Bolus for Protein and Fat?

[lozboz25]

Hello everyone! 🙂

I have just read a article that says a type 1 diabetic should bolus for protein and fat along side carbohydrates.

I have never been told to do this for my son, only to bolus him for carbohydrates by his nurses and doctor. When he was first diagnosed (2019) I did my research and never came across this sort of information but in the recent months I have seen a few type 1s (both adult and parents of children with type 1) on instagram say that they bolus for carbs, protein and fats. One insagram account I came across was run by a mum of a type 1 who was roughly my sons age (8) and she stated that her daughter is on a low carb diet and boluses for protein and fat.

I am intrigued as to how many type 1s do the same and bolus for protein and fats. Has this always been a factor to consider?

I have googled it, and I did get an answer as to yes fat and protein should be bolused for! Now I have many questions. Bolusing for carbs and finding the correct carbs:insulin ratio is hard enough work nevermind throwing in protein and fat as well.
How do you find the correct ratio to bolus for protein and fat? What is the general rule?

I wanted to ask you guys what your thoughts are on it. Any information on the matter. Any educational information, advice or if you bolus of protein and fat.

I just thought it was an interesting subject to touch on as I was not aware of this information and I want to learn more on the matter.

Edit: My son isn't on a low carb diet we like carbs in this house hold! 😉
Thank you for reading.

 

[Inka]

No, @lozboz25 If you eat sufficient carbs, you don’t have to bolus for protein and fat. Some countries (Poland?? Can’t remember) do add a bit on for protein and possibly fat too, but the vast majority of Type 1s don’t. There’s no need unless you’re consuming huge amounts of protein or protein alone.

As for low carb, I’ll keep my answer polite but it’s not something I’d ever eat myself or, importantly, give a child of mine. The only reason they have to bolus for protein is because they’re starving their bodies of the carbs they need. Diabetic control is actually harder without carbs. More than that, large numbers of those people have hypo unawareness. Avoid like the plague is my advice @lozboz25 !

 

[Inka]

Edited my post to add a warning above @lozboz25 Can’t write it as bluntly as I’d like to, but avoid!

 

[Robin]

I don’t, if i’m eating a good mix of protein, fat and carb together. the only time I find I need to is if I just have scrambled eggs for breakfast, on their own, because I’m in a hurry, in which case i’ll need a unit of novorapid a couple of hours later.

 

[lozboz25]

No, @lozboz25 If you eat sufficient carbs, you don’t have to bolus for protein and fat. Some countries (Poland?? Can’t remember) do add a bit on for protein and possibly fat too, but the vast majority of Type 1s don’t. There’s no need unless you’re consuming huge amounts of protein or protein alone.

Thank you.
I had just seen a fair few people on instagram both parents and type 1 themselves (from the UK) say they bolus for protein and fat but I myself had never heard or been told to do this for my son.

I did get it that it will depend on lifestyle and eating habits and how the person's body maybe reacts to protein and fat? But netherless it got me intrigued to ask if other type 1s do it.

 

[everydayupsanddowns]

No. In my 30+ years I’ve never reduced my carb intake enough to make this necessary. I think @rebrascora (who chooses a low carb approach for T1 as an adult) may do.

Low carb is not recommended for young people with T1. There is clinical trial evidence that shows it is unhelpful, and may cause harm.

The only think I find is that occasionally with a larger (higher fat) meal, there may be a late rise possibly due to the larger amount of food (and perhaps some of the fat and protein) taking longer to absorb than the usual ‘rapid insulin’ timeline of 4-5 hours. But I have a rule of thumb for takeaways and such that works around this with a split dose and adjusted ratio.

There’s a rough guide to protein/fat absorption here for those on low carb.

Thread 'Glucose conversion (from DSF)'

Nov 7, 2022

Shared from the former DSF (Diabetes Support Forum). Kindly shared by @Pattidevans

• The Moderator Team
• Replies: 0
• Forum: Links

• 

 

[lozboz25]

No, @lozboz25 If you eat sufficient carbs, you don’t have to bolus for protein and fat. Some countries (Poland?? Can’t remember) do add a bit on for protein and possibly fat too, but the vast majority of Type 1s don’t. There’s no need unless you’re consuming huge amounts of protein or protein alone.

As for low carb, I’ll keep my answer polite but it’s not something I’d ever eat myself or, importantly, give a child of mine. The only reason they have to bolus for protein is because they’re starving their bodies of the carbs they need. Diabetic control is actually harder without carbs. More than that, large numbers of those people have hypo unawareness. Avoid like the plague is my advice @lozboz25 !

Thank you.
I don't give my son a low carb diet, I want him to be a normal boy and eat normal just like the rest of us so he has carbs. When he was first diagnosed we did try a low carb diet and like you said he kept going low, and his nurse at the time told us that low carb is not good as he will become hungrier faster and won't stay full for long - the low carb diet lasted a week if that!! Xx

 

[lozboz25]

Edited my post to add a warning above @lozboz25 Can’t write it as bluntly as I’d like to, but avoid!

Thank you x

 

[Inka]

I’d also add that glucose release from protein is unpredictable. So, a formula saying bolus for 50% of protein could lead to hypos if your body only converts 10% to glucose. The amount converted to glucose varies day by day, by the individual, by what type of protein is eaten, by what you eat it with, etc etc. It could be 50% but it could equally be 0%.

 

[lozboz25]

I don’t, if i’m eating a good mix of protein, fat and carb together. the only time I find I need to is if I just have scrambled eggs for breakfast, on their own, because I’m in a hurry, in which case i’ll need a unit of novorapid a couple of hours later.

Thank you. X

 

[Drummer]

@lozboz25 - purely from a biological view point, fat breaks down into things other than glucose - they can be used for energy, but they are separate from the use of glucose.
Protein can be used to generate glucose, it has its own little metabolic cycle for doing so.
These are inter cellular processes, so going on after digestion and transporting in the bloodstream. So many different factors at play.
During digestion I believe that fat can alter how and when carbohydrates are dealt with in the gut - so that is another consideration.
Low carb is, in many cases, ideal for type 2s, but when trying to create as normal as environment as possible for a type 1, particularly a young one, it seems an unnecessary complication.
I grew up in a low carb environment - but that was mostly because so many in the family were undiagnosed diabetics at that time, probably myself included.

 

[lozboz25]

No. In my 30+ years I’ve never reduced my carb intake enough to make this necessary. I think @rebrascora (who chooses a low carb approach for T1 as an adult) may do.

Low carb is not recommended for young people with T1. There is clinical trial evidence that shows it is unhelpful, and may cause harm.

The only think I find is that occasionally with a larger (higher fat) meal, there may be a late rise possibly due to the larger amount of food (and perhaps some of the fat and protein) taking longer to absorb than the usual ‘rapid insulin’ timeline of 4-5 hours. But I have a rule of thumb for takeaways and such that works around this with a split dose and adjusted ratio.

There’s a rough guide to protein/fat absorption here for those on low carb.

Thread 'Glucose conversion (from DSF)'

Nov 7, 2022

Shared from the former DSF (Diabetes Support Forum). Kindly shared by @Pattidevans

• The Moderator Team
• Replies: 0
• Forum: Links

• 

Fascinating, thank you.
I wouldn't/havent put my son on a low carb diet. I'm glad there is research to show it can cause harm.

 

[lozboz25]

@lozboz25 - purely from a biological view point, fat breaks down into things other than glucose - they can be used for energy, but they are separate from the use of glucose.
Protein can be used to generate glucose, it has its own little metabolic cycle for doing so.
These are inter cellular processes, so going on after digestion and transporting in the bloodstream. So many different factors at play.
During digestion I believe that fat can alter how and when carbohydrates are dealt with in the gut - so that is another consideration.
Low carb is, in many cases, ideal for type 2s, but when trying to create as normal as environment as possible for a type 1, particularly a young one, it seems an unnecessary complication.
I grew up in a low carb environment - but that was mostly because so many in the family were undiagnosed diabetics at that time, probably myself included.

Thank you for your reply!
I did think it was complicating things even more, but recently ive just seen so many people on instagram saying they bolus for protein and fats that it got me thinking is this new information that I've haven't come across. A few of the accounts are parents of type 1s children.
We don't follow a low carb diet, I never wanted that for my little boy. I want him to eat just like any other child his age and enjoy his food.

 

[nonethewiser]

Find there are some meals whereby extra units are required for protein/fat, even when meal contains ample carbs, for such times it involves another bolus 1-3 hours after eating. Interesting that some people don't experience same.

Did once try low carb, found my insulin usage remained same but involved lots of injections way over & above than before embarking on it, so didn't stay on a low carb diet for long, maybe 10 weeks or thereabouts.

 

[SB2015]

If I choose to have a very low carb meal <10 g I find that any protein causes me chaos, as I never take account of protein in my calculations. Too much to do that on top of sorting out carbs. I generally make sure I eat => 30g of carbs and this then means that my body uses the carbs in preference to the protein, so I don’t need to worry about managing any protein as well.
We have enough to remember with working out carbs.

 

[rebrascora]

I find it very easy to manage my diabetes on a low carb way of eating with Libre or other CGM and I don't calculate boluses for protein, I just do a 2 unit correction when my high alarm goes off at 8.2. You would have to be eating a really significant amount of fat to need to bolus for fat or more likely adjust your basal to cover it since fat release is much slower even than protein which is much slower than carbs.
I would agree with @nonethewiser that I probably use the same amount of insulin per day as I would if I was following a normal diet with more carbs, but I need more injections because if I added the protein bolus to the carb bolus I would be hypo before the protein released, plus I would have to try to calculate it, so I just inject a correction for it a couple of hours after the meal. It was less easy before Libre, but now I just respond to my Libre results. It does definitely involve more injections but a lot less thinking and calculating the way I do it by responding to my Libre and I usually average about 85-95% TIR, so I get pretty good results. I suspect it would be difficult if not impossible on a pump with HCL unless the algorithm was specifically programmed for low carb..... and I imagine that would be complicated. I find it really quite easy with MDI though.

I would strongly disagree with your nurse about being hungry between meals or after meals on a low carb way of eating as it is exactly the opposite. Carbs can make you feel hungry about 2 hours after meals because they break down and release their energy within that period and then there is no more until the next meal whereas protein releases glucose for about 6 hours, so easily tides you over into your next meal, essentially acting like very low GI foods and I get the carbs from the tomatoes and onions etc up front so my meal is supplying me with a steady trickle of glucose over about 8 hours post meal. Protein and fat are also more satisfying/satiating than carbs, so again, more likely to keep hunger at bay than triggering hunger after your meal.
I follow a low carb way of eating because I have experienced significant health benefits from cutting carbs and it certainly doesn't prevent me from having very tasty nutritious food, I just don't generally have the beige foods that usually accompany them like bread and rice and pasta and potatoes. I am not fanatical about it.... I shared a single portion of fish and chips with my partner last night.... but I am definitely happier and healthier avoiding them most of the time and just getting my carbs from tomatoes and onions and other low carb veggies and berries and the odd fun size apple and natural yoghurt and nuts and the odd square of dark 75% chocolate etc.

 

[Leadinglights]

I find it very easy to manage my diabetes on a low carb way of eating with Libre or other CGM and I don't calculate boluses for protein, I just do a 2 unit correction when my high alarm goes off at 8.2. You would have to be eating a really significant amount of fat to need to bolus for fat or more likely adjust your basal to cover it since fat release is much slower even than protein which is much slower than carbs.
I would agree with @nonethewiser that I probably use the same amount of insulin per day as I would if I was following a normal diet with more carbs, but I need more injections because if I added the protein bolus to the carb bolus I would be hypo before the protein released, plus I would have to try to calculate it, so I just inject a correction for it a couple of hours after the meal. It was less easy before Libre, but now I just respond to my Libre results. It does definitely involve more injections but a lot less thinking and calculating the way I do it by responding to my Libre and I usually average about 85-95% TIR, so I get pretty good results. I suspect it would be difficult if not impossible on a pump with HCL unless the algorithm was specifically programmed for low carb..... and I imagine that would be complicated. I find it really quite easy with MDI though.

I would strongly disagree with your nurse about being hungry between meals or after meals on a low carb way of eating as it is exactly the opposite. Carbs can make you feel hungry about 2 hours after meals because they break down and release their energy within that period and then there is no more until the next meal whereas protein releases glucose for about 6 hours, so easily tides you over into your next meal, essentially acting like very low GI foods and I get the carbs from the tomatoes and onions etc up front so my meal is supplying me with a steady trickle of glucose over about 8 hours post meal. Protein and fat are also more satisfying/satiating than carbs, so again, more likely to keep hunger at bay than triggering hunger after your meal.
I follow a low carb way of eating because I have experienced significant health benefits from cutting carbs and it certainly doesn't prevent me from having very tasty nutritious food, I just don't generally have the beige foods that usually accompany them like bread and rice and pasta and potatoes. I am not fanatical about it.... I shared a single portion of fish and chips with my partner last night.... but I am definitely happier and healthier avoiding them most of the time and just getting my carbs from tomatoes and onions and other low carb veggies and berries and the odd fun size apple and natural yoghurt and nuts and the odd square of dark 75% chocolate etc.

What you do clearly works very well for you but I suspect it would be something that would be difficult for a parent with an 8 year old child to manage.
Children just don't like the sort of foods that adults do except my granddaughter who at 4 loved olives.

 

[helli]

What you do clearly works very well for you but I suspect it would be something that would be difficult for a parent with an 8 year old child to manage.

I would struggle to follow rebrascoras way of managing diabetes with her diet. I would not want to expect a high alarm two hours after most meals and need to respond with another bolus. It feels like diabetes is controlling my life too much.
But I accept we are all different and it works for her.

I just don't generally have the beige foods that usually accompany them like bread and rice and pasta and potatoes.

I don't consider these "beige foods".
I think of beige food as processed carbs such as pasties and pies with non-descript fillings or other convenience foods such as reconstituted potatoes like oven chips.
This is the food my MIL feeds me because she doesn't know how to cater for a vegetarian. It is tasteless and textureless.
Rice is white. Pasta can be a variety of colours. Potatoes are red or white. Freshly baked bread is wonderful.

 

[Inka]

Yes, there’s a big difference between processed junk-like carbs and less processed ones @helli Many years ago, I worked in a whole food restaurant and the salads were things of wonder. We had an enormous salad bar to choose from, with, of course lots of veg and fruit, but also an amazing assortment of whole grain salads and tubers. There was buckwheat, millet, polenta, etc, and all perfect for a healthy diet, as well as being very tasty. We even had blue potatoes once!

 

[Leadinglights]

Yes, there’s a big difference between processed junk-like carbs and less processed ones @helli Many years ago, I worked in a whole food restaurant and the salads were things of wonder. We had an enormous salad bar to choose from, with, of course lots of veg and fruit, but also an amazing assortment of whole grain salads and tubers. There was buckwheat, millet, polenta, etc, and all perfect for a healthy diet, as well as being very tasty. We even had blue potatoes once!

I grew some blue potatoes a few years ago, unfortunately when they were cooked they turned a very unappetising grey colour.
I think you can almost say vegetarian is main stream now whereas in the 50ies when I was a kid and my Dad was vegetarian, options were slim to non existent in many places.
The cafe at Ryton Gardens operated as veggie in the early days but sadly did not remain so as they didn't get enough footfall. I remember going to Cranks in London which I believe was one of the very early wholly veggie restaurants.