I think 53% of protein converts to carbohydrates. I use "Bubba Burgers" as a visual clue, in that they are like 25G of protein so I bolus for 10-12G of carb for a burger about that size. If he's on top of his BG, I would not worry about an A1C being "too low" as teenagers are generally clever. I think the problem, from what I've read here, is that they are inclined to be disengaged or to think "I don't need to deal with this, I have more important things to do..." which I suspect is often a mistake. 7 suggests that he's not making that choice so, as long as he's not passing out all the time, I'd let him keep rolling.
That's a HUGE victory!! I was like 37 before I could reliably wake up with decent BG!!
Wow! He's certainly doing something right. I usually try and convert my proteins into carbs (as AcidRock describes), although I have found this to be a little trial and error. With a meal that is heavy in protein and fats, I find that I can spike a few hours later. So I will usually do a dual wave bolus right when I start to eat. But I use a pump....
But again, with an A1C that good during his teenage years, I really wouldn't worry too much.
As for Hashimoto's -- yes, it is commonly seen in people with T1 because it is also an autoimmune condition. He should be regularly screened for that (they are probably already including it in his regular bloodwork, but just check to be sure).
I would recomend join the TAGers group as your questions seem related to this: http://www.tudiabetes.org/group/tagers. I am a member and this group was formed after the book "Total Available Glucose" (1989). The book isn't a great read, but the relevant part is that 100% of carbs are converted to glucose, 59% of protein is converted to glucse (over 4-6 hours) and 10% of fat is converted to glucose (over 6+ hours). The group discusses ratios and ways to handle different meals. There are even many MDI members that could directly discuss those issues specifically. Read around and I found it to be a wealth of information. And tell your Tyler that he is doing a great job.
From my own personal experience, I find that fatty meat (even lean ground beef) if hard to dose for. A cheeseburger is a great example. Using 80/20 lean beef you are looking at 0 carbs for the meat (yay!) however you have 22g of fat and 19g of protein to account for. Your body is going to convert that into energy (hopefully). Add in a slice of cheese 7g of fat and 5g of protein and the bun which if you're using good old hamburger buns are 33g of carb per serving.
On paper, you have 33g of carbs! Hooray, so one small dose of insulin and you're done!
Incorrect. You need to worry about the carbs from that bun in the short term (think hour, 2 hours after eating). However that protein and fat from the meat and cheese are slow burners on the glycemic index. You are going to have to account for those over the next 4 or 5 hours.
I find that I can't treat 1g of fat/protein like carbs, but usually on have to take a bolus of roughly half the total amount of those 2 hours after eating.
I agree and these are the original ideas of the TAGers group. One of the original questions posed was why does my BG rise very slowly after I eat just a steak (0/negligable carbs). TAG explains that per laboratory testing 59% of the protein will be converted into glucose over mayber 4 hours. This is why some pumpers use a dual wave bolus for high fat and/or high protein meals. The extended (square) bolus will combat the digestion of the protein. I suggest you take a look as TAGing opened up a new view on digestion/metabolism for me.
Capin - I heartily agree with your referring the OP to the TAGers group. It helped me a lot when I decided to change my diet to moderately low carb. I now reliably use an extended bolus to cover the protein/fat content of my meals. The TAGers forum has a wealth of useful information!
I agree with what has been said about bolusing for protein, but want to add that in my experience, timing a bolus for a very low- or no-carb meal is different than timing a shot for carbs.
As MyBustedPancreas mentioned, it can take much longer for protein to affect BG than carbs- especially with a higher fat meal. For a low- or no-carb meal, I take a shot about 15 minutes before eating, or even immediately before eating. The timing isn't as crucial as when bolusing for, say, pasta, but there can be a slow, gradual rise over 3-4 hours. I recommend keeping an eye on BG at the 3 or 4-hour mark to see the impact of protein on Tyler's BG.