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[IPu] Fat, Protein and Insulin

Hi All,
This was listed as "Fat and Insulin", but really is about the BG effect
of large amounts of protein.  So if you eat large amounts of protein
remember this one  ....

From: "Sarah Dowdell" <email @ redacted>
To: <email @ redacted>
Sent: Friday, June 09, 2006 1:53 AM
Subject: [IP] fat and insulin

> <<<(I'm about 1:33 for ratio) that I'm okay, but if I try for something 
> fatty, it always spikes later on. And I understand that, but how do I 
> figure for that? For example: Went out to eat the other night. I had green 
> beans, cole slaw, 6 oz sirloin (grilled) and a skewer of grilled shrimp. 
> All very healthy. I'm on Novolog 70/30 and I bolus for snacks with plain. 
> I take 6 units of mix before dinner. Did my usual thing, took my 6 units. 
> Two hours later, my sugars were beautiful, but before I went to bed it 
> jumped to 158 without anything b/w dinner and bedtime. So I know there's a 
> later jump with fat (assuming they cook with more fat in restaurants), but 
> how do I adjust for that in the beginning, or do I just do a corrective 
> bolus later.>>>

 Don't forget protein too!  What I've found is that something high fat will
 cause the carbs in the meal to be digested more slowly, but I don't
 neccessarily need more insulin (or at least not much more).  What the fat
 does is cause you to need your insulin delivered slowly over several hours
 to stay flat.  With protein, I find that I actually need much more insulin
 than the carbs alone would suggest, and I need to give some insulin
 delivered up front and more delivered slowly over the course of several
 hours (or sometimes as a second bolus altogether 2-3 hours later).  For the
 meal you described above, I would need about 1/3 of my insulin up front 
 dinner and the remaining 2/3 delivered as a square wave over 4-6 hours.

 While you are still on 70/30, it will be very difficult to have much
 flexibility about how much insulin you can take and how you can deliver it
 since 70/30 is a very inflexible regimen.  It sounds like you are still
 making some insulin on your own so you can get by using 70/30 right now (if
 I ate the meal you described and gave only my normal dose of insulin, I
 would have spiked well into the 300s--I would have been thrilled with a BG
 of 158), but long term it might not be the best thing for control, and
 certainly not the best thing for flexibility.  If your doctor is resistant
 on the insulin pump front, you can try to get on a more flexible 
 type regimen and do MDI (multiple daily injections).  This is usually one 
 two shots a day of Lantus as strictly your basal insulin, and Novolog when
 you eat or for high blood sugar corrections using a proper insulin to carb
 ratio and correction ratio.  This can be up to 6-8 shots a day for some
 people.  Others can get by with less than that if they have a more regular
 schedule.  Working with 70/30, however, you would probably need to give a
 correction bolus an hour or two later of just Novolog, if you want to treat
 yourself occaisionally.

 There is some discussion about whether or not it is better to count only
 carbs and calculate boluses based on that (works fine for most meals since
 most meals are not super high in fat or protein and the fat and protein are
 "taken care of" in the ratio), or to count carbs, protein and fat and
 calculate boluses based on that.  Carb counting alone tends to fall apart
 when you eat out at restaurants or eat high fat/high protein foods (pizza,
 take out chinese, steak, etc.).  The second method is called TAG (total
 available glucose) and generally you count 1 for 1 grams of carbs, 1/2 g 
1g of protein, and 1/4 g for 1 g of fat (can vary from individual to
 individual).  Note--you do need a different ratio for your bolus if you do
 TAG versus just carbs, all of which are very individual.  For example, if
 you just count carbs your ratio might be 1:15, but if you count carbs,
 protein and fat, you might have a ratio closer to 1:20.  However, you
 probably will end up taking the same amount of insulin for most meals, but
 you'll only have say 30 g of carbs in the first case, but 40 g of carbs +
 1/2 protein + 1/4 fat in the second.

 I hope this isn't too much information!

 Sarah, dx'92, pumping'00
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