Protein at dinner causing overnight BS spikes

[Abi W]

Hi everyone

I've lurked on here for a while after stumbling across the forum by accident (and it is incredibly helpful, so I can't thank you all enough), but this is my first question (apologies if it should be on one of the nutrition threads). I've had Type 1 for nearly 20 years, I'm on Apidra and Lantus (split dose) and as of recently I'm on a real drive to understand in detail what's going on in order to bring and keep my HbA1c down.

So, just wondering whether any other Type 1's experience the phenomenon of protein at dinnertime sending sugars soaring by 4am, and how you deal with it?

I've only recently made the connection between meat at dinner and the night highs (or puzzlingly elevated fasting sugars), and the only way I've found to deal with it is eating very little protein with my evening meal (bye bye steaks and pizzas with cheese, but even a bit of white fish or lean chicken has to be very small if it's not to cause the rise, so I know it's not the fat causing delayed carb absorption). I can't take extra Apidra at bedtime because my pre-bed sugars are generally around 6 and I'd wake up hypo by 1am. And it's really frustrating not being able to eat even a small portion e.g. one chicken drumstick!

Am I just super-sensitive to protein? Very few books mention the chemistry of why it can cause your sugars to rise. But even when they do, they don't really tell you how to deal with it, other than avoiding the foods that cause it or making sure to eat carbs with it (which in my case doesn't stop the delayed spike), so I'd be really grateful for anyone's thoughts or experiences on this.

Thanks!
Abi

 

[phoenix]

No you aren't super sensitive, protein can raise glucose levels later, Personally I find a lower effect from things like white fish and for me it's definitely exacerbated by a lot of fat .
To be honest if I have a largish meal, particularly after about 7pm I will use an extended bolus on my pump. Before pumping I might have split the dose and taken some before the meal and some a bit later; but this doesn't help with a very delayed increase.
When I was diagnosed my (French) doctor was very against me having the main meal in the evening. I thought it was just cultural but I have to admit I find it much easier to deal with midday main meals than evening ones (still tend to eat in the evening )

 

[bethan90]

I have read that your body can only use 30g of protein at one time so anything over 30g per meal gets stored as glucose (something similar to this anyway). I find that I do get a small spike if I have a large amt of protein at one time but normally straight after the meal and it normally settles.

I see you mentioned pizzas. Pizzas are the devil for me. They are high in carbs and high in fat/sat fat. This causes the digestion of carbs to be delayed, normally after the fast acting insulin has worn off, so you get a spike hours after eating. My dietician advised me to take half of my fast acting straight after the meal and the other half of the dose 2 hours later. I also do this for take aways. It seems to help although I still often wake up >12 after a high fat meal :-( pizza just seems to be one of those meals I have to avoid, or just stick with eating one slice only.

 

[Abi W]

Hi, and thank you both very much.

Very helpful to know, Phoenix, that you deal with it using an extended bolus - overnight control for protein (delayed spikes) and exercise (night hypos) is one of the reasons I'm keen to go on a pump. I totally agree that a larger midday meal makes more sense but is difficult in practice!

Bethan, thank you for mentioning 30g - that's the first time I've heard a concrete figure (I've only seen "the size of the palm of your hand"), so that's going to be helpful for me to judge amounts from now on. Sadly split doses don't work because the rise is just too delayed. Pizzas and steak? Oh well, I'm with you on the "one slice only" rule now, as otherwise I get the textbook post-meal low followed by delayed spikes

I'll see how it goes!
Abi

 

[Cobra3164]

Hi, it is interesting that the body processes excess protien to sugar and that is a very valid point. But also we have to understand that the body does require that set amount of protien especially so your body can produce sufficient amino acids and these are vital to all organs all the way down to the single cell which need amino acids to produce their own messenger protiens which maintain cell health. The more wrong thing to do would be to have too little protien in your diet but if you do cut down on it in the morning remember to take on board complex slow release carbs to take you through to your next meal they will supply energy for between 4 to 5 hours if our body doesnt have sufficient protien or carbohydrate the right sort then this will be detrimental to diabetes, balance is the key and I do understand that this can take some time to discover.

All the best

Simon aka Cobra3164

 

[bennyg70]

Baine of my life at the moment! If I have a healthy tea I wake up to healthy sugar readings, If I have a meal out or a larger than average meal, or higher in fat or protein, then I can go to bed with normal BS, and wake up with reading around 10 - 15 which really upset my day!

Theres beena lot of suggestions to me reagrding split dosing, but like you I think mine is such a delayed rise - I reckon approx 6 hours till the rise begins. The only thing that I can try (Which I havnt gt round to doing yet) is ay eating bad meal at 7 pm (Therefore expecting start of rise at say 1 pm) and injecting a couple of units at 12.30 say to try and co- incide.

Its dangerous, but i need to find a way over it. The next problem then is determining, how much is too much, what pushes me over the boundary for needing this extra shot! For me its meals out and takeaways.

Last ngiht we went out and I had a portion of mash potatoe with carrots and a lamb shank... Fatty, and Id say a high protein meal? Injected and was perfect at bed floating around 7.5.

Woke up this morning 15mmol.

On a good day when I have say brown rice and veg and small meat, ill go to bed at 7 and wake up between 5 and 7. Grrrrrr.

Ill share my finidings... when i find them!

 

[Abi W]

Thank you very much Simon for your advice. Please don't worry, I make sure I get enough protein at lunch and always have porridge for breakfast but very helpful to have your reminder of what it is we're trying to achieve (and why we need the protein). I just find the dinner/overnight thing very frustrating...

BennyG - your experiences mirror mine! I'm in the same boat re. trying to work out what pushes you over the boundary (I will try Bethan's 30g tip) and how to time extra units at bedtime. It drives me crazy not having the lamb shank on a evening meal out (or only eating 3 bites of it - I'm teeny-tiny, so it doesn't take much to push me over the mysterious protein boundary). Good luck with your trial and error-ing! I'll likewise share anything concrete I find.

Abi

 

[michellem]

It's weird. I can the same thing but with the healthy food, brown rice especially! Have to really increase my insulin to carbs ratio and go to bed with good blood sugars but some time in the early hours it spikes. Very annoying.

 

[pennyjwills]

I eat lean protein, veg and use unsweetened soya in my diet and limit bread, potatoes pasta and rice. Im on basal/bolus 5 injections a day and I get morning hypers of 14-15. my diabetes doctor cant undrstand either as I log my insulin and I use Myfitnesspal to calculate all the carbs. I've tried so many different things to try and lower my morning sugar but it hasnt worked. One consultant said that maybe its natural for my body to shoot glucose into my blood stream on waking and that I'm testing after this happens. I'm still trying to find out and its been happening years despite an active healthy lifestyle.

 

[bethan90]

penny, have you tried upping your long acting? if you have and it hasn't worked maybe you are going hypo over night and then glucose is being dumped in to your system by your liver to combat the hypos.
I would think the most common answer is the long acting dose is too low.

 

[Willsnan]

I am new to the forum, but have had diabetes since 1973. I've been on a pump since last December, but prior to that was having problems with morning hypers even though I could get my HbA1c down to 6.5. I did a carb counting course which was amazing, and following on from that I used a continuous blood monitor for 6 days. This was a real eye opener as it showed that my BS fell so low around 1am that the meter couldn't even read it! It also showed a classic dawn phenomenon and the combination of the 2 sent my sugars skywards. Without the 6 day monitoring I am convinced that I would never have worked out what was happening. It may be worth those of you with protein spikes asking your specialist diabetes nurses to set this up for you. I have done this twice now - both before and after I had my pump and it is well worth the effort. I struggle with eating proteins after 8pm and although my consultant is quite sceptical about protein spikes, I'm going to CBM again to get to the bottom of this. There is a short waiting period to set this up, but in the past I have only waited about 4 weeks, so hopefully anyone who wants to try won't have to wait too long.
Good luck.
Helen

 

[Rainey]

You may also find that protein & fat take much longer to digest than carbs so slowing rises in blood sugar until later. This is the remit behind many current dietary trends.