Dissent at the JDRF Discovery evening...

tim2000s · Nov 17, 2015

One of the senior dieticians on the DAFNE programme spoke at the JDRF meeting this evening. Unfortunately for her, she ran into a fair amount of resistance when discussing how a type 1 should eat. Her topic was bolusing for protein and fat, so a number of us piped up and said we don't eat much in the way of carbs as they are unnecessary and cause too much variation in glucose levels.

I think she felt a bit ambushed as there were a few of us around he room able to push back quite strongly on this topic. Okay, so I might have been a little too vocal (whoops) but it was interesting to talents her afterwards and discuss the libre graph demonstrating what we were talking about.

A good evening otherwise, meeting some new T1 faces and people that I've met in Facebook groups, along with @iHs and @ewelina. Good to see you both.

The health care bodies are starting to catch up though!

Edited to remove name of dietitian.

noblehead · Nov 17, 2015

That's interesting that the dietitian spoke about bolusing for protein & fat, what did she actually say about it @tim2000s?

tim2000s · Nov 17, 2015

It was quite an interesting set of points when we got away from the discussion about carb reduction.

They key points were (what we seem to understand on here already) relating to fat having a delaying effect on carb absorption, plus an accelerating effect after 2-3 hours. High fat/high protein driving a delay in high bg levels and that the trigger point in fat amounts seems to be 40g at which point it seriously affects bg levels.

She also mentioned that 70g of pure protein has the equivalent effect on bg to 20g of carbs (I thought this protein number a bit high).

She talked about bolusing for protein, used the polish calculation as an example and mentioned that different people seem to use different insulin profiles for different amounts of fat and protein. I mentioned a 50:50 split multi wave at 50% of u per weight of carbs. She said she'd seen that before, but no clear guidance. Very much trial and error. The issue is a lack of evidence based information makes dieticians uncomfortable.

ewelina · Nov 17, 2015

Lots of general advice that Ive heard many times before. Its good that they are starting to recognise the need of blousing for protein and fat. We need more of a practical advice though. I think I will just continue experimenting on myself
It was good to meet you @tim2000s and @iHs . Looking forward to meeting you on 28th again

ewelina · Nov 17, 2015

tim2000s said:
It was quite an interesting set of points when we got away from the discussion about carb reduction.

They key points were (what we seem to understand on here already) relating to fat having a delaying effect on carb absorption, plus an accelerating effect after 2-3 hours. High fat/high protein driving a delay in high bg levels and that the trigger point in fat amounts seems to be 40g at which point it seriously affects bg levels.

She also mentioned that 70g of pure protein has the equivalent effect on bg to 20g of carbs (I thought this protein number a bit high).

She talked about bolusing for protein, used the polish calculation as an example and mentioned that different people seem to use different insulin profiles for different amounts of fat and protein. I mentioned a 50:50 split multi wave at 50% of u per weight of carbs. She said she'd seen that before, but no clear guidance. Very much trial and error. The issue is a lack of evidence based information makes dieticians uncomfortable.

I think I will eat pure protein for dinner tomorrow to check how much insulin I actually need for it. Lets say plain chicken breast. I suspect this 70 to 20g can be true if there is no fat

tim2000s · Nov 17, 2015

I'll do something similar in the morning @ewelina using whey protein powder. Should be a roller coaster...

ewelina · Nov 17, 2015

tim2000s said:
I'll do something similar in the morning @ewelina using whey protein powder. Should be a roller coaster...

Let us know about your result. I'm definitely not looking forward to tomorrows dinner !

Blackers183 · Nov 18, 2015

tim2000s said:
It was quite an interesting set of points when we got away from the discussion about carb reduction.

They key points were (what we seem to understand on here already) relating to fat having a delaying effect on carb absorption, plus an accelerating effect after 2-3 hours. High fat/high protein driving a delay in high bg levels and that the trigger point in fat amounts seems to be 40g at which point it seriously affects bg levels.

She also mentioned that 70g of pure protein has the equivalent effect on bg to 20g of carbs (I thought this protein number a bit high).

She talked about bolusing for protein, used the polish calculation as an example and mentioned that different people seem to use different insulin profiles for different amounts of fat and protein. I mentioned a 50:50 split multi wave at 50% of u per weight of carbs. She said she'd seen that before, but no clear guidance. Very much trial and error. The issue is a lack of evidence based information makes dieticians uncomfortable.

Very interesting topic all. I did DAFNE 12 months ago and the rule was no adjustment for protein or fat so I wonder where her view was coming from.

You're right tim2000 20gms CHO from 70gms protein is very high, that gives a ratio of 28% carbs by weight, rice is a standard of 35% by weight! I don't convert fat ( hopefully I don't eat much but it is 'nice') or protein to carbs and have never seen a need based on my BGL readings and what I eat - horses for courses?

noblehead · Nov 18, 2015

tim2000s said:
It was quite an interesting set of points when we got away from the discussion about carb reduction.

They key points were (what we seem to understand on here already) relating to fat having a delaying effect on carb absorption, plus an accelerating effect after 2-3 hours. High fat/high protein driving a delay in high bg levels and that the trigger point in fat amounts seems to be 40g at which point it seriously affects bg levels.

She also mentioned that 70g of pure protein has the equivalent effect on bg to 20g of carbs (I thought this protein number a bit high).

She talked about bolusing for protein, used the polish calculation as an example and mentioned that different people seem to use different insulin profiles for different amounts of fat and protein. I mentioned a 50:50 split multi wave at 50% of u per weight of carbs. She said she'd seen that before, but no clear guidance. Very much trial and error. The issue is a lack of evidence based information makes dieticians uncomfortable.

Encouraging news that a senior dietitian on the DAFNE programme recognises that fat & protein has an effect on postprandial bg levels, we can only hope that this is filtered down and taught on the course itself.

Sadly it is trial & error for most people, but after reading about the latest research on the role of dietary fat & protein in type 1 diabetes management it would appear they are working on a algorithm to hopefully make bolusing much more effective.

tim2000s · Nov 18, 2015

ewelina said:
Let us know about your result. I'm definitely not looking forward to tomorrows dinner !

Had to abort this morning. Didn't have time to sort it all out unfortunately.

Blackers183 said:
Very interesting topic all. I did DAFNE 12 months ago and the rule was no adjustment for protein or fat so I wonder where her view was coming from.

Her anecdotal comments were the most interesting in relation to this, and something that will make many people's blood boil. The reason that Protein and Fat were not included in DAFNE was that the professionals thought (in their wisdom) that, and I quote "Patients would find the algorithm too confusing". They were extremely surprised when they asked, that patients wanted to know more about it...

Blackers183 said:
You're right tim2000 20gms CHO from 70gms protein is very high, that gives a ratio of 28% carbs by weight, rice is a standard of 35% by weight! I don't convert fat ( hopefully I don't eat much but it is 'nice') or protein to carbs and have never seen a need based on my BGL readings and what I eat - horses for courses?

I meant this the other way around. Typically, when I've experimented with whey protein at 30g, I've found a reaction similar to 20g of CHO, so 70g to achieve the equivalent of a 20g CHO rise seems high. What I would note though is that this seems to be a double response in that there is an initial glucagon response followed by gluconeogenesis as the velocity of the rise changes.

noblehead said:
Sadly it is trial & error for most people, but after reading about the latest research on the role of dietary fat & protein in type 1 diabetes management it would appear they are working on a algorithm to hopefully make bolusing much more effective.

Yes, you are correct. I haven't yet tried the Polish Algorithm to its full extent and maybe @ewelina can comment on that one, but what I should do is try Pizza and see how well it works! What Anita did mention is that many clinics in Europe (not just Poland) now use this algorithm with pump patients.

ewelina · Nov 18, 2015

tim2000s said:
Had to abort this morning. Didn't have time to sort it all out unfortunately.

Her anecdotal comments were the most interesting in relation to this, and something that will make many people's blood boil. The reason that Protein and Fat were not included in DAFNE was that the professionals thought (in their wisdom) that, and I quote "Patients would find the algorithm too confusing". They were extremely surprised when they asked, that patients wanted to know more about it...

I meant this the other way around. Typically, when I've experimented with whey protein at 30g, I've found a reaction similar to 20g of CHO, so 70g to achieve the equivalent of a 20g CHO rise seems high. What I would note though is that this seems to be a double response in that there is an initial glucagon response followed by gluconeogenesis as the velocity of the rise changes.

Yes, you are correct. I haven't yet tried the Polish Algorithm to its full extent and maybe @ewelina can comment on that one, but what I should do is try Pizza and see how well it works! What Anita did mention is that many clinics in Europe (not just Poland) now use this algorithm with pump patients.

BEfore you start using polish method you need to discover what your ratios for carbs and protein/fat are. Dont assume they will be the same as you use now (especially for carbs). I was advised by polish dietitian to run number of experiments to determine them. A bit of a hard work as you need to eat pure carbs or pure protein to check how much insulin you need for them separetely. You also should do that at different times of the day,as they differ.

Daibell · Nov 18, 2015

Hi. Good to hear that bolusing for fats and protein was mentioned. I think we all need to be aware of their effect, but in practice we may just need to increase and or re-time the dose a bit without complex algorithms. I like the comment that dieticians are only guided by an evidence-base. Isn't the fact that many are obese on the current Western high carb diet enough evidence that's it's bad?

Brunneria · Nov 18, 2015

Daibell said:
I like the comment that dieticians are only guided by an evidence-base. Isn't the fact that many are obese on the current Western high carb diet enough evidence that's it's bad?

Blackers183 · Nov 18, 2015

I am very glad I joined this forum, you learn so much.

T1 24 years, David, Australia.

tim2000s · Nov 18, 2015

Daibell said:
Isn't the fact that many are obese on the current Western high carb diet enough evidence that's it's bad?

To be fair, none of the three dieticians that I've seen this year have been

Daibell said:
Hi. Good to hear that bolusing for fats and protein was mentioned.

She said that she would send out a PDF of the slides when she was done, so I'll stick the content of that up somewhere. The detail on the effects of fat as an accelerant with glucose is quite useful, as well as the extended duration of glucose action. Just think Chips and Pizza!

zjed · Nov 18, 2015

At least you have some professionals in the UK that you can discuss/debate the whole protein/fat issue. The last dietitian I spoke to from Diabetes Australia said 'yes, protein and fat can affect your bgl, you should search the net for more information', clueless.

Hopefully that sort of encounter will encourage the dieticians to do a bit more research so they can be prepared for you next time...

ewelina · Nov 18, 2015

tim2000s said:
I'll do something similar in the morning @ewelina using whey protein powder. Should be a roller coaster...

I cancelled my protein test tonight. I went as low as 2.5 just before dinner which freaked me out a bit (especially that I didn't feel very low). Will try tomorrow

ewelina · Nov 20, 2015

ewelina said:
I cancelled my protein test tonight. I went as low as 2.5 just before dinner which freaked me out a bit (especially that I didn't feel very low). Will try tomorrow

Right, here my results Both consumed at lunch time with nothing else (yuk, yuk, yuk ). Quite interesting findings and both shows that calculating calories from protein/fat works. The only thing that doesnt work for me is timing of extended bolus. Polish method would recommend about 8h for fish and 4h for ham. For me much less needed, about 3h for fishand 2h for ham

lunch 19 nov - smoked halibut- 53g protein, 52g fat
insulin given - 3u
Ratio for 100 kcal from protein/fat - 0.41u
Ratio for 10g carb at lunch time - 0.8u

Lunch 20 nov - lean ham - 60g protein, 11g fat
Insulin given - 1.6u
Ratio for 100kcal from protein/fat - 0.47u
Ratio for 10g carbs at lunch time - 0.8u

RuthW · Nov 21, 2015

ewelina said:
Right, here my results Both consumed at lunch time with nothing else (yuk, yuk, yuk ). Quite interesting findings and both shows that calculating calories from protein/fat works. The only thing that doesnt work for me is timing of extended bolus. Polish method would recommend about 8h for fish and 4h for ham. For me much less needed, about 3h for fishand 2h for ham

lunch 19 nov - smoked halibut- 53g protein, 52g fat
insulin given - 3u
Ratio for 100 kcal from protein/fat - 0.41u
Ratio for 10g carb at lunch time - 0.8u

Lunch 20 nov - lean ham - 60g protein, 11g fat
Insulin given - 1.6u
Ratio for 100kcal from protein/fat - 0.47u
Ratio for 10g carbs at lunch time - 0.8u

I'm confused. Without blood sugar readings, how does that show anything? And where can we find the Polish algorithm? I'm interested but just hearing snippets about it here and there on these boards?

ewelina · Nov 21, 2015

RuthW said:
I'm confused. Without blood sugar readings, how does that show anything? And where can we find the Polish algorithm? I'm interested but just hearing snippets about it here and there on these boards?

Yes sorry , my readings were within range and I showed how much insulin I needed to cover those meals. Polish method was explained somewhere on the forum, if I find the link I will post it. If not I write it again

Dissent at the JDRF Discovery evening...

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