One of the most frustrating things that I often read (or hear) is that a low carb diet produces seemingly perfect blood glucose levels.
I certainly don’t have a problem with anyone who chooses to follow a low carb diet, and I can definitely see the benefits to being more mindful of my carbohydrate intake.
However, I find it incredibly frustrating that nobody ever talks about how they manage their blood glucose levels around fat and protein. Because, with the exeption of a few ‘free’ foods (non starchy vegetables, anyone?) the major trade off to carbohydrates is eating more fat and protein.
I’ve sort of conceived this idea that if one chose to contantly fuel their body with fat and protein, you could just offset their effects with a higher basal insulin dose. But what about those who just want to enjoy steak or pizza night without the spike?
Other than monitor your blood sugar levels closely and see how your body responds because everyone is different, Dr Google was very little help in this regard. I get that this topic is very individual in nature, but the information out there is scarce.
My first useful insight into this topic came from Gary Scheiner’s book Think Like a Pancreas. Suggesting that many restaurant and take out meals are naturally higher in fat, he suggests employing a temporary basal rate of 50% as a starting point to combat insulin resistance.
Gary also suggests that protein is only converted to glucose when the carbohydrate content in a meal is insignificant, and therefore only recommends making adjustments for protein when consumed in low or no carb meals. As a starting point, he suggests counting 50% of the protein in a meal as carbohydrate and delivering insulin through either an extended bolus on a pump or a delayed insulin dose when blood glucose starts to rise.
My second valuable insight came from meeting Dr Kirstie Bell, a researcher from the University of Sydney at the ADS-ADEA conference last year. I was absolutely engrossed in her research into fat and protein bolusing, and managed to catch up with her in Perth earlier this month.
Unlike conventional thinking, Dr Bell’s research suggests that fat and protein alone don’t impact blood glucose levels. It’s the lack of sufficient insulin that does. In people without diabetes who produce insulin, the impact of slowly digested fats and proteins is minimal. For people with diabetes who don’t produce insulin however, the impact is quite the opposite.
Ever had one of those nights where you’re correcting a high blood sugar level over and over with very little effect? Dr Bell also suggested that higher fat meals pushed the blood glucose peak of a meal out later, and caused a sustained blood glucose response due to insulin resistance caused by saturated fat.
Protein also produced a noticeable blood glucose response within 2 hours of being consumed. Research findings suggested that protein required adjustments in both mixed and no carbohydrate meals, with mixed meals having a greater degree of impact on blood glucose levels.
The most interesting point for me was hearing the concept of finding a ‘sweet spot’ in insulin dosing for higher fat and protein meals. Research suggested that if insulin was given too early, participants went hypo. But if insulin was given too late and insulin resistance had already set in, finding an optimal blood glucose result was too difficult.
For me, this is one of the things that makes diabetes so difficult to manage. I truly wish that all food was created equal. I wish that I could count the carbs, give insulin and it would produce the same effect on my levels each time.
At the moment I definitely need to put more effort my fat and protein bolusing, because I am definitely seeing a lot of slow and unwanted spikes after my meals.
Want to know more? Check out the resource website www.ibolus4t1d.com, and you can find @drkirstiebell on Twitter.
My feeling on protein bolusing has evolved over the years. Sometimes I have and other times i have not. As I have lost weight I bolus for protein less ad less. I currently do not unless the meal I eat is very low carb, then I use 50%. I seldom do this these days. I am OK with that.
I go through the motions. Sometimes I am really motivated to do so, other times not so much.
I have followed the American Diabetes Assoc. well balanced type1 diet for 40 years and have perfect health with no complications.
I hear ya! It is definitely something that needs to be looked into more, with proper research, and more guidelines provided (even though everyone is different…). Lately I have been having just that little bit more of carb, so the protein doesn’t take affect (& I therefore don’t have to worry about it), but I do enjoy a nice pizza, or creamy sauce & sausage with my pasta and all I can do for that is a correction 2 hrs later, and more often than not that is not enough, even allowing for a little extra to begin with!
Thanks so much for this very helpful post! Over the years I have had similar problems and have occasionally tried bolusing a little more to avoid the BG rise. The alternative idea of doing a temporary basal to compensate could be a good one. It could avoid the rise in BG and, more importantly, might lessen the severity of the BG crashes that I sometimes experience later.