Bolusing for fat, protein AND carbs in a meal

[ewelina]

I looked at that thread and the links before but I found the methodology of the calculations a bit mind-boggling, to be honest .

However, "Every 100kcal from fat and protein is one PF portion," makes it all sound a bit easier. That just means that after all these years, I will finally have to learn to calorie count. And there is loads of info out there about calorie counting (even for innumerates like me). So the next thing to work out is the timing of the extended bolus.

Yes I know this article looks rather scary! I gave up after few lines
Calculations are not that bad I don't think you need any software. 1g of protein=4kcal, 1g of fat=9kcal. You can use something like myfitness pal or even cal&carbs. If you know calorific content of the whole meal, deduct calories from carbs (1g carbs=4kcal) and you get calories from protein and fat ( for example portion of macaroni cheese is 40g carbs and 460 kcal. Kcal from carbs is 160 so you can calculate that from protein and fat is 300kcal). Hope it does make sense
The hardest part of this method was finding what my ratios are. I would recommend eating carb free meal, and on the base of your readings, finding your ratio for protein and fat. You should do the same for carb meal (without any fat or protein) as well. A bit of hard work I must say, especially when you have different ratios throughout the day

 

[ewelina]

I'm going to have to pull my socks up and give it a go, I see.

Tbh, my most horrifying spikes are when I eat a big chunk of salmon. I guess it is the fat and protein combined.

But I can give up pizza, but I'll never give up salmon. So I must master this.

For a big chunk of tuna (lets say 200g) I would need about 2u. Protein spikes me nearly as quickly as carbs!

 

[RuthW]

The big chunks of salmon would spike me for sure. Have you read The Rosedale Diet? He speaks od P turning to glucose and recommends no more than 3 oz per meal. I was eating much more and was always seeing high numbers. Then I tried his approach and they immediately dropped. New research (for what it is worth) is most adults only need 45-60 g protein a day divided into 3 meals. Lower my P as well as dividing it between meals made a huge difference.

It is VERY hard to eat out and get it right. You never know what is in the foods. I tend to just order salads and eyeball the protein. It is not fun eating out anymore and it is not fun trying to correct mistakes. It takes days to get back to normal.

I haven't read it, but I know one of two things can happen when we eat protein. Either the body uses it for growth and repair. In that case it is in fact insulin which carries the amino acids into the cells where they are needed. Or, if the protein is in excess of what is needed for growth and repair, the body converts it into glucose, so it can be used for energy (if, for example, you don't eat more easily available sources like carbs) or stored as fat (as excess carbs or fat would be stored). So either way, protein requires insulin to be used by the body.

For me, as with many T1s, we have used that strategy of eating consistent but limited portions of protein alongside carbs and "folding the protein in" to our insulin:carb ratio so that it effectively becomes invisible.

So ewelina is right. Once you start to calculate protein separately, you will need a lower insulin to carb ratio.

Lately, I have been weight-training so I have increased the amount of protein I eat. And this has highlighted this issue for me.

 

[Kristin251]

For a big chunk of tuna (lets say 200g) I would need about 2u. Protein spikes me nearly as quickly as carbs

I definitely agree! How much P would you guess you eat at a meal? I am VLC and think I need 1/2 unit per 5g P, a little less at dinner. When I talk grams of P I am talking pure P, not the weight. So 3 oz is roughly 21g and I eat about 40 in animal and the rest in veg P.

Exercise always spikes me and especially weight training. I SHOULD do it because it is good for us but I don't feel like extra blousing and trying to figure out that game. With me it is such a wild card. Sometimes I need lots of insulin and sometimes very little and there is no way to judge until I go low or high. I have no consistency there. I have maintained my muscle since insulin so I have put this aspect to the side but good for you!
I also think when I eat larger portions of protein I cannot get insulin right unless I split doses and then it is almost time to eat again or go to bed. I haven't played with this either.

 

[ewelina]

I definitely agree! How much P would you guess you eat at a meal? I am VLC and think I need 1/2 unit per 5g P, a little less at dinner. When I talk grams of P I am talking pure P, not the weight. So 3 oz is roughly 21g and I eat about 40 in animal and the rest in veg P.

Exercise always spikes me and especially weight training. I SHOULD do it because it is good for us but I don't feel like extra blousing and trying to figure out that game. With me it is such a wild card. Sometimes I need lots of insulin and sometimes very little and there is no way to judge until I go low or high. I have no consistency there. I have maintained my muscle since insulin so I have put this aspect to the side but good for you!
I also think when I eat larger portions of protein I cannot get insulin right unless I split doses and then it is almost time to eat again or go to bed. I haven't played with this either.

I don't really have set amount of protein/fat I eat. It differs from meal to meal and that's why I'm so motivated to find the way of blousing for flexible eating. it work most of the time but I would lie saying its always perfect. I ate lots of **** tonight (having friend around and ready meals for dinner) and I'm 11mmol at the moment. Not great but I'm not sure if its possible to have it under control all the time

 

[RuthW]

Yes, there are so many factors in Type 1. Something I didn't add earlier because I didn't want to complicate things, s that one way for me to get rid of my typical evening spike is to exercise either after the meal, or even before my evening meal. So I often don't have the spike, in spite of eating a fair bit of fat and protein.

But I want to learn to deal with every factor independently so I can predict and prevent spikes when I can't exercise them off.

 

[Kristin251]

I think sometimes just a 'new day' is a factor, LOL.
Sometimes exercise helps and sometimes it goes the other way. Good for you for sticking to it.

 

[steve_p6]

Hells bells its complicated! How i survived 10 years as a child/teenager on a single daily shot of monotard I have no idea. Since I went onto the Libre my control has improved hugely, but boy have my eyes been opened!

 

[freddy2]

Yes I know this article looks rather scary! I gave up after few lines
Calculations are not that bad I don't think you need any software. 1g of protein=4kcal, 1g of fat=9kcal. You can use something like myfitness pal or even cal&carbs. If you know calorific content of the whole meal, deduct calories from carbs (1g carbs=4kcal) and you get calories from protein and fat ( for example portion of macaroni cheese is 40g carbs and 460 kcal. Kcal from carbs is 160 so you can calculate that from protein and fat is 300kcal). Hope it does make sense
The hardest part of this method was finding what my ratios are. I would recommend eating carb free meal, and on the base of your readings, finding your ratio for protein and fat. You should do the same for carb meal (without any fat or protein) as well. A bit of hard work I must say, especially when you have different ratios throughout the day

I like to learn about this stuff and followed the TAG total available glucose, where it is bolus for about 100% carbs, 50% protein and 10% fat.
the polish is very different, If you are doing 100g of protein =1 measure and 100g of fat =1 measure, or did I misunderstand and I have the wrong end of the stick?

I think I just got it, you add the protein and fats together, and 100g of both together = 1 measure ...right?

 

[ewelina]

I like to learn about this stuff and followed the TAG total available glucose, where it is bolus for about 100% carbs, 50% protein and 10% fat.
the polish is very different, If you are doing 100g of protein =1 measure and 100g of fat =1 measure, or did I misunderstand and I have the wrong end of the stick?

No, you calculate calories from protein and fat. 1 protein/fat portion=100 kcal from fat/protein
1 g protein=4kcal, 1g fat=9kcal

 

[RuthW]

Hells bells its complicated! How i survived 10 years as a child/teenager on a single daily shot of monotard I have no idea. Since I went onto the Libre my control has improved hugely, but boy have my eyes been opened!

Yes, me too. Diabetic since 1967. I think I had a dose of good luck every day along with the insulin.
But recently I have been thinking that the way the NHS transferred us all onto MDI about 30 years ago, with absolutely ZERO training (compare with DAFNE courses nowadays) was actually entirely irresponsible, and very bad clinical practice. I think if this were the US, there would be a class action taking off about now.

 

[yingtong]

Yes, me too. Diabetic since 1967. I think I had a dose of good luck every day along with the insulin.
But recently I have been thinking that the way the NHS transferred us all onto MDI about 30 years ago, with absolutely ZERO training (compare with DAFNE courses nowadays) was actually entirely irresponsible, and very bad clinical practice. I think if this were the US, there would be a class action taking off about now.

Oh I remember this so well,how did we survive,and injection insulin zinc suspension 80 strength.Diagnosed 1962 but have survived without hardly any problems.

 

[RuthW]

Yes, I think we have a lot in common, but I also think the old days of rigid routines may have been quite effective. We didn't really need to know as much as we need to know now. We did need a LOT of self control, though!

Anyway, back on topic, I am starting to play with these calculations about protein and fat and it is working quite well......so far.

 

[tim2000s]

Yes, me too. Diabetic since 1967. I think I had a dose of good luck every day along with the insulin.
But recently I have been thinking that the way the NHS transferred us all onto MDI about 30 years ago, with absolutely ZERO training (compare with DAFNE courses nowadays) was actually entirely irresponsible, and very bad clinical practice. I think if this were the US, there would be a class action taking off about now.

It's interesting isn't it... I remember the advice my cousin was given when put on MDI and it was based on testing before eating but had little concept of carb counting. My family and I couldn't understand it.

 

[yingtong]

Yes, I think we have a lot in common, but I also think the old days of rigid routines may have been quite effective. We didn't really need to know as much as we need to know now. We did need a LOT of self control, though!

Anyway, back on topic, I am starting to play with these calculations about protein and fat and it is working quite well......so far.

I still use a lot of the rigid routines of yest_a-year.When I was firstdiagnosed I used to have to weigh out meat and cheese presumably to take into account the protein and fats and I am not so sure it was far wrong,certainly without taking into account fats and proteins I get spikes..

 

[Kristin251]

I still weigh P but eat about the same amount of fats and veg. If I don't weigh P I can spike or drop. Annoying but part of the game

 

[noblehead]

I still use a lot of the rigid routines of yest_a-year.When I was firstdiagnosed I used to have to weigh out meat and cheese presumably to take into account the protein and fats and I am not so sure it was far wrong,certainly without taking into account fats and proteins I get spikes..

That's interesting @yingtong, do you recall how the fat/protein to insulin ratio worked?

I was only ever told to count carbs in Carbohydrate Exchanges, one exchange equalled 10g of carbs.

 

[yingtong]

That's interesting @yingtong, do you recall how the fat/protein to insulin ratio worked?

I was only ever told to count carbs in Carbohydrate Exchanges, one exchange equalled 10g of carbs.

I am looking through my old paperwork and found an old diet sheet and it said I was allowed 1000 calories a day.I will keep looking to try and find what you asked for noblehead.

 

[RuthW]

Well, today I weighed and measured almost everything, and made pretty good estimates. I stayed low fat (one factor at a time!) And it has been great! Because of the discussion on this thread, I got the calculation for the extended bolus right for my evening meal. No peak at all after my meal! Nope! Flat in the 5 mmols all evening. I'm feeling ever so slightly ecstatic here!
I also hit the protein fairly hard around midday with toast and peanut butter, then three scrambled eggs and toast. I didn't do an extended bolus for that because I knew u would be out walking in the afternoon. About four hours after the eggs, I had a slight peak - 8.2. But considering I only boluses 0.1 unit for the eggs and toast, that was pretty good too. Though really I think I couldn't have done an extended bolus of 0.2 and expected perfection.
I think this could really work well. I'll give it a few more days on low fat + carbs, then try adding in the confounding factor: the fat!

 

[RuthW]

I still use a lot of the rigid routines of yest_a-year.When I was firstdiagnosed I used to have to weigh out meat and cheese presumably to take into account the protein and fats and I am not so sure it was far wrong,certainly without taking into account fats and proteins I get spikes..

Can I ask how old you were when diagnosed? I suspect some instructions were given to my parents and never passed on to me. I was five when diagnosed, and only last year my mum said, "Oh yes, we were told you should eat some protein at every meal." Sheesh! Nearly fifty years on she tells me!