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How does protein affect blood glucose?

tim2000s

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Thought I'd conduct a little experiment this morning to try and see just how protein is digested/converted to glucose in the body.

My experiment? From a stable, fasted, start, ingest a set amount of protein in Milk Protein form and monitor using the libre.

Prior to ingestion (at roughly 6.20 am), my glucose level was showing 4.4 and a flat arrow, demonstrating a level of stability for about an hour ahead of the test.

I ate a protein bar containing 20g of protein and 2g of carbs. The resultant graph is shown below. As soon as I hit 10 mmol the intramuscular insulin shot was applied.

It's fascinating because it shows an incline that is not so far off that seen when eating chocolate. Protein definitely has a very clear impact on my blood glucose levels.....

 
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Great post, illustrates a point that in my opinion is not highlighted enough, that in the LCHF diet, the amount of protein must also be very carefully controlled, not just the carbohydrates.
One mostly hears of carb counting, it never seems to highlight protein counting.
 
Interesting! This is got to be why even though I am following a low carb diet, I am still having trouble controlling blood sugar!
 
linda321 said:
Interesting! This is got to be why even though I am following a low carb diet, I am still having trouble controlling blood sugar!
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Note that the protein bar was effectively "distilled" protein, and, similarly to whey protein, it pushes up blood glucose very quickly as it is such a pure form.

I've found that eggs are also pretty fast acting. Chicken is slower and red meats seem a lot slower, probably due to the abundance of fats.
 
I'll leave what I originally wrote but I thought I'd just check to see if there were any recent experiments with T1 . This one was published in February and they didn't find a significant rise from pure protein and that other studies had used mixed meals or high fat and protein meals (cat amongst pigeon time?)
http://www.hindawi.com/journals/ije/2015/216918/
"In conclusion, the ingestion of a pure protein load does not seem to have a clinically significant impact on glucose levels in adult T1DM patients treated with insulin pumps. Thus, small protein-based snacks do not require prandial insulin blousing"

Ummm!

In a non diabetic eating protein causes a simultaneous release of insulin and glucagon .These to a certain extent counter balance each other in effect on blood glucose. This graph shows what happens ( bit small and not sure about the units) In non diabetics there is no immediate rise in glucose levels.

http://www.medbio.info/horn/time%203-4/homeostasis_2.htm

There are experiments that also show no subsequent rise in glucose after protein ingestion in type 2s http://journal.diabetes.org/diabetesspectrum/00v13n3/pg132.htm
In mixed meals added protein eg whey protein has been found to stimulate a higher insulin release in T2 diabetics resulting in a lower glucose level. http://ajcn.nutrition.org/content/82/1/69.full

Do T1s get a glucagon/glycogen release ? Is your morning rise just due to the protein or are other 'morning' hormones involved? I agree about the effect of eggs?. 've always wondered if it has something to do with the proteins in eggs being more easily assimilable Whey, according to the paper above elicits a high insulin release in non Ds and T2 subjects
but it could be something to do with the proportions of different amino acids.

Gannon and Nuttall, also found that some amino acids raise insulin more than others. Some amino acids, not the same ones resulted in a higher glucagon release than others . There are also differences in resultant glucose concentrations
They end though by saying that it's all very complicated and not well understood .They don't know whether responses are different in T2 to normal subjects (and don't mention T1) http://onlinelibrary.wiley.com/doi/10.1002/iub.375/pdf
 
I'm not sure @phoenix. The key point in determining relationship to dp is that I get up at 4.30 and typically see dp between then and 5.15.

What's probably a useful control is the previous day where I drank a bpc at the same time and over the next three hours I saw a rise of 1.0mmol, in line with my Levemir wearing off.

I'm aware of the insulin release properties of whey. It's why bodybuilders use it post training to replenish exhausted muscles and stimulate muscle growth.

Some interesting questions don't you think?
 

Thanks Jack. Yes I am still on Novomix 30. I have an appointment with the consultant at the end of the month so will be asking if I can change over then. Thanks for the link. I hadn't seen that before and it looks as though it might be a good idea to split my morning dose, between then and lunchtime.
 
@tim2000s I think that during the morning, with a high cortisol level, the body automatically produces sugar (for whatever reason) when you eat (anything) as it "feels" that you are having some intake. Have you tried eating lots of proteins during the afternoon/night (with no carbs) to see with your freestyle libre how it affected your sugar level ?
 
I'm a type 1 and have always found that eggs push up my BSs especially if fried. Soft boiled eggs seem OK but I now allow 5 grams when I do my carb calculations.
 
Typically, it always affects my glucose level. Just at different rates. A lunchtime salad with v low carbs and chicken also sees an increase in levels. It isn't really anything to do with morning cortisol levels.
 
Thanks for letting us know! For my part, i notice a big difference between beef meat and other sources of protein. For the same amount, beef will make my sugar rise way more! Am I the only one?
 
I've been doing some reading around this recently as it's quite an interesting topic. This is probably the best "easy read" as it cites sources.

http://wholehealthsource.blogspot.co.uk/2013/04/glucagon-dietary-protein-and-low.html

I think the most interesting point is one I've seen elsewhere and is made in @phoenix earlier post. Protein ingestion seems to have two processes associated with it. An insulin and glucagon response and gluconeogenesis. The latter of these two is a slow increase, and I wonder whether we have treatment for that right in the basal bolus regime, but I'll come onto that one later. The former is the one that I want to mention first.

There are a number of studies that show that protein causes a significant insulin reaction in the body, causing insulin levels to increase in non-diabetic individuals. This study by Holt is one of them.

The key point being that protein does generate a disproportionate insulin response in a non-diabetic. This is believed to be down to one of the other actions of insulin, which is to open the pathways into muscle for the consumption of amino acids. If there is an insulin response in the absence of carbohydrate, then there needs to be a glucagon response to release CHO from the liver to deal with the other aspect of the insulin response.

In those of us who don't have any insulin, it looks as though high protein items continue to generate a glucagon response (as per the graph in the original post), and this is proportional to the amount of protein eaten, without the insulin response. I suspect that an insulin response is triggered but can't be fuilfilled. What's less clear is where the statement that 58% of protein can be converted to glucose has come from. Does this actually look at blood glucose concentrations post-prandially and therefore take into account the increase driven by Glucagon?

On to the second point relating to gluconeogenesis (gng). We're always told that this is a slow process. Well, it does seem to be, and with the understanding of the above, my libre plots and insulin dosing make a lot more sense. But here's the rub. The steady increase caused by gng is slow enough that really the existing QA and FA insulins (NovoRapid and ActRapid as examples) really have actions that are too quick for gng countering.

If you are eating a low carb diet, and are on MDI, should you really be taking a higher basal insulin level to counter this steady rise that occurs after eating rather than trying to manage it with rapid acting? If you are on a pump, I think the answer is likely to be that you use a slightly increased TBR for a few hours post protein ingestion, but you don't have this flexibility with MDI.
 
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tim2000s said:
What's less clear is where the statement that 58% of protein can be converted to glucose has come from. Does this actually look at blood glucose concentrations post-prandially and therefore take into account the increase driven by Glucagon?
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Really good question. Having read the papers on it a few years ago I believe that the energy yield is calculated from the chemistry of the chemical reactions overall in the known metabolic pathways. I don't think it's an empirical test, it's theoretical. So I don't think it's likely to include the glucagon response (which would presumably net out with the insulin response anyway in a non diabetic).

The steady increase caused by gng is slow enough that really the existing QA and FA insulins (NovoRapid and ActRapid as examples) really have actions that are too quick for gng countering.
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Definitely agree. Pumps are perfect for GNG because they offer extended and / or delayed bolus delivery.
If you are eating a low carb diet, and are on MDI, should you really be taking a higher basal insulin level to counter this steady rise that occurs after eating rather than trying to manage it with rapid acting?
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Alternatively what I used to do on MDI is dose for protein using an older slower acting QA insulin rather than the modern ones, and take it post meal rather than pre meal. I used Actrapid and Regular insulin.

Taking into consideration what you say here, I might use newer fast QA insulin to handle the immediate response and then top up with a slower older post meal QA for the GNG part.
 

I have a cgm sometimes and use Tresiba and rapid pens. I eat low carb. I really really struggle with the effect of protein on my bg. I have treat nights twice a week where we have a nice low carb meal, I have 2 glasses of red wine and a low carb dessert. Tonight I took 2 units rapid for my meal and dropped really low after for sometime, took 4 dextrose slowly over time but now it is at 8.9mmol, it has been slowly rising the last 1.5 hrs. I just don’t know how to manage this.? Wonder if I should take my rapid 2 hours after my meal? Has anyone tried this?
 
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