Body's response to fatty food?

[Gardevoir]

Hi,

I had 3 small chocolate biscuits last night, injected 1 unit more than I usually would've and ended up hovering around 20 mmol/L throughout the entire night despite injecting another 12 units in total for that single high. I'm aware of how fats delay the breaking down of sugars but I never thought about why it did what it did last night.
1 of these biscuits is 8,5g in carbs. In the evenings, I inject 1 unit per 15 grams. I had 3 biscuits = 25,5 -> I injected 3 units.
I was good for 3 hours and then started rising from 10.7 at 10:31 PM to being 21.9 at 3:06 AM. Where's this sugar rush coming from? I injected a lot on top of the units I injected for the amount of sugar which works with every other meal (and/or snacks) in the evenings. Even when eating a 76g carb bag of chips in one go, I don't spike like this.
I had dinner 1,5 hours prior to eating the chocolate. I was stable. I was sitting down during all of it.

What's the explanation for this? Am I missing something? I'm T1.
Thank you in advance

 

[SimonP78]

I don't find the chocolate in chocolate biscuits delays anything very much, I'd be tempted to look at what you ate for supper instead, could that have been absorbed slowly?

Re large doses to bring BG down, when high the body becomes insulin resistant, so more is needed than at normal BG levels. That does sound like rather a lot of insulin though, which again makes me wonder about carbs from supper.

Was this on a libre or via fingerprick, as they can differ quite a lot when outside the normal range. I.e. you may not have been as high as you thought.

What does your BG normally do in the evening/overnight? Are your levels stable today (i.e. you weren't coming down with a lurgy)?

 

[Gardevoir]

What does your BG normally do in the evening/overnight? Are your levels stable today (i.e. you weren't coming down with a lurgy)?

They often rise in the evening (primarily because of dinner) but have been stable today. Only reason I'm commenting now is because I got woken up by my low alarm.

Was this on a libre or via fingerprick, as they can differ quite a lot when outside the normal range. I.e. you may not have been as high as you thought.

Libre

I don't find the chocolate in chocolate biscuits delays anything very much, I'd be tempted to look at what you ate for supper instead, could that have been absorbed slowly?

I usually don't have an issue eating them either. My dinner had low carbs compared to what I usually eat for no reason in particular (was perhaps not that hungry?) 45g carbs in total. Pasta, veggies, meatballs.

To put it into perspective; I had 133g the evening before, injected 9 units and ate at 8 PM. I dropped to 3.3 at 9:33 PM which I quickly corrected to 7.1 and I was fine until 1 AM when I rose to 18.1.

 

[Gardevoir]

Had dinner today. 204g, 14 units (2x 7) at 9 PM. 3.7 at 2 AM, 20.6 upwards trend at 5 AM. I had pasta with tomato sauce and mear today. Very odd.

 

[SimonP78]

Had dinner today. 204g, 14 units (2x 7) at 9 PM. 3.7 at 2 AM, 20.6 upwards trend at 5 AM. I had pasta with tomato sauce and mear today. Very odd.

That sounds ok, aside from the low, do you get dawn phenomenon? I split my evening meal bolus to avoid a post-supper/early-evening low (caused by a mis-match between insulin activity and carb digestion), this low can shift around a bit depending on insulin and carb absorption rates.

To put it into perspective; I had 133g the evening before, injected 9 units and ate at 8 PM. I dropped to 3.3 at 9:33 PM which I quickly corrected to 7.1 and I was fine until 1 AM when I rose to 18.1.

This sounds like a classic case of needing to split insulin and take more across the 2 (or more) doses. This is exactly what I used to have happen.

I usually don't have an issue eating them either. My dinner had low carbs compared to what I usually eat for no reason in particular (was perhaps not that hungry?) 45g carbs in total. Pasta, veggies, meatballs.

Any sauce with the food (which can often contain quite a lot of oil/fat to presumably slow digestion), how many units did you take to cover the 45g of carbs?

I don't have firm figures re carb absorption rates, but the top end for pure glucose is ~60g/hr, apparently it's possible to manage 90g/hr with a glucose/fructose blend (both re use for e.g. Triathlons, though the caveat here is that exercise delays digestion, I don't know how much of an effect that will be for very readily absorbed "sugars" though). Normal food is nowhere near these numbers, so I'd be thinking more on the order of 30g/hr or less (but don't quote me!), potentially with quite a long tail, even without the addition of fat/protein. I need to do some more research, which your post has reminded me about.

The other thing I'd suggest you look at is your basal dose: does this control your BG stably overnight? If you're also getting a rise due to insufficient basal this isn't going to help.

 

[Jaylee]

Hi,

I had 3 small chocolate biscuits last night, injected 1 unit more than I usually would've and ended up hovering around 20 mmol/L throughout the entire night despite injecting another 12 units in total for that single high. I'm aware of how fats delay the breaking down of sugars but I never thought about why it did what it did last night.
1 of these biscuits is 8,5g in carbs. In the evenings, I inject 1 unit per 15 grams. I had 3 biscuits = 25,5 -> I injected 3 units.
I was good for 3 hours and then started rising from 10.7 at 10:31 PM to being 21.9 at 3:06 AM. Where's this sugar rush coming from? I injected a lot on top of the units I injected for the amount of sugar which works with every other meal (and/or snacks) in the evenings. Even when eating a 76g carb bag of chips in one go, I don't spike like this.
I had dinner 1,5 hours prior to eating the chocolate. I was stable. I was sitting down during all of it.

What's the explanation for this? Am I missing something? I'm T1.
Thank you in advance

Hi,

You on MDI or pump?
If MDI, what basal??

 

[Gardevoir]

do you get dawn phenomenon?

I do.

Any sauce with the food (which can often contain quite a lot of oil/fat to presumably slow digestion), how many units did you take to cover the 45g of carbs?

3 units. I take 1 unit per 15g carbs for my evening meals.

I don't have firm figures re carb absorption rates, but the top end for pure glucose is ~60g/hr, apparently it's possible to manage 90g/hr with a glucose/fructose blend (both re use for e.g. Triathlons, though the caveat here is that exercise delays digestion, I don't know how much of an effect that will be for very readily absorbed "sugars" though). Normal food is nowhere near these numbers, so I'd be thinking more on the order of 30g/hr or less (but don't quote me!), potentially with quite a long tail, even without the addition of fat/protein. I need to do some more research, which your post has reminded me about.

I didn't know there was a "limit" on how much sugar your body can break down like that but it does make sense.

The other thing I'd suggest you look at is your basal dose: does this control your BG stably overnight? If you're also getting a rise due to insufficient basal this isn't going to help.

If I have a nice BG before going to bed ~2 hours after my meal, I don't go high or low overnight.

You on MDI or pump?
If MDI, what basal??

I inject using Aspart Sanofi and Tresiba.

 

[Gardevoir]

I might be phasing out of my honeymoon phase. I've noticed it during my meals at work as well (I am accounting for the difference in physical activity) but didn't think of how to fix it or why it's happening in the first place. I thought I'd perhaps have the carbs off but I no longer think that's the case. I actually think it's a bit easier than that;

I had 67g earlier, injected 5 units. I usually inject 1:20 so that'd be 4 units + 7g left. I took 5 and went from 5.7 to 6.1 in 2 hours, only "peaking" at 10.2 ~1h after consumption before the insulin nicely brought it back down. I took 5 units and ended up being slightly higher, which makes me believe I should start injecting more units per meal. 67/5=13.4, so I should try to inject based on 1 unit per 13g carbs (?).
I plan on doing that until Monday and see how that goes. If I'm not making sense or missing out on info, please correct me.

 

[SimonP78]

That makes sense, I need to inject more in the evening typically, though I also tend to split my dose as otherwise I end up going low immediately after supper, then high later on (as I need treat the low, but don't take extra insulin to cover that).

 

[Gardevoir]

That makes sense, I need to inject more in the evening typically, though I also tend to split my dose as otherwise I end up going low immediately after supper, then high later on (as I need treat the low, but don't take extra insulin to cover that).

I experience the same and have started splitting my dose for higher carb meals and it turned out great. Hit 92% time in range today

 

[Billy H]

Hi,

I had 3 small chocolate biscuits last night, injected 1 unit more than I usually would've and ended up hovering around 20 mmol/L throughout the entire night despite injecting another 12 units in total for that single high. I'm aware of how fats delay the breaking down of sugars but I never thought about why it did what it did last night.
1 of these biscuits is 8,5g in carbs. In the evenings, I inject 1 unit per 15 grams. I had 3 biscuits = 25,5 -> I injected 3 units.
I was good for 3 hours and then started rising from 10.7 at 10:31 PM to being 21.9 at 3:06 AM. Where's this sugar rush coming from? I injected a lot on top of the units I injected for the amount of sugar which works with every other meal (and/or snacks) in the evenings. Even when eating a 76g carb bag of chips in one go, I don't spike like this.
I had dinner 1,5 hours prior to eating the chocolate. I was stable. I was sitting down during all of it.

What's the explanation for this? Am I missing something? I'm T1.
Thank you in advance

I noted that you understand the fat slows sugar uptake, but Diabetes UK recently promoted a paper that highlighted a further issue regarding fats eaten.
It has been found that fats are converted to sugar around 3 hours or so after consumption.
The paper recommended checking glucose levels around 2.5 to 3 hours after eating higher levels of fat and taking a correction dose to compensate at that point.
I found the information in the paper highly accurate in my case but was very surprised to find none of my medical professionals were aware of it.

 

[Antje77]

It has been found that fats are converted to sugar around 3 hours or so after consumption.

Can you please provide a link to this study?
While I know many people take a split bolus or the equivalent on a pump for meals containing both significant carbs and fats because the fats delay the carb hit, I've never heard about fats being converted to sugar/glucose.

 

[Billy H]

Can you please provide a link to this study?
While I know many people take a split bolus or the equivalent on a pump for meals containing both significant carbs and fats because the fats delay the carb hit, I've never heard about fats being converted to sugar/glucose.

There is loads of research reports online - here is just one

Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management

OBJECTIVE. Current guidelines for intensive treatment of type 1 diabetes base the mealtime insulin bolus calculation exclusively on carbohydrate counting.

diabetesjournals.org

 

[Antje77]

It has been found that fats are converted to sugar around 3 hours or so after consumption.

There is loads of research reports online - here is just one

Dietary Fat Acutely Increases Glucose Concentrations and Insulin Requirements in Patients With Type 1 Diabetes: Implications for carbohydrate-based bolus dose calculation and intensive diabetes management

OBJECTIVE. Current guidelines for intensive treatment of type 1 diabetes base the mealtime insulin bolus calculation exclusively on carbohydrate counting.

diabetesjournals.org

Thanks for looking it up, interesting study.
But very small, only 7 people. And the conclusion is not that fats are converted to glucose, and nowhere does it speak of 3 hours.
The meals used in the study are very high carb, which may make a difference as well.

 

[SimonP78]

It is interesting to see that not only does fat slow digestion, but it also appears to increase insulin sensitivity. There are some interesting references in the paper's conclusions section, thanks for the linky.

As a side note, I'm sure I've read somewhere that fat (as well as protein) is partially converted to glucose in the absence of any carbs. I've always wondered quite how many carbs are needed to avoid this effect (and indeed what happens with a mix of protein and fat - nuts for example, which also have some carbs.....).

I must confirm that it's both fat and protein that are partially converted. I will Google and report back!