would have enough carbs not to have to worry.
However, I would split my insulin for high fat meals because the fat slows the carb absorption. Thankfully this is easier with a punp when I can just extend my bolus over a longer period. But I still have the problem of how long to extend it. I find this depends on a number of factors-
- my starting level
- the size of the portion
- how much fat is in the meal

I confess I just eyeball it and make a guestimate. So I cannot provide any hard and fast rules.
I do agree to ignore Christmas because it is a one off

 

[Lucyr]

I also only bolus for protein when its a very low carb meal and i tend to guess. E.g. my breakfast this morning was 1 sausage, 1 egg and mushrooms with coffee. I stuck a couple of units insulin in because from experience a low carb breakfast gives me a spike and that helps tame it

 

[nonethewiser]

Even with carbs in meal have to bolus for fat & protein when eating larger amounts, was pain on injections not so now using pump.

 

[rebrascora]

Basically what @helli said....
If your bread and butter pudding was made with anything other than low carb bread, then you would almost certainly not need to bolus for the fat and protein and especially if this was a dessert following a meal that contained carbs because the body doesn't need to break down the protein and fat into glucose if it has enough from carbs in that meal. In that situation, the protein and fat can slow down the release of glucose from the carbs so a split dose could well be needed unless your levels were high to start with but the bolus should be calculated on the carbs only. I believe any meal above 30g carbs as a rough estimate, will not need the protein and fat taken into consideration and you would need to be eating an awful lot of fat to make the fat worth calculating. Even though I eat low carb, I don't bother to calculate for protein. I just do a correction a couple of hours after my meal when I see my levels have reached 8 and are drifting upwards. I can understand in the days of finger pricking, when you had no idea what your levels were doing in between, that calculating protein might be necessary on a low carb diet, but with Libre it is much easier just to watch your levels and adjust with corrections when you need to. Life is too short to be calculating a bolus for carbs and protein and fat in my opinion but the latter 2 only need calculated if it is a very low carb meal and that is the whole meal, not just one part of the meal like a dessert.

 

[gillrogers]

Ok thanks everso much. @rebrascora Barbera can i ask please ive noticed a lot of people say that they if theyare rising a coupke of hours after a meal they give a correction. Ive understood that this can lead to stacking insulin? Do you not find it can put you in a pickle heading for a hypo if youre doing it as low as an 8?

 

[rebrascora]

Ok thanks everso much. @rebrascora Barbera can i ask please ive noticed a lot of people say that they if theyare rising a coupke of hours after a meal they give a correction. Ive understood that this can lead to stacking insulin? Do you not find it can put you in a pickle heading for a hypo if youre doing it as low as an 8?

I personally feel that a lot of the guidance around not stacking insulin was based on people relying on finger pricks and not knowing what their levels were doing between those finger pricks which might be 4 hours apart or even at 2 hours after a meal, you had no idea if your levels were rising or dropping at that time. With Libre, whilst it is not quite as accurate as finger pricking, it gives you the ability to see what is happening all the time and build up a much better picture of how our bodies respond to food and insulin. I usually scan about 30 times a day every day which gives me a lot of understanding of how my body works and enables me to keep an eye on my levels very closely if I do stack insulin. My low carb approach means that I do need to stack corrections and I would rather inject 2 small corrections an hour or two apart than jab one bigger one and risk my levels dropping fast, so my levels tend to drift up and down rather than spikes and drops. The protein and fat release from my diet means that stacked corrections work well for me because it is slow release glucose. If I get to 8 and drifting upwards 2 hours after a meal (when carbs will mostly have released, then that protein is just starting to release, so I might inject 2 units and an hour later if it is still drifting upwards and I have reached mid 9s I will inject another 1-1.5u and that will usually turn it. Yes this means more than one injection per meal but I usually don't eat 3 meals a day and breakfast works pretty well with just one injection, so it is usually only 1 or 2 more injections a day and I don't find that a problem. I am not recommending that people stack insulin corrections if they are not on a low carb diet or they don't have Libre to see what their levels are doing, but just saying that this works for me with my diet. Once my levels get above 10 my FIasp becomes much less effective and I have to inject much larger corrections to get it down, so it is far better for me to proactively jab corrections at 8 for protein release.

 

[gillrogers]

I personally feel that a lot of the guidance around not stacking insulin was based on people relying on finger pricks and not knowing what their levels were doing between those finger pricks which might be 4 hours apart or even at 2 hours after a meal, you had no idea if your levels were rising or dropping at that time. With Libre, whilst it is not quite as accurate as finger pricking, it gives you the ability to see what is happening all the time and build up a much better picture of how our bodies respond to food and insulin. I usually scan about 30 times a day every day which gives me a lot of understanding of how my body works and enables me to keep an eye on my levels very closely if I do stack insulin. My low carb approach means that I do need to stack corrections and I would rather inject 2 small corrections an hour or two apart than jab one bigger one and risk my levels dropping fast, so my levels tend to drift up and down rather than spikes and drops. The protein and fat release from my diet means that stacked corrections work well for me because it is slow release glucose. If I get to 8 and drifting upwards 2 hours after a meal (when carbs will mostly have released, then that protein is just starting to release, so I might inject 2 units and an hour later if it is still drifting upwards and I have reached mid 9s I will inject another 1-1.5u and that will usually turn it. Yes this means more than one injection per meal but I usually don't eat 3 meals a day and breakfast works pretty well with just one injection, so it is usually only 1 or 2 more injections a day and I don't find that a problem. I am not recommending that people stack insulin corrections if they are not on a low carb diet or they don't have Libre to see what their levels are doing, but just saying that this works for me with my diet. Once my levels get above 10 my FIasp becomes much less effective and I have to inject much larger corrections to get it down, so it is far better for me to proactively jab corrections at 8 for protein release.

Thank you @rebrascora , that makes alot of sense to me. Thank you for explaining. I have been actually considering possibly taking actions like that on occasions where im still rising 2-3 hours after a meal. Think ive worked out now whats causing it. I had 2 boiled eggs and no carbs for breaky yeasterday. No insulin. Got to lunch fine. But my lunch bolus didnt seem to work like it usually does and 2 hours later i was still rising. So this was by then 6 hours since my boiled eggs. Ive had this happen before after ive had them and the pattern just dawned on me after reading the replies here. In the end i waited until tea and gave my correction. But ive noticed i can drop to fast on a correction. Lyumjev is pretty darn speedy with no food intake. So i end up giving half the correction with my meal bolus and the other half after.