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Re: [IPk] Fat

Hi Heather,

I second what Di just said, only I'm about to be way more tedious about it 
(as I am wont to be ;> ).

We need more insulin for high-fat foods because fat slows the absorption of 
glucose into the bloodstream. That is why chocolate bars are now considered 
not so good for treating hypos: they may take too long to work. We may 
remain low for long enough that we overtreat with extra sugar because we 
can't feel a difference in bg level for about half an hour (and half an hour 
with a hypo feels like eternity!). Plus, we could be doing something that 
requires attention and incapacitated for longer than necessary while waiting 
for the choc to do its thing. When we eat high-fat meals/desserts, we need 
more insulin because it may take several more hours for the carb involved in 
the meal or sweet to be metabolized: the fat will keep the glucose in the 
bloodstream for longer.

That fact is important in treating a hypo in someone on isophane/NPH as 
sometimes a hypo can seem not to go away because of the continued action of 
the intermediate-acting insulin on the carbs used to treat the hypo, but 
some fat and protein can moderate the action of the insulin. When I was on 
injections (March 1993-June 1996), my diabetes educator (= DSN) insisted 
that I have c.20g carbs in the form of half a can of Coke (or a smallish 
glass of orange juice, or whatever was quick and high in sugar) to treat a 
hypo immediately, and then a half-glass of milk plus something like half a 
cheese sandwich or some cheese and crackers about half an hour later if I 
would not have a regular meal for a few hours (but if a regular meal were 
just around the corner, the snack would not be necessary).

Further, type 1s on injections may find that they can avoid mid-morning 
hypos by having a bit of fat (cream cheese, peanut butter, or even regular 
cheese) with breakfast (of course, the other way to avoid a mid-morning hypo 
is to be sure your pre-breakfast short-acting insulin is correlated to your 
actual food intake--DAFNE rules!).

On a pump, a high-fat meal may be dealt with in a few ways. Pumping 
old-timers like me may be set in our ways and happy to test every hour or 
two after a really indulgent meal in order to judge whether another little 
bolus of Humalog is in order. The other ways to go involve using the 'dual' 
or 'square-wave' bolus options on at least the MiniMed 507 and later models.

As far as I know, just as only you can figure out your carb:insulin ratio, 
only you will be able to figure out a ratio for fat:insulin. Far as I know, 
given that most of us wouldn't be able to guess exactly how much fat is in 
anything we eat as well as we can guesstimate carbs, trial-and-error is the 
method for handling fat. Test every hour or 1.5 hours after the next rather 
rich meal you have and see what your bg does. The next time you have the 
same meal (if you have it again, that is!), anticipate the action of your bg 
(bearing in mind the variable I'm about to mention...!)

Last thing on fat/carbs/insulin from me (for now!!!): A Big Variable should 
be considered whenever you take more insulin than usual for a rich meal. 
Remember that if you have a meal with significant fat content in the evening 
_after you've had a good workout in the afternoon_, glucose will go back 
into your muscles in the middle of the night. If I've had a good run around 
5 p.m. and a big dinner leaves me with a bg of around 13 at midnight, I tend 
to leave it and go to bed. Then I wake up at 7.30 a.m. or so with a lovely 
bg and I'm happy.

My last HbA1c (taken 2 weeks ago) was 6.5: I must have found a good strategy 
for myself through the past 6 years of trying and erring! I hope you can get 
things sorted.

All the best,

IDDM 9+ years; MiniMed pumper 6+ years; embarrassed not to have kept regular 
logs in years, but hey, have still managed a 6.5 HbA1c....

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