The Role of Dietary Protein and Fat in Glycaemic Control in Type 1 Diabetes.

[noblehead]

This makes for interesting reading and may change the way in which carb counting courses such as DAFNE are taught:

http://link.springer.com/article/10.1007/s11892-015-0630-5/fulltext.html

 

[tim2000s]

Have they been reading @martykendall 's work? It's essentially the same stuff we've been talking about on here for some time!

What it does is provide a properly reviewed paper that demonstrates that MDI isn't quite good enough for managing IDDM, and that insulin therapies need some further investigation and understanding. I'd say it could also be used as a direct pressure point for obtaining a pump. Good find @noblehead

 

[ewelina]

This makes for interesting reading and may change the way in which carb counting courses such as DAFNE are taught:

http://link.springer.com/article/10.1007/s11892-015-0630-5/fulltext.html

Im just implementing method called 'Warsow school of insulin pump therapy' by Ewa Pankowska. It allows you to calculate the bolus taking into account not only carbs but also protein and fat. It really works,very useful if you eat low carb.

 

[dtennant9]

Interesting reading.
My biggest issue currently is my BG readings the next morning if I have a high fat evening meal. Just can't seem to get it right. I can have a slightly higher bedtime reading, take the appropriate correction and then either be much the same or raised the next morning.
Maybe I should be accounting for a higher dose the the Carb content to begin with but over a longer period of time.

 

[tim2000s]

The issue with high fat meals late evening is that you effectively need a distributed bolus to manage it. This is really hard when using MDI and asleep!

 

[noblehead]

Have they been reading @martykendall 's work? It's essentially the same stuff we've been talking about on here for some time!

What it does is provide a properly reviewed paper that demonstrates that MDI isn't quite good enough for managing IDDM, and that insulin therapies need some further investigation and understanding. I'd say it could also be used as a direct pressure point for obtaining a pump. Good find @noblehead

The Joslin study did some research on this some years ago too, plus the role of fat and protein on postprandial bg levels have been known for some time and was mentioned in the early editions of Think Like a Pancreas. Sorry I didn't read Marty's posts when he was on the forum, but yes a pump is a great piece of kit to deal with slow-rising postprandial bg levels

Im just implementing method called 'Warsow school of insulin pump therapy' by Ewa Pankowska. It allows you to calculate the bolus taking into account not only carbs but also protein and fat. It really works,very useful if you eat low carb.

Not heard of this Ewa Pankowska, is this a book or is it accessible on the web?











.

 

[noblehead]

Interesting reading.
My biggest issue currently is my BG readings the next morning if I have a high fat evening meal. Just can't seem to get it right. I can have a slightly higher bedtime reading, take the appropriate correction and then either be much the same or raised the next morning.
Maybe I should be accounting for a higher dose the the Carb content to begin with but over a longer period of time.

High-fat meals can make you insulin resistant for several hours after eating, if you've got the book Think Like a Pancreas there's a good explanation in there that explains the process.

 

[ewelina]

The Joslin study did some research on this some years ago too, plus the role of fat and protein on postprandial bg levels have been known for some time and was mentioned in the early editions of Think Like a Pancreas. Sorry I didn't read Marty's posts when he was on the forum, but yes a pump is a great piece of kit to deal with slow-rising postprandial bg levels



Not heard of this Ewa Pankowska, is this a book or is it accessible on the web?











.

When you google her name you will find medical publications but they are not easily accessible. I found the research about the software developed for this method http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2901033/
There is lots of info online but only in polish Im afraid. Its not difficult method but you need to calculate calories (or fat and protein). Its widely used in Poland but mainly for pump users (due to use of extended boluses for fat and protein).Im happy to explain the method if anyone is interested. Its my first week of fully using it and it works wonders for me. No problem with bbq yesterday and huge portion of icecream the day before

 

[Robinredbreast]

This makes for interesting reading and may change the way in which carb counting courses such as DAFNE are taught:

http://link.springer.com/article/10.1007/s11892-015-0630-5/fulltext.html

I have read some of it and it is very helpful in understanding how 'non carb foods' affect us. Thanks for the link, I will read more later.

 

[noblehead]

Thanks @ewelina, just has a quick look at that article and it looks interesting what they say about FPU's. will have a better look over the weekend, thanks again

btw, have you used a square-wave yet, I was going to use one the other week but backed out.

 

[tim2000s]

have you used a square-wave yet,

This is what I want - I approximate these regularly via MDI.

 

[noblehead]

This is what I want - I approximate these regularly via MDI.

I mainly use Dual-Wave bolus on a pump as I find I still need a few units of insulin upfront even if the meal is just protein & fat (as in a cheese omelette say).

A Square-Wave bolus gives an even amount of bolus over an extended period, I was reading about it several weeks ago and they were saying its a great option when a meal is spread out over several courses or for those who have gastroparesis problems.

 

[ewelina]

Thanks @ewelina, just has a quick look at that article and it looks interesting what they say about FPU's. will have a better look over the weekend, thanks again

btw, have you used a square-wave yet, I was going to use one the other week but backed out.

Yes i use it a lot now (I assume square wave bolus is the same as extended bolus on accuchek). Yesterday for bbq meal over a period of 8 hours! It is a bit scary at the beginning but it really works if you know how to program the right timing.
Im having another educational session on Monday and still have few question but Im really happy with how it has worked so far.

 

[tim2000s]

I mainly use Dual-Wave bolus on a pump as I find I still need a few units of insulin upfront even if the meal is just protein & fat (as in a cheese omelette say).

A Square-Wave bolus gives an even amount of bolus over an extended period, I was reading about it several weeks ago and they were saying its a great option when a meal is spread out over several courses or for those who have gastroparesis problems.

Typically on a no carb meal this is what I do - 2.5u upfront then 2u at each of the next two to four hour intervals. It's probably more like a multi-wave bolus due to the dose sizes, than a square wave. That's the gluconeogenesis coming into play thanks to excessive amounts of glucagon. Now if we had Symlin licensed in the UK, then I'd need far less insulin as I wouldn't have to contend with the excess glucagon.

@ewelina, I've read that article before. It makes for an interesting idea.

 

[noblehead]

Typically on a no carb meal this is what I do - 2.5u upfront then 2u at each of the next two to four hour intervals. It's probably more like a multi-wave bolus due to the dose sizes, than a square wave. That's the gluconeogenesis coming into play thanks to excessive amounts of glucagon. Now if we had Symlin licensed in the UK, then I'd need far less insulin as I wouldn't have to contend wiht the excess glucagon.

The Dual/Multi-Wave are basically the same thing, from reading Pumping Insulin some pump manufacturers prefer to use one over the other in the instruction manuals and some terms are even patented (unbelievably).

 

[tim2000s]

some terms are even patented (unbelievably).

That I can believe. There are some terms in my industry that are practically industry standard terms yet are not used in documentation by a load of groups due to patents!

 

[ewelina]

This is what I want - I approximate these regularly via MDI.

Typically on a no carb meal this is what I do - 2.5u upfront then 2u at each of the next two to four hour intervals. It's probably more like a multi-wave bolus due to the dose sizes, than a square wave. That's the gluconeogenesis coming into play thanks to excessive amounts of glucagon. Now if we had Symlin licensed in the UK, then I'd need far less insulin as I wouldn't have to contend with the excess glucagon.

@ewelina, I've read that article before. It makes for an interesting idea.

Its something you have been using for low carb meals. Difficult on MDI but possible if you are dedicated
The big advantage of that method is that you can calculate the exact dose and timing. So far it was more of a guess for me