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Re: [IPk] low fat

In message <email @ redacted>, Diana
Maynard <email @ redacted> writes
> The 
>only thing to bear in mind is that if you mix high fat and high carbohydrate 
>in the same meal (e.g. pizza), his BGs are likely to remain higher for 
>longer, because the addition of fat slows down the absorption of carbs.

One thing also to bear in mind is what people mean when they say 'high
fat', or 'low fat' - do they mean large ABSOLUTE amounts of fat, etc.,
or do they mean high or low percentages of fat, etc.?

Before I delve into the explanation, I would just like to reiterate that
there is no such thing as a 'diabetic diet'.  What is good diabetes
management is really, really simple (but difficult to achieve!): you eat
what you want to eat (depending on all kinds of factors, from cultural
ones through to what you can afford, and not ignoring long-term health
issues,  but you pays yer money and takes yer dinner).  You learn what
that food will do to your blood glucose.  You learn what insulin will do
to your blood glucose, and you predict how much insulin will give you a
flat line blood glucose level.  You then measure your blood glucose to
see how far out your guestimate was, correct if need be, live, and
learn.  Most people never do the maths which follows ... they just
'know' that pizza is 'high fat' and needs a different kind of bolus.
The calculation that they do do is 'how much carbohydrate is in this
meal' and do a simple division sum (often divide by 10, or 12 or 15!) to
come up with how many units of insulin they must inject. 

Back to the difference between the two kinds of 'high fat' meals:
Take pizza, the one I ate last night.  That has, in half a pizza, which
is what I ate:  55.9g CHO, which has 4 calories a gram (so 224 calories
from CHO).  It has 14.1g fat, which has a whopping 10 calories per gram
(so 141 calories from fat), and 21.3g protein, which again has 4
calories per gram (so 85 calories from protein).

So the half a pizza had 450 calories, of which 50% came from CHO, 30%
from fat, and 20% from protein (roughly!).  This made it, for me, a high
fat meal, because I normally have 60% as CHO, 25% as fat and 15% as
protein.  But it wasn't particularly a 'high fat' meal in that 450
calories is not particularly a lot (for me) - a meal with just as much
fat (14.1g), but eaten not as 30% of calories but as part of a typical
meal, would have been 25% (i.e. eaten as part of a 564 calorie meal,
together with an additional 28.7g of CHO - in other words, the same
pizza, but followed by a large banana!

Both the absolute amount of carbohydrate (56g or 84g) and the proportion
of carbohydrate (50% or 60%) can have an effect.  Some people have an
upper absolute limit, beyond which they can't adjust the insulin to
match their intake - for Di, for example, it's quite low at 30 or 40g -
for many people it's around the 100g mark.  Some people also have to
adjust the timing or dosage of the insulin - I split my dose 75%/25% for
a 'normal' meal, but for one with a high proportion of fat (like that
pizza), it gets closer to 50%/50% (with a pump you can give a proportion
'now', and a proportion over a time - so you can really force the curve
of insulin activity to match the curve of the food activity.

Best wishes to all,

dm 30+, 508 1+, always lousy at mental arithmetic, but good at

Pat Reynolds
email @ redacted
   "It might look a bit messy now, but just you come back in 500 years time" 
   (T. Pratchett)
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