Bolusing for Burgers

A sneak-peak at the data my endo downloads from my pump.
I’ll show more later in the week.

One of the observations that Dr. Right made when reviewing my data last week was that I would often have stubborn-highs in the time between dinner and bed.  Not spikes, but plateaus; the kind that hover in the 220 mg/dl range and don’t seem to budge.  No matter what.

I had suggested that my basals might need tweaking.  When I set my original basal rates years ago, my lifestyle was thus: sit motionless on the train and at work all day, run around like crazy with my son at home.  That pattern was my regular weekday routine for years.  Over time, “train” changed to “car” and “son” changed to “sons”, but the routine was the same.

Lately, my job has become much more rigorous.  Instead of working at a desk, I’m in the field, on my feet and active all day (sporting a temporary basal and fighting lows).  By the time I get home, I’m physically drained so I do nothing – especially when three hours of playoff hockey is on the tube. The answer should be that the lower evening basal, optimized to the high-exercise evenings, is no longer right.  Right?

Wrong.

My correction boluses have been a couple of units – and they’ve also seemingly been useless. So if I doubled, or even tripled, my evening basals, it still wouldn’t be enough.  (It might help, but this is where the don’t-try-to-fix-too-many-things-at-once rule comes into play).  Instead, I was told the following.  First, increase my sensitivity aka correction factor.

Second is something I had never in my 31 years of diabetes done: bolus for protein.

I suppose that, in my attempts to do better, I’ve been trying to curtail the high-carb, spike before bedtime dinners.  As a result, I’ve had more protein, and that’s kept by BG’s stubbornly high all through the night.  Protein metabolizes slower than carbs, but some of it does ultimately turn into glucose.  He told me that I need to bolus for the protein.

After taking the regular carb bolus, I should bolus the equivalent of 10 carbs for every three ounces of protein – and extend (square-wave) it over three hours.  That seemed logical, but a bit excessive.  Does this mean that every meal will have the net effect of being increased by about 10 carbs?  Eventually, we agreed to try 10 carbs for every 3 ounces AFTER the first 3, over 3 hours.  Sounds like some complex 401(k) match formula of days past (my current job’s 401(k) match formula, by the way, is easy to understand: it’s zero.).

Since I’m not yet able to bust-out the smart-scale that Leah “Lovehatediabetes” mentioned on Saturday, I’ll be using the rule of thumb that three ounces is about the size of the palm of your hand – another reason life would be easier if I had more than two hands!  But for this meat-eating carnivore (redundancy intentional, for emphasis), the plan seems to make sense.  Still, it’s too soon to tell if it will work.

Extended bolusing for protein: such an odd, but sensible concept.  Something you just can’t do without a pump.  Have you ever heard of such a thing?

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Posted on May 8, 2012, in Diabetes, Insulin pump, Type 1 and tagged , . Bookmark the permalink. 4 Comments.

  1. Welcome to the world of TAG (total available glucose)! There is actually a TAGgers group on TuD that Danny started. There are some good examples there. Actually the 10 grams of carbs for the first 3 ounces of protein would fall on the low end. I just looked at the spreadsheet I had using 40% for protein & 10% for fat and that worked out to about 15 grams of carbs. The official TAG book recommended 57% for protein & 10% for fat but it is kind of like carbs and figuring out what works for you.

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  2. I’ll have to look more into that, Kelly, thanks! Your 40% and 10% that you mention — are those percent carbs of the total meal? Seems high to me, but this is a whole new look at things. I’ll definitely take a look at some of the references you gave me…

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    • Scott, when I pulled up my sample to answer this, I just noticed I had some other stuff on my spreadsheet with protein other than the just the hamburger. The total protein for my calculation was 27.5 and the hamburger was only 16.5 grams of protein. It looks like your endo used the default 57% protein & 10% fat – that is like they start people out at 15 grams of carbs per unit of insulin & you figure out where you fall.

      If you wanted to use the 40% and the 3 ounces of hamburger had 16.5 grams of protein, take 16.5 x 40% = 6.6. I buy the 90% lean hamburger so mine only had 5.1 grams of fat. You would take the 5.1 x 10% = 0.51. Add 6.6 + 0.51 = 7.1. You would bolus for 7.1 grams of carbs over 3-4 hours.

      You would bolus for your carbs like you normally do. Some people program it all into one bolus but I always thought it was easier to do carbs first then the TAG part that gets extended.

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  3. I don’t add extra to a bolus for something like a burger (but I do combo bolus it because of the fat), but a steak – whew! That’s an extended bolus for SEVERAL hours just to keep things in range!

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