Replies to This Discussion

Permalink Reply by Brian (bsc) on February 10, 2013 at 8:00am

Dr. Bernstein recommends that you count half the protein as carbs, so I would count 30g of protein as though it were 15g of carbs and bolus accordingly. I don't count fat.

Another view is a more modern version of the exchange system called Total Available Glucose (TAG), where you count carbs as 100%, protein as 58% and fat as 15%. This system is taught at certain places as a way to count carbs. Joslin also has a blog on TAG, but they count carb/protein/fat as 100/50/10.

When having a meal that is dominated by protein and fat, your insulin timing and profile is also of concern. Protein can take 3-5 hours to digest, by the time it hits your bloodstream, your insulin may be gone. You can deal with this by delaying your bolus, using R or if you have a pump using an extended or dual wave bolus.

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Permalink Reply by Hannah Hamlin on February 10, 2013 at 9:18am

Thanks! I've read Dr. Bernsteins book and have been doing the half protein as carbs thing but it just doesn't seem to be enough. I'll look into the TAG system. I think incorporating insulin for fat will make a difference. Thanks so much! I'm on MDI's but I've noticed that waiting to bolus for high fat and protein meals helps.

Thanks again, Hannah

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Permalink Reply by Brian (bsc) on February 10, 2013 at 10:12am

What do you mean it is not enough. Are you high at 2hrs or do go high 3-5 hours after? I think a delayed bolus may really help for those high protein/fat meals.

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Permalink Reply by Hannah Hamlin on February 10, 2013 at 10:30am

My highs have been 3-5 hours after meals. I may try delaying my bolus further. Thanks.

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Permalink Reply by still_young_at_heart on February 10, 2013 at 1:08pm

There's an MDI technique that I learned from KellyWPA and others called tiering. You take a portion of your insulin before the meal and then take a second shot an hour or two later with the rest of your calculated amount. The first shot will take care of your carbs and the second will handle the protein and fat.

Of course getting the amount of insulin, correct split and correct timing are all things to be worked out but that's even true if you use a dual wave bolus on a pump.

Good luck,

Maurie

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Permalink Reply by Brian (bsc) on February 10, 2013 at 1:14pm

That is a good suggestion. Another option would be to use Regular (R).

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Permalink Reply by David (dns) on February 10, 2013 at 2:23pm

That is what I have been doing for some time. Didn't realize someone else had figured it out too. I developed the method some time back as experience showed it was the only way to get a flat response. For me, anyway.

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Permalink Reply by Hannah Hamlin on February 10, 2013 at 3:43pm

Maurie, I've heard of a split shot before but haven't tried it. It may be a good time to try it out. Thank you for you input!

David, That's awesome that you were able to figure it out on your own. Glad it works for you!

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Permalink Reply by Annabella on February 10, 2013 at 12:45pm

There's a Group here on TUdiabetes called Taggers United, you might want to look there & ask questions.

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Permalink Reply by Stemwinder on February 10, 2013 at 2:39pm

As Annabella suggested, there is a group for taggers. Here's a link TAGgers UNITED

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Permalink Reply by Hannah Hamlin on February 10, 2013 at 3:45pm

Thanks! I'll check it out.

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Permalink Reply by Gerri on February 10, 2013 at 1:37pm

I do low carb & count 50% of protein grams. I take a small bolus to cover the carbs & a second injection several hours later. I don't bolus for fat. But, if it's a fat heavy meal, I delay the second bolus since fat slows down digestion.

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