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When counting your carbs before bolusing, do you factor the amount of fat into your calculation at all?
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Since I use a closed loop system my accuracy in carb counting has gotten less accurate. I donāt have to be as precise
Yes.
Higher fat meal, longer extended bolus.
Lower fat meal, shorter extender bolus.
Generally, I eat a low-fat diet. However, there may be occasions when I eat a high fat meal, and use an extended bolus. But, I don’t calculate for fats.
Not so much actually counting it, but being aware itās there and is going to delay absorption. Changing a regular bolus to an extended bolus to cover high carb and fat food like pizza and Chinese food.
I wish CGM paired with my pump allowed for dual and square-wave boluses.
In the good old days it would take 90 minutes for digestion on my low-fat diet. I would add 2-3 hours for pizza and high-fat food digestion with extended boluses.
Then gastroparesis reared its ugly head. All bets were off. I now use the best artful artifice to finesse and approximate the equations diabetic educators recommend. Biology and faulty nerves often work at wicked purposes. š
Ditto
Yes, delayed stomach emptying can be another monkey in the wrench!
I read that fat also inhibits the action of insulin. It also said how much is different for everyone, some need 10% more insulin, some need double. Seems risky to experiment much, but I usually increase the carb count by 10% and do the usual extended bolus.
I have travelled extensively around the world. I never have taken my Gvoke HypoPen with me. Do you think everybody can read English to administer the glucagon injection?
A never leave home without my Glucose tablets PERIOD!
Answered in error.
I only bolus for carbs and when my bg starts to rise later (after a couple of hours) I look at the upward trend and ācorrectā for the fats. I think Iām pretty successful at it since my endocrinologist says being in-range at 93% is really good.
For me fat usually requires a bolus a few hours after a meal. Tried keto but was not for me. BS all over the place. Iāll stick to low carb moderate fat.
I do factor in the amount of fat in a meal in order to administer a dual-wave bolus of insulin.
With meals such as pizza or chips (French fries) I tend to give two thirds of my bolus immediately and the remaining third over a period of about 1.5 hours.
Pizza!
It gets a delayed bolus.
Other than that, not often. I stay away from fatty meals.
. Fat slows digestion so it will determine extended bolus or not.
I only consider the amount of fat if my meal is pizza or another meal with lots of cheese. If that’s the case then I extend the bolus delivery but I don’t increase the carb count.
If the food has a greater amount of fat/protein if may factor in the dosage, but there is no specific math for that I know ofā¦.
Likely being attentive at the back end of that dosage ( I.e. 3-4 hours later.)
I rarely eat high fat meals. I use extended bonus when I do
Pizza is the meal that requires me to extend the bolus dose but doesn’t affect the amount of insulin bolus I use to cover the carbohydrate amount.
I only take the fat into consideration if it is a high fat meal, like pizza. Then I use extended bolus.
I consider the amount of fat to determine if, and how long, to set up an extended or dual-wave bolus. I do this to account for the effect of the fat slowing absorption of the carbs, and thus slowing of the rise of BG. For me, if I don’t do this I will end up with high BG much later than usual after the meal.
Through experimentation for different foods, and limiting the varieties I’ve come to involuntarily account for fats, like with pizza or various meats.
I try to avoid fat rich meals in the evening but when I donāt I increase my basal rate.
Just as an “extended” bolus.
Fat clearly increases the need for insulin by making the person more insulin resistant for 6-12 or more hours, and also by a more direct mechanism. There really is no concensus on how to cover, and it does vary from person to person. As a rule of thumb, if there are carbs and fat, I increase carb counts by 30-50% and give the extra as a 2 hr delayed bolus w pump, or a second bolus at 1-2 hours for pizza. If fat alone like nuts, I don’t cover unless a large amount. I do cover cheese if a larger amount but no set way to do it. One suggestion is consider as 1 gram fat = 1/2 to 1/3 gram carb. Coverage for fat is needed, but it is highly varied based on individual experience.
I try to eliminate variables by trying to maintain same doses of MDI at same times. I try for each breakfast to have same grams of fat, protein, and net carbs. Each lunch has the same food values as preceding dayās lunch. Each dinner has same value as preceding dayās dinner. If I deviate, I try to anticipate what effect it will have and lower or increase fast acting lispro, and/or plan on a snack. I try to be aware of and correct for unusual exercise, or poor sleep or unusual menu item if eat at a restaurant or taco truck.
Pizza is the one food that I have to consider the fat with my calculations
In 22 years of pumping, I never counted Fat or protein. However, I do count fat and protein now. Recently, as I am getting older, I’ve had issues with spiking BGs after eating even with adjusting carb ratios, etc. Protein tends to affect the BG more than fat, but since I’ve starting counting fat, my Time In Range is much beter.