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When counting your carbs before bolusing, do you factor the amount of protein into your calculation at all? If so, share how in the comments!
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I used to when on an Animas with High Protein Meals but with Tandem CIQ I no longer need to
I tend to count it more for dinner because Iām less likely to do
Activity after. If Iām active during the day, I donāt account for it in my lunch bolus.
No. When I count carbs … I count only carbs.
I also douse for 60% of the protein count.
Yes when the meal is high in protein/fat. Normally bolus post meal since these nutrients usually are delayed regarding BG interaction.
I adjust for fat, but not protein. The small amount of butter it takes to grill a sandwich requires me to add 10 grams to the sandwich carbs.
I see nutritionists have failed the diabetic community again š
Always. I found that every 8g of protein=1carb equivalent. I add that up to my total carbs, and that % is my extended bolus over 1-2hrs, depending on fat in my meal.
At home, I weigh out all my meals. Tedious, but the control is worth it. And I’m better at estimating when eating out! That allows me to treat myself on occasion, too: the cake at birthdays are excursions that have less impact in the grand scheme.
I add 1/2 of the grams of protein to my carb grams
As I eat keto/LCHF (<20 grams of carbs/day) I don't count carbs for every meal. Instead I have banned certain foods that I know include too much carbs. The foods remaining are seldom of any problem since the total amount of carbs is very small. I almost always take 2 units of Humalog to every dinner I eat. Makes my life very easy. No counting, no decision making; just bolus and eat.
I need to "overeat" a lot before the protein has an impact on my bg, but when this occasionally happens (like at Christmas, a summar party etc), I add an extra unit of insulin due to the extra protein. But no counting. Just a visual estimation.
I do much the same as you. I try not to exceed 25 grams at a meal and consume some keto.
Do you lift weights or do resistance exercises? Has going ketogenic caused you to lose muscle mass? Does it interfere with your aerobics or yoga or Pilates?
Wanacure:
No I don’t lift weights in a gym or similiar. But my house is from 1907, including a large garden, so that has demanded me to do a lot of “muscle resistance work”.
Besides of that now exercise more than every in my life. The last 3 years I in average spend more than 10 hours/week in different kinds of physical activities. Daily long walks, running (16 miles/week), badminton, and more. So I have more muscles now than 25 years ago (current age is 52). Since I never go “low” in my bg anymore, exercising is no longer a problem, compared to before when I ate a more traditional type of diet (like the SAD diet). Switched to low carb/LCHF 12 years ago.
See an old article at DietDoctor, https://www.dietdoctor.com/overall-now-completely-new-life
My understanding is that 40% of meal protein is converted into carbohydrates, so I include 40% of protein only if the meal has a significant amount of protein.
Only when Iām eating low carb and have to bolus for the proteins to stop from growing high. If itās a zero carb meal, I still have to bolus for what gets converted.
When counting carbs I check for fiber amount. If it’s high enough content I deduct that amount from carb count. The fiber amount has to be pretty good amount tho.
I calculate any type of bean protein into my total carb count.
“Bean protein”??? Beans contain more carbs than protein. But they are usually relatively low carb so even with canned baked beans, most of the carbohydrate content is because of the sauce added to the baked beans and the sugar content of that sauce.
I use the 8grams of protein = 1 carb
Same here
Thank you! I have never heard this. Do you count fats as carbs too? What ratio?
That is similar to the recommendation by dr Jake Kushner, see this YT clip https://www.youtube.com/watch?v=FInnC6IMo9g&t=1007s
I count meat protein if it has a higher fat content. I donāt count lean proteins.
I always count protein/fats and used to bolus for it about an hour and half to two hours after I ate for it. Now I use R insulin and take it about 30 minutes after I eat.
Why, may I ask, do you bolus after you eat?
I only count carbs for protiens that have fillers like sausague or sugars that may be added like meatloaf.
I increase/decrease only when anticipated protein intake is much more/less than normal; for relatively small deviations from normal, I make no adjustment.
If eating high protein I calculate 25% of pro and fat as carb. Also just add a few carbs on if high in fat
When I eat a regular low carb menu, which is often, the amt. of protein and fat is important to figure in. I try to just eat an amount of food that results in a bolus of 3-4 pre bolus and more later if needed, 1-2 units, sometimes as much as 3. It is more of a gut feeling, portion evaluation, and type of food observation rather than counting anything in real numbers.
Sometimes we learn by trial and error. Though I rely on labels and supposedly objective analysis of foods, they sometimes just do not correlate with each other. And sometimes my body tells me something different.
After 55 years Iām still a very poor calculator of what bolts is needed when Iām in trouble But as we eat Banting protein and fat is very important
I’ve never figured out the right amount to bolus with protein!
I selected “sometimes”. I rarely eat just a protein food. Most protein foods have some carbs in them. Example is yogurt. Even “no sugar” brands have 7 to 10 g of carbs. I depend on the label.
I usually do include protein and fat in my bolus for meals. I also frequently use extended bolus to acomodate the non-carb items.
Yes put only if it exceeds a curtain amount. For example, if consuming 4oz of protein then no extra bolus is needed. If consuming say 8oz, I give an extra .5 unit immediately and somewhere between .5 – 1 unit spread over 3 hours.
I donāt have the time or energy to do all this counting. With TIR as a new and popular metric, I use it to my advantage and not worry about minute details anymore. I donāt care if Iām 120 after a meal or 170 after a meal. If Iām 170, I just inhale a 4u and be on my merry way!
Gotta pack kids lunch, make breakfast, brush their hair, get myself lookinā pretty and get off to work. š
Inhaled works so fast it eases the pressure (for me) of having to be so exact after years of liquid insulin dosing.
Just wish they would come out with a 2 unit. I don’t weigh enough to take 4 unit.
I’m a plant-based eater so I eat a high carb diet, low fat/protein. When I bolus before a meal, I factor the amount of fat in my calculation.
I eat less than 40 grams of carbs a day. I dose Novolin-R to cover my protein plus a little Humalog to cover the startup of the meal. I don’t actually count carbs since I don’t eat the suicide diet that the ADA recommends.
I factor in protein for my daughter for breakfast, usually 30% as additional carbs. And once my daughter is asleep she always has a good rise, so I bolus her protein (and fat) from dinner at that point. It depends if she is eating a good amount of fat and protein for lunch if so, I usually wait and do another bolus on the rise.
Kathryn, can I ask – you bolus for carbs only at mealtime and then again a little bit for protein/fat some time later? Like an hour later? More? Less? I’m new to all this and don’t know where to go to ask!
Hi Robin, For breakfast, I bolus my daughter upfront with extra for protein and fat. Sorry, I miswrote in my previous comment. I figure out 30% of the fat of the meal and 50% of the protein and add that as additional carbs upfront. For lunch and dinner, I only bolus for carbs, but then bolus again once the initial bolus starts to wear off any time from 1.5 to 3 hours later as her physical activity is a bigger factor around these meals. I highly recommend keeping a food journal in the beginning to see how different foods affect you and keep track of how much insulin you gave to improve upon it the next time you have a similar meal. After awhile, you can develop a formula that you find works best for you.
The protein/fat content changes when I bolus. Protein/fat affects how fast I absorb the carbs, so if I bolus before a meal with protein/fat, the insulin kicks in before I’ve absorbed the carbs, and I tend to go low.
Sounds like a similar situation. If I have only protein and/or fat, there is no need at all for bolus. If carbs are added with fat or same amount of protein, I vary between lows or extended highs. I assume digestion is the issue. When I eat high fat meat, I always use lower or extended bolus.
Not usually unless the food has a higher protein & fat content – like pizza, or a mixed vegetable casserole dish baked with dairy, eggs with or without meat, chicken, or fish. It depends on how the food is prepared – whether the protein and plant based food is raw, fried, roasted, baked, or stewed.
I generally only add in proteins if I am eating a larger than normal amount of protein, as if I go to a steak restaurant or get a large burger. Those larger than home-cooked meats shoot my sugar up and it is probably because of the proteins and fats. In those circumstances, I add about 30% more insulin than I calculate normally. I also do that if I eat an egg in the morning as an egg will shoot my sugar up and keep my sugar from coming back down for hours. Because an egg really extends how long my sugar stays risen, I like to eat an egg in the morning on the days where I will be physically active for a good 3-4 hours right after breakfast as the egg keeps my sugar from dropping too quickly. . In addition to adding insulin, I extend my bolus with about 85% immediately and with 15% extended.
I always count protein. When eating low carb, the bolus really is to compensate for the amount of protein. The amount of carbs being small and consistent.
I use a modified Warsaw method if fat and protein are high. I usually end up with one unit or so over for or five hours. It stops the late rise.
I dont play the bolus game at all…
I also add in my fat grams. I figure this works because I eat a high carb diet.
I only bolus for carbs. If eating high protein or high fat meal, I expect this to slow down carb absorption, so do use the extended bolus feature.
I’m intrigued by the protein dosing being described here. I have had some persistent highs that take hours to come down after a fatty cheeseburger & fries meal. I always assumed I underestimated the carbs, but maybe not? I’m prone to lows, so am timid about dosing for non-carbs.
I have been T1D for 52 years. I suffer from many complications. One of which is gastroparesis. Animal fat and protein are slow and hard to digest. Carbs and fat/protein present 2 separate and distinct peaks on cgm. I generally eat a plant based diet because it is easier and more consistent to digest. Traveling Monday and spent the night at a Holiday Inn Express. Free breakfast, so I sure wanted to get my money’s worth. Huge breakfast, 4 frozen biscuits, 3 sausage patties, large apple muffin, 3 cartons of milk. Bgl was declining and hit 95 as I started eating. Took 12.0 units of Humalog. Bgl rose to 179 and then started slow decline. I call the second rise the second wave. It started climbing and peaked at 3.5 hours. This was the impact of fat and protein. The peak was 250. It was stubborn to fall and took 7.0 units of insulin. The spike from fat and protein is significant. In individuals with normal digestion it appears with carbs. Patients are told to only worry about carbs and never analyze the impact. Because of gastroparesis I have known and bolused for it for more than 20 years. In the early days, I mixed Humalog and Humalin R, Regular. This worked great. Started pumping and used normal and extended boluses. I want you to think about something. Fat and protein produce a leak. Normal boluses work great for peaks. Basal or extended boluses produce flat lines. With a cgm, I use staggered bolused. The live data allows me to adjust on the fly. Not possible with extended boluses. Think through everything that I have told you, please.
Thanks for the tips, John! I think my Dexcom and I need to do some fun meal experiments to figure this all out… š
I am on a very low carb diet yet still needed insulin to cover my higher protein intake. I found that I needed to bolus for a full 30% of protein grams on top of any carb to keep my sugars stable.
Because I eat somewhat low carb, I have to dose about 50% of g protein as carbs and extend bolus for slightly higher fat meals.
Many years ago I started out on an ADA exchange meal plan. There were fat exchanges, bread exchanges, fruit exchanges, meat exchanges, milk exchanges, and vegetable exchanges and free exchanges. Thatās how I learned about fat grams, carbohydrate grams, protein grams in various foods. Nowadays I subtract grams of fiber from total grams of carb to get net grams of carb per serving for fruits and vegetables. Yes, fat and protein grams affect blood glucose but not as fast as net grams carbohydrate. As a kid I eventually learned to count protein as 50% of net grams carb. If I eat 1 to 2 oz of nuts or seeds at beginning of meal itāll slow blood glucose rise. If my bg is trending low, Iāll eat carbs first then protein and fats last. On another patient site and also by a doctor I was told NOT to go ketogenic if I wanted to build or even just maintain muscle mass. One thing I know: if you increase your fats and proteins and decrease your carbs, you will be able to cut your fast acting insulin (lispro) but may have to increase your long acting insulin (glargine). Will going ketogenic cause me to lose muscle mass or make it harder to add muscle mass when lifting weights?
I would say no. As long as you eat enough protein (ideally animal based protein), you will not loose muscle mass. That’s just an old myth about ketogenic diets. But if you cut carbs, minimize protein and fat, you will loose muscle mass (and you will soon feel terrible).
If you cut carbs, you must provide your body with energy from the other macronutrients and that is protein and fats.
Please note that when you switch from eating a highcarb diet to a lowcarb diet, you might feel depleted and tired during the first weeks. If you are also currently is doing a lot of exercise, your results will go down the first months. This is due to that you must train your body to use energy from fat, instead of carbs during exercising and that might take some time. Don’t worry, this is just a transition phase, and you will also not loose any muscles during this phase. Add some extra salt to your meals, since it’s rather common to loose a lot of fluid in the beginning when switching to a lowcarb diet, and with that loss of fluid follows a lot of minerals. This lost might cause headaches or feeling tired.
Read more about this very common issue at https://www.dietdoctor.com/low-carb/keto/flu-side-effects
Protein is never used for the math of the dosage calculation itself. It does factor in when you are trying to severely delay a huge spike