Bolusing for Fat/Protein

[Cyborg]

Since the pump manufacturers have decided to not take into consideration fat and protein content when determining bolus amounts (for those pumps that have food databases). What percentages do most of you use to bolus for fat and protein? How do you determine how much to bolus? Is there a certain limit under which you do not take into consideration fat/protein at all?

I understand the concept of extended boluses, but when does the fat and/or protein content justify an extended bolus? And what determines the duration of the extended bolus? Is it the amount of food, the glycemic index of the food, the amount of fat and/or protein, or a combination of all of the above? Or is it one of those personal, customizable, trial-by-error things that we each need to figure out for ourselves?

[Cinnabon]

They do recommend that you don't eat more than the protein you are eating be no more that the size of the palm of your hand. I like this, and I do eat a bit more. Chicken and pork do not affect me the same as red meat and fish, but this is just me.
It is a bit of trial and error, but what I usually do is calculate, a lil less, but as if they were carbs. Some prefer to do a Dual/square wave bolus. I don't know if your pump has this option.

[RobB]

I've been told time and time again not to count protein when bolusing. This doesn't work for me and it's good to hear the same from others. If I don't bolus for the meat, my BG goes way up. I haven't tried the square wave or dual-wave yet because I don't seem to get the after dinner lows. BTW, I also bolus for Scotch! Yes, I like a drink now and then. But all booze has calories and I bolus for straight whiskey as well as wine and of course, beer which I seldom drink.

[Mich]

I've been paying close attention to various sources for carb counts and one is "The Calorie King" 2006 Edition, which was recommended by my CDE. I was surprised to find carbs listed for my favorite red wines.

Another explanation for carb counts (Dr. Bernstein the no-carbs guy, who I've found to be a good bottom-line explainer) says carbs in wine are negligible. He also gives a lengthy explanation of how alcohol can lower your blood glucose for some time if consumed with food. He also spends some time pointing out "hidden" sources of unexplained highs--like malto dextrin added to sweetners to make them easy to dissolve in your iced tea.

Gary Scheiner, who wrote THINK LIKE A PANCREAS (an accurate summation of living with diabetes told with good humor) warns to count the carbs in whichever alcohol you are drinking and beware of the delayed drop in blood sugar later.

Since the various opinions seem to differ slightly, I will weigh them all, then add a liberal amount of true life experiences as found in this group's postings.

My own personal experience does seem to bear out some carb content for vino, with sweet whites being the highest (duh!) and beer being the highest of all. I'm still trying to balance gastroparesis, fatty foods, stress times and alcohol to make it all come out right. At least life is never boring with diabetes!

Mich

[Cyborg]

I've done a lot of low carbing and from personal experience I've also learned that I need to bolus for protein and fat. I use 2 methods to come up with the equivalent number of carbs, based on 1) weight of steak, or 2) amount of protein. For steak, I've found I can weigh an uncooked steak and take 10% of the weight as the equivalent grams of carbs. Alternately, for steak or other proteins I can also take 25% of the protein content in grams as the equivalent grams of carbs.

To bolus for these "equilvalent carbs" I do a 30/70 combo bolus over a 3 hour duration, which gives 30% of the insulin up front and the other 70% is given throughout the 3 hour duration period (like a temporary basal). Since the protein takes longer to digest this seems to work out very well for me with meals that have high protein content. So far, meals containing chicken wings, steak and shrimp have worked out well. I'm not sure if all protein sources take the same time to digest as steak so perhaps different ratios or durations might be better for different protein sources and for different people.

Most meals have a combination of protein and carbs. Lately I've been experimenting with doing regular boluses for the carb part of the meal and the combo boluses for the "equivalent carb" portion of the meal. Had a low just now from doing that for a 6 inch subway so I think the type of protein is important. Trial and error, trial and error... :vollkomme