Some Insights into Fat and Protein Bolusing

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.

Festive Isolation

Diabetes is an extremely isolating condition to live with. I think I’ve dealt with that isolation quite well over the past couple of years, both by building good support networks around me and simply acknowledging that it exists. Diabetes is not normal, and I feel more normal just by saying that out loud.

But there’s still something about this time of year, where that isolation feels a little greater.

It’s hard being surrounded by loved ones who don’t have diabetes, or don’t seem to care about diabetes, at this time of the year. Watching others being all merry and carefree and sometimes living like there’s no tomorrow, can make that isolation feel somewhat greater.

Hey, that’s fine. I don’t expect extended family members who I see a few times a year to remember about diabetes. I don’t expect, nor do I want special treatment just because I have diabetes.

But I also find it extremely insulting to be asked about diabetes the minute I’m sitting down with my helping of dessert.

“How do you manage sweets with your diabetes?”

“Do you have to be careful?”

“It’s not too much sugar?”

I manage my diabetes 24 hours a day, seven days a week, 365 days a year. 366 in a leap year. Diabetes extends far beyond dessert time. It extends into my nights. Into my weekends. Into my physical activity. Into my work. Even into my sleep. Misconceptions like these do me a great injustice.

As someone who actually has to live with this condition every day for the rest of his life, it’s ludicrous to suggest that I don’t know what’s best for me. Or that I would, you know, be tipping poison into my mouth if I knew it would kill me.

I don’t think anyone takes pleasure in inflicting feelings of guilt and shame, and yet ill timed comments like these do just that. In fact, feelings of guilt and shame can spiral even further into anxiety, depression and even disordered eating.

So if you are planning on seeing a loved one with diabetes during this festive season, here’s a better way that you can support them and help reduce those feelings of isolation.

Check in. Say hi. Ask them how they’re doing. Genuinely, and not just in passing. Show them that you care. Ask us about day to day life with diabetes, because hell, it’s a bloody big part of our lives!

However when it comes to dessert time, the only question a person with diabetes should be asked is how delicious it is.

While I’m at it, check out these pearls of wisdom on best supporting a loved one with diabetes from My Therapy App!

The Real Deal

 

As many of the people around me will attest to, I don’t have a very broad depth of cuisines. I can’t stand recipes that have long ingredient lists, none of which I can ever find in my cupboards and fridges at home. Ingredients which I will have to buy for the one recipe, and have no use for ever again. Over the years, I’ve been well trained to adapt.

Which brings me to the above. I’ve pulled together this baked Cookies and Cream Cheesecake a number of times this year. It contains a few simple ingredients, is super easy to make, and takes no more than an hour to get into the baking pan. The four carb centric ingredients are easy enough to add together and divide by the number of slices I’ve cut up. Of course, a guess or a glance at Calorie King works just as well…

This Cheesecake has proven to be a winner every time. Even if I am getting accused of becoming a repeat offender, or robbing my Sister of her signature dessert.

I must admit that I felt a little hesitant about making this for a group of people with diabetes this week. However at the end of the day, this was me.

I simply can’t get my head around artificially sweetened, sugar free or low carb alternatives. People in my type 1 circles rave about some of those options, but I feel they pale in comparison.

When it comes to dessert and diabetes, I have one motto.

I want the real deal.

Count carbs. Give insulin. Enjoy every mouthful. Don’t feel guilty for it.

If I’m going to do it, I’m sure as hell going to do it right.

“How Do You Manage Sweets With Your Diabetes?”

My red, plastic plate was piled high. I’d grabbed a scoop of hot apple crumble topped with Connoisseur ice-cream, a Cherry Ripe chocolate cupcake and a slice of liquor sponge cake from the desert table at our family get together over the weekend.


Get togethers in our family are all about the food. I spent most of Thursday telling Mum that she’d prepared way too much for our get together that evening, and the remainder of the weekend saying I told you so. Nonetheless, you still want to try and have a little bit of all the deliciousness.

“How do you manage the sweets with your diabetes?” my Uncle asked me as I sat down at the table with my plate.

After all these years with type 1, you sort of begin to expect these kinds of questions. I mean, even I get a little conscious when I sit down with a piled plate, wondering what others must think.

I went on to explain that I would look at the plate and estimate that I had at least 100g of carbs there.

I went on to say that I would enter 100g into my insulin pump, and that the pump would deliver an insulin dose for me.

I went on to explain that I can technically eat anything, so long as I cover it with insulin.

I went on to explain that I should still be mindful of how many carbs I eat, but that it was Easter and I didn’t care so much today.

I went on to explain that if it wasn’t Easter and I did care a bit more, a back up bolus of at least 15 minutes would also be helpful.

I didn’t explain the months of hard work that went into perfecting my basal rate, so that my mealtime insulin does its job and doesn’t get stuck in quicksand.

I didn’t explain how I weigh all of the food I prepare at home, multiply that weight by carb factors, and then divide it by my own unique insulin to carb ratio.

I didn’t explain how some foods are digested very slowly, while others are digested very rapidly, and insulin needs to be backed up or delayed accordingly.

I didn’t explain that a larger, higher fat or restaurant meal, requires a temporary basal rate for several hours to combat the insulin resistance.

I didn’t explain the importance of checking my blood sugar levels post meal, to ensure that my insulin is doing its job.

I didn’t explain that sometimes I get it wrong, and I end up eating my way out of lows.

I didn’t explain that sometimes I also get it wrong, and I end up shovelling down insulin and bucket loads of water at 3am to bring down the highs.

I didn’t explain the huge investment I’ve had to put into learning, observing and applying, so that I don’t make these errors so often and see more numbers in range.

I know that my uncle wasn’t trying to be rude or judgemental. And it was nice of him to ask. I liked that it opened up the dialogue, and that I could deflate the stigma around sweets and diabetes.

It’s just a shame that despite how simply I’d put it, nobody in that room will remember a word of what I said.

It’s a shame that despite how many times I check my blood sugar or pull out my pump during the day, nobody seems to notice the diabetes.

It’s a shame that I’m only ever asked these questions when I’m seen with a plate piled high with desert.