Bolusing for proteins

[insanity]

Hi all,

This was very briefly mentioned on the tail end of another thread but I need a little more information.
Those who don't know me, I'm a type 1 on an insulin pump. I've recently been attempting some low carbing (at the moment I'm down to around 150g carbs a day - I know this is a little high in comparison with some of you but bare with me), My sugars dramitically came down and I was a little more stable unless exercise was involved.

I seem to have solved the exercise problem however, now I cannot stablise my sugars. Tonight we had a chicken breast, peas, sweetcorn, the smallest bit of mash imaginable and gravy. I worked out the following carb counts for my insulin bolus:

Mash 2 units
gravy 1 unit
peas & sweetcorn 1 unit

thus I bolused 4 units over a period of 30 minutes via my pump. This used to work perfectly, occasionally i'd have a hypo, however tonight 2 hours post meal my bs was 16.8!!!! I didn't do a correction unit as I was headed out to an exercise class (and yes I know your not meant to exercise over 15mmol but i'm very hypo prone so left it to try to avoid the hypo I usually have. 1 hour after the class, hypo free but a bs of 17.2!

So, my question is, can someone explain to me how the protein is being absorbed as carbohydrate (this was suggested to me in a previous thread) and if this is the case, how on earth am I meant to work out how much insulin to start giving with meals...?

 

[smidge]

Hi Insanity!

I read the previous thread and have the same issue. I take around 50g carb a day and definitety struggle with the 'protein effect'! I don't use a pump, so don't really know what to suggest. A couple of points, though - it isn't consistent with me -sometimes it happens and other times it doesn't, so i'm pretty worried to attack it with extra insulin; it is more pronounced now i'm on Levemir/Apidra - until recently I was on Insuman basal/Apidra and I think the insuman peak was dealing with it, so I'm studying and recording and trying to work out the exact pattern so that I can work out when the peak of insulin need to be to deal with it - I'll then ask for the insulin whose profile I think closest matches my needs. We'll see! Lastly, omellette and steak with salad seem to be the worst culprits - roast dinner with 2 small pieces roast potato seems to be better - the only carb my body seems prepared to tolerate :crazy: So, I know this is no help to you :lol: but I'll be sure to let you know if i learn anything useful from my study and I'll watch the responses to your thread with interest :lol:

In the meantime, Good Luck with sorting it out!

Smidge

 

[insanity]

Haha,well at least we both no we're not alone Smidge! Hopefully we'll find someone with an answer. watch this space thanks for replying

 

[Pneu]

I also low carb and use a pump so hopefully I can offer some insight although it can be a little hit and miss!

Firstly the general rule of thumb I follow is that I need to cover protein at 60% of my carbohydrate ratio... i.e. if you would normally inject 1 unit for 10g carbs then 1 unit covers just under 17g of protein so (10 / .6 = 16.6....) So if you are eating quite high protein meals then you will still actually need a reasonable amount of insulin.. now this is where a pump is great because protein covert's quite a bit slower than carbohydrate to glucose.. so I would normal do say a 30/70% split on the bolus over 1 or even 1.5 hours depending on the fat content..

Now the tricky thing is that if you are still eating a reasonable amount of carbohydrate then it starts to get very messy as to when you need to cover for protein.. I have found that much more than 80g of carbs / day gives me real headaches as to when I need to cover for protein as sometimes I do and sometimes I don't...

The good news I guess is on a sub 80g day my blood glucose will sit the WHOLE time between 3.8 - 4.6 mmol/l it hardly moves at all maybe + 1/2 mmol/l @ 1 hour post meal.. the problem is on those days where you are on the cusp and thus not sure what 'mode' your body is in..

Case in point was last night where I went out for a meal and had a pizza for the first time in ages.. I accepted that it was going to not be a good night on the BGs... it wasn't so terrible but this morning I went back to my normal eggs / bacon for breakfast covered the protein and then caught a hypo before it hit because my body had dropped out of ketosis back into carb mode! Meal had no carbs but my body also didn't covert the protein... so now I am going to spend today covering protein and testing to figure out when I jump back into ketosis!

IMO it's best to be in 1 camp or the other.. either you are in ketosis 99% of the time (other than perhaps the odd treat) or your not.. being on the edge is not a fun place for glucose control.

 

[insanity]

Thanks for that pneu, although can I aske what you mean by going back into a ketosis state as I was always told that was a dangerous state to be in for a type 1 diabetic?

I work with a 1unit = 10gcarbs also so will try to give a bolus per 17g protein and see what happens. It's mad, I never thought I'd ever have to bolus for a protein.

 

[Pneu]

No worries Instanity type I's often hear Ketosis or Keytones and instantly worry!

Keytones are a by product of when our body has to burn fat rather than carbohydrate to generate energy.. in a type I they are often associated with DKA because the body has no insulin it is forced to burn fat generating keytones which then turns into a run-away cycle of dehydration; high blood glucose and a whole load of hurt.. it is a natural cycle that gets out of control due to the lack of insulin.

If you eat few or limited carbohydrates then you put your body into this state of ketosis where it is burns fat, producing keytones.. in its self this is not dangerous and is a perfectly normal state to be in.. As long as you continue to take background insulin and keep yourself hydrated then you will have no problems.. exactly like any normal person would have no problems eating a low carb diet.

Now to explain the protein.. our body has a glucose requirement; specifically your brain which for certain functions can not use fatty acids as fuel.. as such if you are not eating carbohydrate and therefore have a limited supply of glucose it needs to get this glucose from somewhere.. it does this by converting protein in to glucose.

So what I meant by my post was this... for stable blood glucose your best to do one or the other.. so you are either always covering protein (low carb say sub 80g / day) or never covering protein (higher carb say 150+g / day).. if your somewhere in the middle you may find sometimes you need to and sometimes you don't which will as you have found out cause all sorts of headaches managing your blood glucose.

 

[insanity]

No worries Instanity type I's often hear Ketosis or Keytones and instantly worry!

Keytones are a by product of when our body has to burn fat rather than carbohydrate to generate energy.. in a type I they are often associated with DKA because the body has no insulin it is forced to burn fat generating keytones which then turns into a run-away cycle of dehydration; high blood glucose and a whole load of hurt.. it is a natural cycle that gets out of control due to the lack of insulin.

If you eat few or limited carbohydrates then you put your body into this state of ketosis where it is burns fat, producing keytones.. in its self this is not dangerous and is a perfectly normal state to be in.. As long as you continue to take background insulin and keep yourself hydrated then you will have no problems.. exactly like any normal person would have no problems eating a low carb diet.

Now to explain the protein.. our body has a glucose requirement; specifically your brain which for certain functions can not use fatty acids as fuel.. as such if you are not eating carbohydrate and therefore have a limited supply of glucose it needs to get this glucose from somewhere.. it does this by converting protein in to glucose.

So what I meant by my post was this... for stable blood glucose your best to do one or the other.. so you are either always covering protein (low carb say sub 80g / day) or never covering protein (higher carb say 150+g / day).. if your somewhere in the middle you may find sometimes you need to and sometimes you don't which will as you have found out cause all sorts of headaches managing your blood glucose.

Tgat makes so much more sense. Thanks for this. I never knew any of it, I've always just been told never have ketones and its bad if you do. I find I usually have around 0.1-0.2 blood ketones anyway so that makes sense with what I'm eating.

I've half sussed out my proteins but it's very trial and error still. Plus it doesnt help when like you say I mix the two together and don't know how to deal with the rise in sugars. I need to get back into a routine I've been slacking on the exercise for 2 weeks, which probably hasnt helped. Does it take you long to get back in your ketosis state?