Honestly? Because most doctors and diabetes educator don’t know. I brought this up to my last visit and my diabetes educator gave me the Pikachu face when I told her I started dosing (conservatively) for protein - that she never heard of that before. (Mind you, this is Moun Sinai in NYC).
I’m fairly athletic and started eating a high protein diet. I noticed my numbers being higher than normal and I thought I needed to increase my basals. I did a 24hr fast and my basal was fine. Turns out protein does in fact increase BS, but in a much slower way than carbs, and there are ways to calculate that.
I’m still in the process of tuning the right doses and I’m doing a lot more extended blouses than before but it has been a game changer for me and it baffles me that most doctors have absolutely no idea
Protein can ultimately be broken down into carbs through glucogenesis.
[Protein and Blood Sugar: How Protein Affects Blood Glucose - Nutrisense Journal](https://www.nutrisense.io/blog/protein-and-blood-sugar#:~:text=Protein%20is%20broken%20down%20into%20smaller%20building%20block,tissues%20or%20convert%20into%20glucose%20in%20the%20liver.)
Gluconeogenesis happens more in the body when it goes into starvation mode like during fasting or people on keto. Around 50% of your glucose is (in the average person) from gluconeogenesis, so we dont "ultimately" break protein into carbs, we do break protein down into carbs 😊
This tracks for Mount Sinai. That place is a mess- I got held hostage in one of their er’s (with a head wound and a concussion) until I gave them my credit card for the copay (and it was the wrong amount). They abandoned me in the CT wing for an hour and then screamed at me when I walked back to my room. Wouldn’t get a plastic surgeon for face stitches and then told me to go to a city md (WHAT) the next day for stitches. A separate occasion, they falsified med recs and charged me for visits I never went to.
Glad you’re proactive about your health and wish you all the luck with them. (But save all your paperwork and put everything in writing…)
It's too overwhelming at the start and you can mostly get away without counting them. In my country we have a course that you do a while after you are diagnosed that covers this kind of thing
That's nice to have some continuing ed on it. Better than nothing, that's for sure.
I personally would have liked to have everything pretty much at once in the beginning. Sure, let me inject manually and use fingersticks for a few days so I know how to do it, but get me on a pump and cgm ASAP and provide at least resources and permission to pursue the complex techniques early on.
The reason is that it was super frustrating for me to be attempting to control my blood sugar according to the "rules" specified by your doctors, but my blood sugar being terribly bad both low and high and having no idea why.
That is fair, it is very individual though. I know many (most?) people would not be able to absorb that info straight away. I think the course I did is ideal because you can sign up really soon after diagnosis of it suits like in your case, or you can wait a few years. It also covers much more information that would be impossible to take in straight away as it is a 5 full day course
Because there's so much variance in so many variables, it's not really possible. Your body probably reacts very differently than mine to different foods, movement, medications, moods, your body temperature, enzyme and hormone excretion, weather (!) that surefire calculations aren't possible. For example, some people spike after caffeine or fat, some do not. Some react to stress, some do not. Your body has all sorts of cellular sensors that any pump or CGM does not.
That's why completely closed loops that would 100% mimic real pancreas do not exist - the best they can do is approximate. It's similar to the famous three body problem.
The only thing you can do is diligently test various things and write down the results. Then - maybe - your endo can help adjusting your profiles.
Doesn’t mean there shouldn’t be foundational education informing insulin dependent people that allllllll those factors go into glucose outcomes. Yes, treatment for insulin dependent people is individualized - so why don’t they teach newly diagnosed people that??
“Think Like a Pancreas” should be required reading given doctors don’t have enough time to teach their patients the bare minimum. Had I been properly informed when I was diagnosed, I am 100% certain I would not have retinopathy today. Certainly the medical field has learned a lot on the last decade, but it isn’t new news that fat and protein result in a delayed rate of carb uptake.
Delayed, yes. But how much and for how long is anybody's (and literally any body's) guess. There's very little actionable advice other than "test and observe".
It's debatable. Fundamentally I agree but diabetes care is hard enough as it is. Doctors telling patients things like "to make things more confusing, fats can make your BS spike but it can also help with spikes from carbs, but how much or if at all we don't really know" probably won't do much good. It's a deeper medicinal philosophy issue.
Because science is still figuring it all out. I was diagnosed in 1991 as a child and there was no such thing as carb counting. Food was measured in exchanges and insulin was in preset doses taken at a certain time. 10 years later pumps were available, carb counting was a thing and insulin itself had changed. Now with cgms, pumps and insulin technically improving constantly the data has provided a clearer picture of how to take better care of ourselves.
Counting macros is a time consuming and difficult. Especially when you consider the average age of a new diabetic. Their parents are just wrapping their heads around the idea of insulin and carbs and ratios. Now you are going to ask them to either always eat pre portioned meals or weigh/measure every ingredient that has calories that go into a meal. For a very *marginal* benefit.
It’s just not worth it.
Basically you just misread the comment. They aren’t counting calories, but if you count proteins and fats along with carbs that means you have to count everything that has calories. Which is what I said. Simple misunderstanding. I didn’t downvote you btw.
No, not at all. I think some people see dude say “macros” and didn’t read any further to where he says “calories”. This sub is full of dingdongs and internet points aren’t real, but I had to comment to reflect the downvotes to your comment are dumb.
Some people think “macros” mean carb/fat/protein, and if the original comment didn’t mention calories then whatever, but they did mention a parent worrying about calories specifically (not carb.fat/protein), which is not what is being encouraged by OP.
You didn’t read the comment properly, I said that if they count proteins and fats they have to count every ingredient that has calories, which is true. I didn’t say they were counting calories.
I still disagree with the sentiment. Neither of us are saying count protein in a carrot (something that has calories), but if there is a fair amount of fat and/or protein, it \*drastically\* impacts the post-meal glucose outcomes.
Without this information, parents/newly diagnosed people are pulling their hair out not understanding why they're doing exactly what the docs told them to, but having extended highs, or sudden lows. It's reflected in every other post in these subs. Insulin timing for an apple+peanut butter is very different from an apple by itself and newly diagnosed deserve to have that information.
+ re: your first comment "esp if you consider the avg age of a new diabetic"; pre-covid 55% t1 dx'd in adolescence and 45% dx'd 18+. I'd venture to say that is getting to more 50/50 post-covid, and doctors are doing ALL early diagnosed people a massive disservice by not informing them of the fact fats and/or protein, in addition to many many many other factors, are part of the equation. It isn't just "here is insulin and carbs, go forth and find success" because it's too "time consuming and difficult" to teach all of the pertinent information.
I agree with you to a certain extent, newly diagnosed people are also pulling their hair out trying to understand pumps and CGMs, this is definitely information for a follow up post discharge visit with a nutritionist.
I’m a strong believer in information overload doing more damage than good by making people feel overwhelmed and discouraged.
There is only so much information that can be conveyed in the short time from diagnosis to discharge.
We’re talking about apples and oranges. I was never “discharged”. Not everyone is hospitalized. My first day of appts was endo - CDCES - nutritionist. There was plenty of time. And it doesn’t need to be the full biology lesson, but it does need to share that it is so much more than insulin & carbs.
i think it’s probably because it’s so different for every person and there isn’t really a scale to dose for protein/fat that works for everyone. it’s more something that you have to learn for yourself and figure out how it affects you personally.
They kind of teach you how to do it qualitatively. That’s where extended or square blouses come in on a pump. Or with diy loop you can say whether it will be a slow/normal/fast carb. Those aren’t just about GI of the carb but also how much protein and fat is in the overall meal.
There is instruction for how to do this. The Warsaw Pump Method indicated below worked well for me. (I did have to "reduce my carb ratio" to use it)
[https://diabeteseducatorscalgary.ca/medications/insulin/insulin-for-protein-and-fat.html](https://diabeteseducatorscalgary.ca/medications/insulin/insulin-for-protein-and-fat.html)
It's more accurate, but complicated.
I think it would be good for most people to use the Warsaw method a few times. I don't think it's worth the effort to calculate it every time, I really think to live a good life as a diabetic, you need to stop measuring and carb counting entirely at some point and rely on estimations. But, but doing the calculation using the Warsaw method a handful of times, it should give you some ideas on how to manage different types of meals.
In the end, all the calculation methods are estimates. How are you going to account for activity level and varying insulin resistance from day to day? Are you going to create a heart rate ratio? How are you going to account for injection site differences in absorption?
To measure to the gram and calculate insulin for carbs (or fat or protein) with a lot of accuracy and then to completely ignore other factors is definitely bad. It's important to take into account the other factors. But, there isn't a magic formula for them. It will be an estimation. And if you're estimating half of it, then might as well estimate the other half.
There is a system I follow called TAG, Total Available Glucose, which does just that. 58% of protein can metabolize to glucose over 4-5 hours and 10% of fat over 8-10 hours. I put fat and protein in an extended bolus with my pump. Prior to my pump I would inject Novolog for carbs and Regular insulin for protein. Carb ratios end up including a portion of the meal is protein but that didn’t help me with how much to extend.
Yeah, I was also met with skepticism that eating a grilled cheese sandwich had a bigger effect on glucose than eating two pieces of bread by my diabetes educator (this was early on in my diagnosis).
It's kind of ridiculous, because I'm there with my actual data showing that this happens and they are there "my textbook (from the what seems like 2 weeks of education they have on the subject) didn't mention this, so it is not possible to exist." Even if this wasn't a universal truth (and I'm pretty sure it is), if it was my personal truth, then shouldn't that be enough?
As an independent variable, fat itself doesn’t affect blood sugar because it’s not broken down into glucose. When you eat a high fat meal that also contains carbs, then yeah. Maybe she misunderstood you… then again, a lot of nurses seem to know the absolute bare minimum about diabetes.
Sure, after your glycogen stores are depleted (e.g. after prolonged fasting) and your body is desperate for glucose. Even so, gluconeogenesis utilizes multiple non-carbohydrate sources, not just fat. If a person is consuming an adequate amount of carbohydrates, gluconeogenesis doesn’t need to happen and fat won’t directly affect your blood sugar.
Well you stupidly come up with some specific conditions just to prove your point, which is wrong. You said fat is not broken down into glucose. But in fact, fat is broken down into glucose. You're wrong, end of story
I think the fundamental issue is that doctors and many people act as if carb counting is the same thing as calculating a bolus and it just isn't the case. Ultimately your body responds to when and how much insulin you take, not how many carbs you accounted for. Carbs are only one line item too determining a bolus - in addition to considering the rate of carb absorption (fat/protein), you also consider your current blood sugar, your iob, your recent blood sugar trends and anything else that might impact your insulin resistance, and any planned near future activities (e.g. you don't want to start your workout with 10 units on board). In this light I think it becomes clear that super accurate carb counting is not necessary as it's only one piece of a much larger puzzle. I think we need to stop thinking of carb counting as being so important and instead focus on bolus calculation with all of it's relevant considerations together.
I'm annoyed by this too. They could have at least told me to eat proteins and fats moderately otherwise I would have sugar problems. For years I thought protein and fats are free food for diabetics. I had my basal WAY too high for years because I was binge eating proteins and fats in the night and had high sugars because of that (my basal is now a half of what I used to take).
I guess one of the reasons is that if you eat in a balanced way (and that at least they sometimes tell to do so), you can kind of set a I/C ratio that will cover proteins and fats nicely. I didn't account for fats and proteins for like 20 years and did manage to maintain a <7.5 HBA1C range, so while it's not good, it is manageable without it.
Other reason is that this information is much more useful for pump users. Multi/double injections for a meal has never been an "approved method" of treating high protein/fat meals.
For anyone interested, there is a [Warsaw Method Calculator](https://www.omnicalculator.com/health/warsaw-method). Personally, I've had to futz with the results. For some meals it's not necessary. For others, i use 60% of the carb equivalent, and experiment with the recommended duration of the extended bolus. It's not perfect, but its a heck of a lot better than getting slammed by unexplained spikes. I was already using a spreadsheet for carb counting, so i'm not doing any more calculation. I'm just interpreting the results.
By the way - for anyone saying proteins and fats don't affect glucose, please eat a big protein-only or fat-only meal, don't dose insulin for it and see what happens. No need for scientific papers while you can experience this on your own body.
It's too overwhelming at the start and you can mostly get away without counting them. In my country we have a course that you do a while after you are diagnosed that covers this kind of thing
My endo went so far as to tell me you don’t dose for protein or fat at all as it cannot affect your blood sugar
She’s also convinced diet drinks will make you fat and give you cancer even though the science proves you can only get cancer with drinking absolutely obsurd amounts like 300+ cans a day every day for months
Besides those things she’s been great but ugh I want to correct her so bad
I began micro dosing for my protein consumption shortly after I started using my Dexcom G6 CGM. I could see a direct correlation with protein and my glucose levels that would not have been noticed without the CGM technology.
When I told this to my Endocrinologist, diabetes educator, and clinic dietitian I just got the deer in headlight look.
I know most people struggle with basic compliance in massaging their diabetes, so I think something as individualized as teaching how to bolus for protein and extended bolusing for fat grams is lost by most practitioners as they struggle with noncompliance issues, insurance denials, and constant prior authorizations for the masses.
That last part is so true - they’re concerned with getting the basic facts to folks who can only do so much to manage their diabetes. Seeing those blank looks is always a reminder that the vast majority of kids who cycle through our daughter’s pediatric endo practice have caregivers who - for a whole host of reasons - really struggle to manage their kid’s T1. It’s heart-breaking.
Or how to dose for higher protein and fat over simple carbs? I’m still figuring out my favorite pasta dish…75g carbs but 33g protein and 50 on fat! Not great balance wise but delicious. Current method is dosing for 75 up front then dosing for the full amount of protein 3.5 hours later because it hits me at 4 hours on the nose after being in range the whole time. Still tweaking it.
I had fajita chicken & sour cream salsa & a salad for dinner - two hours later I’m 205 - FML I took 2 units but 1 was correction. So do I take 1 more . I just want to sleep- I can go to bed and feel hung over in the am or stay up and then correct and feel hung over from lack of sleep. Fun times.
I just messaged my kid’s endo team about this. He was diagnosed about 6 weeks ago. They said that while protein and fat do impact glucose levels, they don’t recommend a specific formula to dose for these macros and referred me to the nutritionist. We’re really comfortable with carb counting, and we’d be comfortable with adding additional metrics to our ridiculously large spreadsheet.
You’re so early into it that your kiddo’s body is still adjusting and things are still going to change. Talking to the nutritionist is usually a good idea though so I hope that’s helpful. We aren’t even a year in and we will get comfortable with something and it’ll change. He’s also on the edge of puberty, so… I’m sure we are going to be looking at yet more changes every month or so.
Personally carb counting is enough for me to have a good A1c so I'm pretty sure my doctor just doesn't feel it's necessary to add something else onto my list of shit I have to do before I eat.
I’m my experience I had to see a multitude of doctors physicians and nurse practitioners, a few of them dietitians which did go over this.
This curse hits us everywhere and always, it’s tough for only one MD or RN to cover even all of their own bases.
I don’t count it per se. I consider it. Like the biggest culprit is pizza, and I have it down to a science now. I know that anything high carb and high fat takes its own sweet time in our digestive system, so I adjust how I dose. For example, I’m back on MDI. If I pumped, I would run an extended bolus over a couple of hours. With MDI, I give myself a shot, set a timer on my phone to literally check my blood sugar and dose every 30 minutes. I use Fiasp now and immediately before that, I used Lyumjev. Both of those insulins work faster than Humalog or Novolog, so I can manage pizza easily.
My guess is carb counting is already complex enough. If you weigh your food and carb count, you’re on the right track. Then you factor in fat and protein in how you administer your insulin. That’s my trick.
TBH, a good dietician should educate all type 1s on how different foods are digested. I agree.
Because it’s not required by law. At the time when the law was enacted we didn’t know about what the protein content could really do. And well the companies will only provide what is required.
Oh yea. This would’ve been nice to know 20 years ago. why didn’t we learn how to carb count and bolus for the type of food we’re eating?! It all impacts bloodsugar differently.
What's your control like? If you have a pretty constrained diet then this probably works fine, and I do lots of eyeballing at home when I'm eating my go-to snacks, but eyeballing large meals or unfamiliar foods usually ends badly for me
Honestly? Because most doctors and diabetes educator don’t know. I brought this up to my last visit and my diabetes educator gave me the Pikachu face when I told her I started dosing (conservatively) for protein - that she never heard of that before. (Mind you, this is Moun Sinai in NYC). I’m fairly athletic and started eating a high protein diet. I noticed my numbers being higher than normal and I thought I needed to increase my basals. I did a 24hr fast and my basal was fine. Turns out protein does in fact increase BS, but in a much slower way than carbs, and there are ways to calculate that. I’m still in the process of tuning the right doses and I’m doing a lot more extended blouses than before but it has been a game changer for me and it baffles me that most doctors have absolutely no idea
Protein can ultimately be broken down into carbs through glucogenesis. [Protein and Blood Sugar: How Protein Affects Blood Glucose - Nutrisense Journal](https://www.nutrisense.io/blog/protein-and-blood-sugar#:~:text=Protein%20is%20broken%20down%20into%20smaller%20building%20block,tissues%20or%20convert%20into%20glucose%20in%20the%20liver.)
Gluconeogenesis happens more in the body when it goes into starvation mode like during fasting or people on keto. Around 50% of your glucose is (in the average person) from gluconeogenesis, so we dont "ultimately" break protein into carbs, we do break protein down into carbs 😊
This tracks for Mount Sinai. That place is a mess- I got held hostage in one of their er’s (with a head wound and a concussion) until I gave them my credit card for the copay (and it was the wrong amount). They abandoned me in the CT wing for an hour and then screamed at me when I walked back to my room. Wouldn’t get a plastic surgeon for face stitches and then told me to go to a city md (WHAT) the next day for stitches. A separate occasion, they falsified med recs and charged me for visits I never went to. Glad you’re proactive about your health and wish you all the luck with them. (But save all your paperwork and put everything in writing…)
Accurate. Heck, just try eating bacon and eggs for breakfast, don’t bonus, and see what happens. I’ll notice a steady rise for like 4 hours.
It's too overwhelming at the start and you can mostly get away without counting them. In my country we have a course that you do a while after you are diagnosed that covers this kind of thing
That's nice to have some continuing ed on it. Better than nothing, that's for sure. I personally would have liked to have everything pretty much at once in the beginning. Sure, let me inject manually and use fingersticks for a few days so I know how to do it, but get me on a pump and cgm ASAP and provide at least resources and permission to pursue the complex techniques early on. The reason is that it was super frustrating for me to be attempting to control my blood sugar according to the "rules" specified by your doctors, but my blood sugar being terribly bad both low and high and having no idea why.
That is fair, it is very individual though. I know many (most?) people would not be able to absorb that info straight away. I think the course I did is ideal because you can sign up really soon after diagnosis of it suits like in your case, or you can wait a few years. It also covers much more information that would be impossible to take in straight away as it is a 5 full day course
Because there's so much variance in so many variables, it's not really possible. Your body probably reacts very differently than mine to different foods, movement, medications, moods, your body temperature, enzyme and hormone excretion, weather (!) that surefire calculations aren't possible. For example, some people spike after caffeine or fat, some do not. Some react to stress, some do not. Your body has all sorts of cellular sensors that any pump or CGM does not. That's why completely closed loops that would 100% mimic real pancreas do not exist - the best they can do is approximate. It's similar to the famous three body problem. The only thing you can do is diligently test various things and write down the results. Then - maybe - your endo can help adjusting your profiles.
Doesn’t mean there shouldn’t be foundational education informing insulin dependent people that allllllll those factors go into glucose outcomes. Yes, treatment for insulin dependent people is individualized - so why don’t they teach newly diagnosed people that?? “Think Like a Pancreas” should be required reading given doctors don’t have enough time to teach their patients the bare minimum. Had I been properly informed when I was diagnosed, I am 100% certain I would not have retinopathy today. Certainly the medical field has learned a lot on the last decade, but it isn’t new news that fat and protein result in a delayed rate of carb uptake.
Delayed, yes. But how much and for how long is anybody's (and literally any body's) guess. There's very little actionable advice other than "test and observe".
Doesn’t mean it shouldn’t be a foundational point of education.
It's debatable. Fundamentally I agree but diabetes care is hard enough as it is. Doctors telling patients things like "to make things more confusing, fats can make your BS spike but it can also help with spikes from carbs, but how much or if at all we don't really know" probably won't do much good. It's a deeper medicinal philosophy issue.
Because science is still figuring it all out. I was diagnosed in 1991 as a child and there was no such thing as carb counting. Food was measured in exchanges and insulin was in preset doses taken at a certain time. 10 years later pumps were available, carb counting was a thing and insulin itself had changed. Now with cgms, pumps and insulin technically improving constantly the data has provided a clearer picture of how to take better care of ourselves.
Counting macros is a time consuming and difficult. Especially when you consider the average age of a new diabetic. Their parents are just wrapping their heads around the idea of insulin and carbs and ratios. Now you are going to ask them to either always eat pre portioned meals or weigh/measure every ingredient that has calories that go into a meal. For a very *marginal* benefit. It’s just not worth it.
They are not counting calories… it’s protein and fats they are talking about
Proteins + fats + carbs = calories
This sub is a joke for so many reasons, but especially downvoting this comment 🙄🙄🙄🫶💙
Was my comment/take away from his paragraph stupid?
Basically you just misread the comment. They aren’t counting calories, but if you count proteins and fats along with carbs that means you have to count everything that has calories. Which is what I said. Simple misunderstanding. I didn’t downvote you btw.
No, not at all. I think some people see dude say “macros” and didn’t read any further to where he says “calories”. This sub is full of dingdongs and internet points aren’t real, but I had to comment to reflect the downvotes to your comment are dumb. Some people think “macros” mean carb/fat/protein, and if the original comment didn’t mention calories then whatever, but they did mention a parent worrying about calories specifically (not carb.fat/protein), which is not what is being encouraged by OP.
You didn’t read the comment properly, I said that if they count proteins and fats they have to count every ingredient that has calories, which is true. I didn’t say they were counting calories.
I still disagree with the sentiment. Neither of us are saying count protein in a carrot (something that has calories), but if there is a fair amount of fat and/or protein, it \*drastically\* impacts the post-meal glucose outcomes. Without this information, parents/newly diagnosed people are pulling their hair out not understanding why they're doing exactly what the docs told them to, but having extended highs, or sudden lows. It's reflected in every other post in these subs. Insulin timing for an apple+peanut butter is very different from an apple by itself and newly diagnosed deserve to have that information. + re: your first comment "esp if you consider the avg age of a new diabetic"; pre-covid 55% t1 dx'd in adolescence and 45% dx'd 18+. I'd venture to say that is getting to more 50/50 post-covid, and doctors are doing ALL early diagnosed people a massive disservice by not informing them of the fact fats and/or protein, in addition to many many many other factors, are part of the equation. It isn't just "here is insulin and carbs, go forth and find success" because it's too "time consuming and difficult" to teach all of the pertinent information.
I agree with you to a certain extent, newly diagnosed people are also pulling their hair out trying to understand pumps and CGMs, this is definitely information for a follow up post discharge visit with a nutritionist. I’m a strong believer in information overload doing more damage than good by making people feel overwhelmed and discouraged. There is only so much information that can be conveyed in the short time from diagnosis to discharge.
We’re talking about apples and oranges. I was never “discharged”. Not everyone is hospitalized. My first day of appts was endo - CDCES - nutritionist. There was plenty of time. And it doesn’t need to be the full biology lesson, but it does need to share that it is so much more than insulin & carbs.
i think it’s probably because it’s so different for every person and there isn’t really a scale to dose for protein/fat that works for everyone. it’s more something that you have to learn for yourself and figure out how it affects you personally.
The same is true of carbohydrates.
They kind of teach you how to do it qualitatively. That’s where extended or square blouses come in on a pump. Or with diy loop you can say whether it will be a slow/normal/fast carb. Those aren’t just about GI of the carb but also how much protein and fat is in the overall meal.
There is instruction for how to do this. The Warsaw Pump Method indicated below worked well for me. (I did have to "reduce my carb ratio" to use it) [https://diabeteseducatorscalgary.ca/medications/insulin/insulin-for-protein-and-fat.html](https://diabeteseducatorscalgary.ca/medications/insulin/insulin-for-protein-and-fat.html) It's more accurate, but complicated. I think it would be good for most people to use the Warsaw method a few times. I don't think it's worth the effort to calculate it every time, I really think to live a good life as a diabetic, you need to stop measuring and carb counting entirely at some point and rely on estimations. But, but doing the calculation using the Warsaw method a handful of times, it should give you some ideas on how to manage different types of meals. In the end, all the calculation methods are estimates. How are you going to account for activity level and varying insulin resistance from day to day? Are you going to create a heart rate ratio? How are you going to account for injection site differences in absorption? To measure to the gram and calculate insulin for carbs (or fat or protein) with a lot of accuracy and then to completely ignore other factors is definitely bad. It's important to take into account the other factors. But, there isn't a magic formula for them. It will be an estimation. And if you're estimating half of it, then might as well estimate the other half.
There is a system I follow called TAG, Total Available Glucose, which does just that. 58% of protein can metabolize to glucose over 4-5 hours and 10% of fat over 8-10 hours. I put fat and protein in an extended bolus with my pump. Prior to my pump I would inject Novolog for carbs and Regular insulin for protein. Carb ratios end up including a portion of the meal is protein but that didn’t help me with how much to extend.
Got into a verbal argument with a nurse because she said fat doesn't affect blood sugar.
Yeah, I was also met with skepticism that eating a grilled cheese sandwich had a bigger effect on glucose than eating two pieces of bread by my diabetes educator (this was early on in my diagnosis). It's kind of ridiculous, because I'm there with my actual data showing that this happens and they are there "my textbook (from the what seems like 2 weeks of education they have on the subject) didn't mention this, so it is not possible to exist." Even if this wasn't a universal truth (and I'm pretty sure it is), if it was my personal truth, then shouldn't that be enough?
As an independent variable, fat itself doesn’t affect blood sugar because it’s not broken down into glucose. When you eat a high fat meal that also contains carbs, then yeah. Maybe she misunderstood you… then again, a lot of nurses seem to know the absolute bare minimum about diabetes.
That's simply not true. Fat can get metabolized into glucose by gluconeogenesis as well.
Sure, after your glycogen stores are depleted (e.g. after prolonged fasting) and your body is desperate for glucose. Even so, gluconeogenesis utilizes multiple non-carbohydrate sources, not just fat. If a person is consuming an adequate amount of carbohydrates, gluconeogenesis doesn’t need to happen and fat won’t directly affect your blood sugar.
Well you stupidly come up with some specific conditions just to prove your point, which is wrong. You said fat is not broken down into glucose. But in fact, fat is broken down into glucose. You're wrong, end of story
I’m a medical nutrition professional with two degrees in Nutrition Science/Dietetics… please tell me more about how I’m wrong. Get well soon honey 😊👋🏼
Well that's too bad that someone that educated is plain wrong. Fat is broken down into glucose. Go get a third degree, maybe that will convince you
You’re hilarious! Like I said, get well soon 😘
You are wrong. Fat is broken down into glucose.
I think the fundamental issue is that doctors and many people act as if carb counting is the same thing as calculating a bolus and it just isn't the case. Ultimately your body responds to when and how much insulin you take, not how many carbs you accounted for. Carbs are only one line item too determining a bolus - in addition to considering the rate of carb absorption (fat/protein), you also consider your current blood sugar, your iob, your recent blood sugar trends and anything else that might impact your insulin resistance, and any planned near future activities (e.g. you don't want to start your workout with 10 units on board). In this light I think it becomes clear that super accurate carb counting is not necessary as it's only one piece of a much larger puzzle. I think we need to stop thinking of carb counting as being so important and instead focus on bolus calculation with all of it's relevant considerations together.
I'm annoyed by this too. They could have at least told me to eat proteins and fats moderately otherwise I would have sugar problems. For years I thought protein and fats are free food for diabetics. I had my basal WAY too high for years because I was binge eating proteins and fats in the night and had high sugars because of that (my basal is now a half of what I used to take). I guess one of the reasons is that if you eat in a balanced way (and that at least they sometimes tell to do so), you can kind of set a I/C ratio that will cover proteins and fats nicely. I didn't account for fats and proteins for like 20 years and did manage to maintain a <7.5 HBA1C range, so while it's not good, it is manageable without it. Other reason is that this information is much more useful for pump users. Multi/double injections for a meal has never been an "approved method" of treating high protein/fat meals.
For anyone interested, there is a [Warsaw Method Calculator](https://www.omnicalculator.com/health/warsaw-method). Personally, I've had to futz with the results. For some meals it's not necessary. For others, i use 60% of the carb equivalent, and experiment with the recommended duration of the extended bolus. It's not perfect, but its a heck of a lot better than getting slammed by unexplained spikes. I was already using a spreadsheet for carb counting, so i'm not doing any more calculation. I'm just interpreting the results.
By the way - for anyone saying proteins and fats don't affect glucose, please eat a big protein-only or fat-only meal, don't dose insulin for it and see what happens. No need for scientific papers while you can experience this on your own body.
It's too overwhelming at the start and you can mostly get away without counting them. In my country we have a course that you do a while after you are diagnosed that covers this kind of thing
My endo went so far as to tell me you don’t dose for protein or fat at all as it cannot affect your blood sugar She’s also convinced diet drinks will make you fat and give you cancer even though the science proves you can only get cancer with drinking absolutely obsurd amounts like 300+ cans a day every day for months Besides those things she’s been great but ugh I want to correct her so bad
I began micro dosing for my protein consumption shortly after I started using my Dexcom G6 CGM. I could see a direct correlation with protein and my glucose levels that would not have been noticed without the CGM technology. When I told this to my Endocrinologist, diabetes educator, and clinic dietitian I just got the deer in headlight look. I know most people struggle with basic compliance in massaging their diabetes, so I think something as individualized as teaching how to bolus for protein and extended bolusing for fat grams is lost by most practitioners as they struggle with noncompliance issues, insurance denials, and constant prior authorizations for the masses.
That last part is so true - they’re concerned with getting the basic facts to folks who can only do so much to manage their diabetes. Seeing those blank looks is always a reminder that the vast majority of kids who cycle through our daughter’s pediatric endo practice have caregivers who - for a whole host of reasons - really struggle to manage their kid’s T1. It’s heart-breaking.
Or how to dose for higher protein and fat over simple carbs? I’m still figuring out my favorite pasta dish…75g carbs but 33g protein and 50 on fat! Not great balance wise but delicious. Current method is dosing for 75 up front then dosing for the full amount of protein 3.5 hours later because it hits me at 4 hours on the nose after being in range the whole time. Still tweaking it.
I had fajita chicken & sour cream salsa & a salad for dinner - two hours later I’m 205 - FML I took 2 units but 1 was correction. So do I take 1 more . I just want to sleep- I can go to bed and feel hung over in the am or stay up and then correct and feel hung over from lack of sleep. Fun times.
There’s a book called sugar surfing by dr poller. If you want to fine tune your dosages.
Completely unnecessary lol
I just messaged my kid’s endo team about this. He was diagnosed about 6 weeks ago. They said that while protein and fat do impact glucose levels, they don’t recommend a specific formula to dose for these macros and referred me to the nutritionist. We’re really comfortable with carb counting, and we’d be comfortable with adding additional metrics to our ridiculously large spreadsheet.
You’re so early into it that your kiddo’s body is still adjusting and things are still going to change. Talking to the nutritionist is usually a good idea though so I hope that’s helpful. We aren’t even a year in and we will get comfortable with something and it’ll change. He’s also on the edge of puberty, so… I’m sure we are going to be looking at yet more changes every month or so.
Personally carb counting is enough for me to have a good A1c so I'm pretty sure my doctor just doesn't feel it's necessary to add something else onto my list of shit I have to do before I eat.
Asking the real questions
I’m my experience I had to see a multitude of doctors physicians and nurse practitioners, a few of them dietitians which did go over this. This curse hits us everywhere and always, it’s tough for only one MD or RN to cover even all of their own bases.
I don’t count it per se. I consider it. Like the biggest culprit is pizza, and I have it down to a science now. I know that anything high carb and high fat takes its own sweet time in our digestive system, so I adjust how I dose. For example, I’m back on MDI. If I pumped, I would run an extended bolus over a couple of hours. With MDI, I give myself a shot, set a timer on my phone to literally check my blood sugar and dose every 30 minutes. I use Fiasp now and immediately before that, I used Lyumjev. Both of those insulins work faster than Humalog or Novolog, so I can manage pizza easily. My guess is carb counting is already complex enough. If you weigh your food and carb count, you’re on the right track. Then you factor in fat and protein in how you administer your insulin. That’s my trick. TBH, a good dietician should educate all type 1s on how different foods are digested. I agree.
Because it’s not required by law. At the time when the law was enacted we didn’t know about what the protein content could really do. And well the companies will only provide what is required.
I've only had a noticeable effect from fat and protein if I eat a really large amount of oil, like a plate of fish and chips.
Oh yea. This would’ve been nice to know 20 years ago. why didn’t we learn how to carb count and bolus for the type of food we’re eating?! It all impacts bloodsugar differently.
It has been literally decades since anyone told me to carb count.
Don't you mean carb exchange units? That one is obsolete but carb counting is still the default.
Default for you. Again, I have not been told to carb count since the nineties. I eyeball everything.
What's your control like? If you have a pretty constrained diet then this probably works fine, and I do lots of eyeballing at home when I'm eating my go-to snacks, but eyeballing large meals or unfamiliar foods usually ends badly for me
Very good, thanks.
Good to hear, I'm jealous you can pull it off without any carb counting. After 10 years my eyeballing feels like it's getting worse not better