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A simple question to type 1 diabetics

Spiker said:
Exactly. 6g of carbs equivalent as a starting point. Bearing in mind the absolute maximum would be 15g of carbs equivalent.
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Great method. On 30g/day, I've been calculating for half the protein and then guessing, as that's a bit too high. So 25% makes perfect sense.

Lucy
 
at what point do you count it? how do you know if you have had to much, ill often have a lot of meat to make up for not eatting that many carbs
 
itconor said:
at what point do you count it? how do you know if you have had to much, ill often have a lot of meat to make up for not eatting that many carbs
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I would guess that if you inject or titrate against the carbohydrates and get higher BG results than expected then you will know that something else is at play. That "something would be the proteins developing glucose via a biochemical process called GLUCONEOGENESIS..

The example given in earlier posts on this thread illustrate the answer to your question.

Say you eat a 100 gram steak, thats about 25 grams of protein. If you assume that from 25 % to 60% of that protein can be converted into glucose via gluconeogenesis then that meas 25x0.25= approx 6 grams of glucose and in the extreme case 25x 0.6 =15 grams of glucose.

Spiker says that he advises injecting initially for the low conversion rate ie 25%= 6 grams of carbohydrate and then according to your results, adjust accordingly.

So to summarise , the insulin injection dosage = summation of [ meal carb content + 25%* to 60 % of ingested protein ]

* 25 % or protein as the starting injection level.
 
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Pasha said:
I would guess that if you inject or titrate against the carbohydrates and get higher BG results than expected then you will know that something else is at play. That "something would be the proteins developing glucose via a biochemical process called GLUCONEOGENESIS..

The example given in earlier posts on this thread illustrate the answer to your question.

Say you eat a 100 gram steak, thats about 25 grams of protein. If you assume that from 25 % to 60% of that protein can be converted into glucose via gluconeogenesis then that meas 25x0.25= approx 6 grams of glucose and in the extreme case 25x 0.6 =15 grams of glucose.

Spiker says that he advises injecting initially for the low conversion rate ie 25%= 6 grams of carbohydrate and then according to your results, adjust accordingly.

So to summarise , the insulin injection dosage = summation of [ meal carb content + 25%* to 60 % of ingested protein ]

* 25 % or protein as the starting injection level.
Click to expand...
Would this take longer to act? ive noticed i eat dinners of around 30G carbs and take insulin im grand for 2 hours then get spikes in the 3/4 hours later even.
 
itconor said:
Would this take longer to act? ive noticed i eat dinners of around 30G carbs and take insulin im grand for 2 hours then get spikes in the 3/4 hours later even.
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Yes, because the glucose produced by gluconeogenesis is produced later and " misses" the effects of the insulin taken. If a meal is higher in fat, this too has an effect of spiking three to four hours later, or in some cases, even more !

Signy
 
Heathenlass said:
Yes, because the glucose produced by gluconeogenesis is produced later and " misses" the effects of the insulin taken. If a meal is higher in fat, this too has an effect of spiking three to four hours later, or in some cases, even more !

Signy
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This makes a great deal of sense, i had oven chips and steak and this happened, i had pervious thought it may have been fat in the chips but their oven and fairly low fat, i wonder if it was the steak. well this has distorted my carb counting
 
itconor said:
This makes a great deal of sense, i had oven chips and steak and this happened, i had pervious thought it may have been fat in the chips but their oven and fairly low fat, i wonder if it was the steak. well this has distorted my carb counting
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I remember not long after I was first diagnosed I had a steak and chips and bloused accordingly. Ended up having a bad hypo about 1-2 hours after the meal and then my BG shot up to the teens about 5-6 hours after eating! That experience taught me all about the impact of high fat meals and split dosing!
 
itconor said:
Would this take longer to act? ive noticed i eat dinners of around 30G carbs and take insulin im grand for 2 hours then get spikes in the 3/4 hours later even.
Click to expand...

Make sure it's not just your basal insulin not being at the right dose, if you fast and miss that meal-time this will give you a definite answer.

But both fats & protein effects bg levels even when there's small amounts of carbs on the plate, the best way of deal with this is testing postprandial and seeing when your bg levels start to rise, on MDI I would use a split-dose for high-fat meals as where now I can extend the bolus or use a TBR on the pump.

Edited to add, when you do get the insulin dose right make sure to keep a note of it for when you next have that type of meal...........otherwise you'll forget and have to start all over again.
 
Personally, I mainly eat mixed meals. I think that though I calculate according to the carbs, the dose is really based on eating relatively similar proportions of protein/fat/carb . Larger or very fatty meals are better dosed with a dual bolus which means a bit of the insulin is given upfront and the rest is given over a period (this is a pump option)

If I eat a meal with very few carbs (eg:English breakfast or an omelette) I certainly need to dose for it and tend to use 'educated' guesswork ie what seems to be right based on previous experience

Here's a non simple answer using the info from a Dr who tends to be in favour of lower carb diets, .Dr Katharine Morrison
She suggests both a carb bolus and a protein bolus but using different insulins for the two components. Rapid for the carbohydrate and regular, which takes longer to work for the protein element.
She uses the weight (in ounces) of the protein food to calculate the insulin and suggests a formula of 2 units of regular insulin to cover 3 oz of a high protein food. http://www.diabetes.co.uk/forum/threads/advise-please.7034/#post-61596

Here are some examples :
for a person who uses I unit of rapid per 7g carb.

3 boiled eggs and a low carb muffin (10g carb)
for the carbohydrate element 10/7= 1.4units of rapid insulin (or 1.5 with a half unit pen)
for the eggs, this is 3oz so she suggests 2units of regular insulin .

chicken breast salad and berries/cream.
10 g carb .The chicken is a 6oz portion.
Once again the person takes 1.4units rapid for the carbs
Chicken: 6oz (6/3= 2, 2x2=4) 4 units of regular for the protein

The Diabetes Diet: How To Manage Your Diet For Weight Loss And Incredible Blood Sugar Control [Kindle Edition] Katharine Morrison, Emma Baird

Back to me: if I had a chicken salad for lunch my chicken portion would be a little smaller (more like 4-5oz) but I'd probably eat another 20-30g carb from potato or bread. .My insulin dose would end up about the same.
.
 
And lastly, size of the meal - how big its volume and density are - also seems to be very important.

Simple, did you say? :-)
 
noblehead said:
Make sure it's not just your basal insulin not being at the right dose, if you fast and miss that meal-time this will give you a definite answer.

But both fats & protein effects bg levels even when there's small amounts of carbs on the plate, the best way of deal with this is testing postprandial and seeing when your bg levels start to rise, on MDI I would use a split-dose for high-fat meals as where now I can extend the bolus or use a TBR on the pump.

Edited to add, when you do get the insulin dose right make sure to keep a note of it for when you next have that type of meal...........otherwise you'll forget and have to start all over again.
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i have been increasing recently, the Libre is a great help for this with its trends and graphs. i had to increase my evening dose by serval units, and ive upped my morning by 3 and it has helped i think, may still need to boost the morning dose
 
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