How to calculate insulin dosage for high protein meals?

[ashleyp]

Hi everyone. Ive been a type 1 for nearly 3 years now. Ive always eaten a high protein diet as i started weight training around 6 years ago at the age of 18 and up until recently this has caused me no issues whatsoever, even after becoming diabetic.

Over the last few months my BG levels were starting to rise slightly higher than usual after eating. Normally 2 hours post meal my level would be in-between 5 & 7 but i was finding readings to be now closer to 10-12 (obviously not what i want!). I narrowed it down to it being caused by the high volume of protein i was eating with each meal and i am now finding myself having to inject insulin for something as simple as 1 roasted chicken breast, something i never had to do for the first 2.5 years of being diabetic.

After doing some digging online I've found that its due to glucagon being released to match the insulin release (that obviously i am not getting from my body anymore) that shuttles the amino acids from the protein into my muscles.

Do many other people experience this? I was never told that this would happen from any of the diabetic dieticians/nurses or from when i went on the DAFNE course so i was just looking for a bit more info. Slightly annoying as I'm now finding myself not only having to calculate the amount of carbs I'm eating but also if i need to inject extra to cover the protein. I have also found that varying protein sources give different results. I.e beef does not seem to effect me as much as chicken does.

Any info would be great.

Thank you

 

[novorapidboi26]

This is actually quite common, although I have observed it only really happening to people using a pump.......

the lack of slow acting insulin in the body like Lantus or Levemir means that the protein, which is processed significantly slower than carbs, now has no insulin to deal with it.........

the basal that a pump delivers, for the majority, is actually a quick acting analogue, which is in and out a lot quicker and therefore is much more efficient.....leaving no unintentional surplus to mop up the proteins....

fortunately for me, even on the pump, I don't see an effect from protein, not significant anyway.........

I think it will just be a case of trial and error to be honest.......

I may have heard people saying they take half or even a third of the insulin for 10g of protein compared to 10g of carbs, hopefully one of these people will be along shorty.

 

[tim2000s]

Hi @ashleyp, there are a couple of topics that discuss this in great detail. These are here: http://www.diabetes.co.uk/forum/threads/insulin-load-index-most-ketogenic-foods.75704/ and here: http://www.diabetes.co.uk/forum/threads/how-does-protein-affect-blood-glucose.75156/

There are essentially two processes going on. The first, that you have already identified, occurs immediately after eating, when your body believes it needs to release insulin to aid the absorption of Amino acids and glucagon to counter the blood sugar reducing effects of insulin. As you have no insulin, you just see the bg level rise.

There is also the second effect of high protein, which is Gluconeogenesis. This is the process that the body uses to allow the liver to convert protein to glucose. In a non-diabetic, insulin regulates this process, but with subcutaneous injections, more of the insulin goes to peripheral organs so it is less controlled. This results in a slower conversion of excess protein (not being used for muscle repair) to glucose.

Basal rates (whether pump or MDI) are typically designed to cover the function of the liver in a steady, fasted state. In the link to the second topic above, I discuss some of the approaches that you can take to dealing with this effect when on MDI.

Various foods generate different responses. I think the key to this is the fat content of the foods, in line with Marty's paper in my first link. In my experience, Whey protein shakes lead to an almost instant bg increase, eggs are nearly as big a spike followed by chicken breasts and pork and beef (dependent on leanness) in terms of the rate of bg increase. This also affects the timing of insulin you might take with these foods.

Typically when you discuss this with medical professionals, especially DSNs, very few of them understand it. In Dr Bernstein's Diabetes solution, he recommends injecting your Insulin:Carb ratio for half the weight of protein and Marty's discussion recommends 0.54 x the weight of protein.

Ultimately what I find is that for a high protein meal (e.g. 80g protein in a single meal) I need to inject 4u of insulin ahead of the meal and then 1.5-2u at 1.5 hourly intervals to maintain control for the next three hours. On a pump this is obviously easier.