Sarah Howard
Sarah Howard has worked in the diabetes research field ever since she was diagnosed with T1D while in college in May 2013. Since then, she has worked for various diabetes organizations, focusing on research, advocacy, and community-building efforts for people with T1D and their loved ones. Sarah is currently the Senior Marketing Manager at T1D Exchange.
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When counting your carbs before bolusing, do you factor the amount of protein into your calculation at all? If so, tell us how in the comments! Cancel reply
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I factor in carbs, proteins, and fats. I’ve found this works best for me. I’m guessing that I eat a high carb diet so that’s why it’s ok.
Amy, what do you do when you factor the rest in? I use MyFitnessPal for counting carbs but I also get the other information but wouldn’t have the slightest idea what to do with that information.
I was taught (50+) years ago that protein and fat did not affect blood glucose. My current endocrinologist echoes this. However, I have seen contradictory evidence. My endocrinologist & I are working on an algorithm dealing with fat and protein.
Yes! Very low carber here – definitely have to account for protein and high fat content as there is a noticeable rise in BG a few hours later. R insulin in small doses works well.
I include protein (and fat) in my dosing calculations in that they affect how fast I’ll digest and absorb the carbs — it’s less that I’m actually taking insulin to cover them, and more that I’m adjusting how much I’ll extend the bolus. (I have gastroparesis so have to extend most boluses because my digestion is delayed.)
I am pretty lazy about that unless everything is clearly marked. What I do is eat a meal, figure out how it affects me, then adjust it for next time. Fat definitely has a later high. If I take too much insulin with fat, I will go low and then boomerang because I had to eat.
Not pure protein like fresh meat. If protein is something processed that is marked with, for example, processed hamburger patty with 4g of carbs then sure I do. Meat, even plain bacon has zero carbs.
I factor in protein because I eat a very low carb diet and have found that even eating just meat requires a bolus. If I eat 24 grams of protein, roughly 4 ounces, I divide it by 1/3 to 1/2 depending on how lean it is. I also bolus at a lower ratio than had been recommended. Everyone reacts differently and you have to experiment to see what works for you.
Yes. 1/2 protein gets a bolus.
I count proteins in the proportion of 28 during the day and 56 at night and I still count the fat, after multiplying by 0.3 divided by 8
One hour after every meal I have to give 2 units of Humalog spread over 1-1/2 or 2 hours otherwise 3-4 hours after I eat I go high. My pump won’t let me do more than two hours so I have to remember to bolus a duel one hour after I eat. I also give insulin 10 minutes before I eat.
I don’t eat a lot of protein, so don’t factor it in. I do factor in high fat with a dual wave bolus over 2 hours mostly at dinner. Then I have to do another 1 – 2 hour dual or square wave bolus after that for pizza or a high fat dessert.
I bolus for about ~30% protein if I’m eating a high protein meal.
In a low carb meal, I would just wait till BG rises from protein and dose then. In a complex meal, Protein does not concern me. It’s all about carbs and fat. Fat is the more concerning variable where I do my variation of a combo bolus with inhaled Insulin.
I do not count meat because it isn’t a carb, but it seems the calories and fat come into play later on after the meal. My husband used to weigh his food to calculate insulin, and then moved onto counting calories which was 50-60 calories per unit. This was back in the day of no meters, glass syringes, needles that needed sharpened, animal insulin and a week to 10 days of classes before returning home as a juvenile diabetic. We’ve come a long way in the last 100 years, but all of us awaiting the magic word CURE to becoming type NONE.
Sometimes. It depends on protein and fat content – like for pizza, or fruit mixed with yogurt. Then I use an extended/dual wave bolus.
Since the bolus estimate based on carbs is already an approximation whose accuracy is offset by the state of the patient, exercise, insulin activity due to duration in pump, and a guess about serving size, adding proteins into the calculation seems like putting lipstick on a pig.
I generally only count carbs. Don’t count proteins at all. My diet is mostly carbs (fruits, vegetables, grains) with small amounts of meat. On a rare occasion, I make a gluten free pizza. Then I have to use an extended bolus. My blood sugar usually goes up about 6 hours after I eat pizza, which is usually in the middle of the night. I used to extend my boluses for 4 hours. Now my pump only allows 2 hour extended boluses. Tricky business with gastroparesis and celiac.
I definitely factor in protein if it is in the dairy family. I have found that cheese, yogurt, and other such products cause a rise in blood sugars about 1 1/2 to 2 hours after eating.
nobody has been able to tell me how to bolus for fat or protein
I have used the extended bolus, with higher protein foods and things like pizza. I add protein count to carbs with about 2hr extended for 30% of bolus to extend. Not sure if this is what works for everone but works for me most of the time.
Only when eating low carb to I bolus for protein.
I have no idea how to adjust for protein. I have eaten meals with basically no carbs and found that, yes, it does affect glucose levels. Bearing in mind that this is my opinion/guess only, I think it’s the fat. I have read that fat inhibits insulin from doing its job. So I think it’s the glucose that the basal insulin is supposed to cover that’s causing the rise. The same source I was reading said people vary from having to add 10% to 100% to the insulin to cover the fat. That’s a huge range, so I have gradually been trying to figure out where I fall in that range. And I agree with everyone else, anything with more than a small bit of fat content really slows down the glucose rise. If I can, I will wait until my glucose actually goes up a bit before bolusing. Sometimes it’s more than 1/2 an hour. Then I also have to do an extended bolus or my CGM starts alarming at midnight. BTW, I have also tested the carbs vs. fiber calculation on raspberries. Using the equation I was taught, they should count as 0, but my glucose went up a lot. Now I just go by the carbs alone and forget about the fiber part.
I let Loop figure it out. When I enter the carb count in to Loop I do it by choosing the type of carb (fast, medium, slow). If I am having a mixed meal I will enter the carbs separately. So a potato is “fast” – hitting my system in 2 hours, the steak is “slow” taking about 4 hours to affect my blood sugars. Loop figures out the bolus and I just hit the deliver button.
There was no choice for “Rarely.” I am on CGM and MDI and will take an extra unit of insulin when I am having a high fat/protein dinner meal, like roast beef or steak.
For higher fat and protein meals, I will have to bolus again once the initial dose wears off. For my daughter, I will have to almost alway bolus for fat and protein once she is asleep. The lack of activity makes the fat and protein have a larger affect on blood sugar.
I typically bolus for about 1/3rd of the protein I eat. For example if I eat 15g of protein, I will tell my pump I ate 5 carbs. I do eat a very low carb diet though, years ago when I was eating a standard American diet I didn’t bolus for protein. Dr. Bernstein’s book brought this to my attention/taught me how to do it.
I’m reading his book and learning his methodology right now. Nice to see another person applying his ideas and it’s working for them!
It depends on the protein. Meats, no. Yogurt, peanut butter, and milk, yes.
I forgot beans, yes
I’ve never heard of bolusing for protein. I’ve heard about bolusing for fat, but I’ve never found any information on how.
There is a decided lack of knowledge on my end.
Personally I don’t. Though I do slow down my bolus with higher carbs, that is not how I interpret this question. I recall learning years ago that 10% of fat and about 30% of protein ends up being metabolized like carbohydrates. So, if I were to get that refined in my calculations (sadly, not there yet) I would count protein at 30% per gram like another commenter (don’t think I would count for fat.) I do normally subtract a percent of fiber from the protein count though.
Sorry I misspoke, I mean I slow my bolus for higher fat- not carbs. Don’t adjust the amount though.
I eat moderately low carb and find that I do need to bolus for protein depends on the amount but usually 1 unit
Only when it is a very High Protein but Low Carb meal, then I will use the 6/1 protein carb ratio
for regular meals, no adjmt yet i use experience to protein adjmt for fake carbs. example eggs & cheese, no carbs yet adding ’10 fakes’ will keep BG from increasing too much. I like other responses calling for 33% of fat & protein & entering as fake carbs.
I eat relatively low carb. In counting protein it depends on the type of protein. Eggs vs. fish vs. meat. Eggs and fish less extra, meat more extra insulin.probably due to fat. Beans I estimate carbs and round up, but I don’t eat beans often. For all protein I have to watch my CGM for a rise later. If I catch it right I can bolus before the big rise of late breakdown of protein. It is not always the same or predictable depending on activity and other things.. Sometimes I didn’t need extra, so I just watch Dex. Sometimes I overdo the insulin and then have to treat for impending low. I live in fear of not having my Dex. And yet somehow I survived 20 years without. I somehow had good A1 c but had much more variability and much more frequent lows.
I used to before going on the Medtronic 770G. I counted proteins, multiplied by .6, and added to my bolus accordingly.
No official calculation, just keep it in mind in addition to the rest of the compilation of the meal.
Whenever I eat a protein bar or protein powder my blood sugar spikes, even if it’s very low carb. I have to take insulin for the protein just like carb. However, whole proteins like meat do not raise my bg.
I don’t bolus up front for protein but will extend a bolus if I have a high protein meal e.g., steak
Yes. Since I am on a hybrid closed loop that does not allow extended or square bolusing, I half the grams of meal protein and then bolus for that amount about an 1 hr post meal.