27 karma · joined October 4, 2020
Here’s a link to an insulin calculator for fat and protein: https://drlogy.com/calculator/warsaw-method
Sources: “The effect of fat and protein was additive, with blood glucose concentrations increasing by 5.4 mmol/L (97.2 mg/dl) at 5 h, the sum of the individual incremental increases for protein and fat” https://diabetesjournals.org/care/article/38/6/1008/37384/Im...
“Meal composition impacts postprandial glucose excursions. Education on the impact of high-fat and high-protein meals and the adjustment of insulin dosing is necessary.” Source: ADA Standards of Care in Diabetes—2024 https://diabetesjournals.org/care/article/47/Supplement_1/S2...
“Match mealtime insulin doses to carbohydrate intake and, additionally, to fat and protein intake.” Source: ADA Standards of Care in Diabetes—2024 https://diabetesjournals.org/care/article/47/Supplement_1/S1...
“Insulin dosing based on carbohydrate plus fat/protein counting reduces the postprandial glucose levels” Source: Pediatric Diabetes Volume 13, Issue 7 p. 540-544 https://pubmed.ncbi.nlm.nih.gov/22765260/
“research and the use of continuous glucose monitoring have shown that other nutritional properties of food, including fat, protein, and glycemic index significantly affect postprandial glucose excursions” https://diabetesjournals.org/care/article/38/6/1008/37384/Im...
1) You can do an extended pre-bolus before you eat. This gives you a chance the cancel the remaining insulin dose if you learn your meal will change for any reason n-minutes before or during your meal. Maybe the meal unexpectedly tastes bad, you can cancel the remaining insulin. Maybe the restaurant tells you they are out of the dish you order n-minutes ago. This is called different names in various insulin pumps; Extended bolus, temp basal, etc.
2) Pre-bolus and eat AFTER you see your blood glucose decrease for 3-4 readings. Pre-bolusing for static time like 15 minutes before eating does not work consistently because there are lots of variables at play before you eat that directly affect (a) insulin sensitivity and (b) blood glucose. (Environmental temperature, insulin temperature, injection site, adrenaline, stress, pain, previous meals, lipid levels, exercise, medications, illness, to name a few).
Eating after I see my BG decrease for at least three consecutive readings has helped me stay in range (70-140) for 95-100% of the time and maintain a healthy A1C (less than 5).
Cheers!
Resources that helped me achieve excellent control of my type 1 diabetes. My TIR is 95-100% and lowered my A1C from 11.9 to 4.1 (not low carb, I’m high carb in fact):
Fat and protein in meals require insulin 1-2 hours after eating via extend bolus (aka temp basal). Learn how to post-bolus (give yourself insulin AFTER meals) “Fat-Protein Units” (FPU).
Fat x .09 x 8 ÷ I:C = units of insulin Protein x .04 x 8 ÷ I:C = units of insulin
Sum both. Then dose insulin as a temp basal (extended bolus) over n-hours per the Warsaw Method time schedule linked below.
And continue to pre-bolus for carbs like usual 15-30 minutes before you eat (data driven approach is pre-bolus and eat meal AFTER blood glucose values on CGM trend down for 3-4 consecutive readings)
https://waltzingthedragon.ca/diabetes/nutrition-excercise/re...
https://drlogy.com/calculator/warsaw-method
Starting point to determine your insulin-to-carbohydrate ratio: 300 ÷ Total Daily Insulin Dose = 1 unit insulin covers n-grams of carbohydrate
https://diabetesjournals.org/diabetes/article/68/Supplement_...
Two books: https://www.amazon.com/Think-Like-Pancreas-Practical-Insulin...
https://www.amazon.com/gp/aw/d/0593542045/ref=tmm_pap_swatch...
One podcast: https://www.juiceboxpodcast.com/diabetesprotip
Get blood test for all five Type 1 Diabetes Autoantibodies: (this can be done for free) GADA IA-2A IAA ZnT8A ICA
Get blood test for pancreatic C-peptide.
Get blood test for A1C.
Check out tzield if you test positive.
I can share sources if you’re interested. I’m. T1D.