More High Fat Meal Questions

[Abby-Dabby-Doo]

I'm prepared to take the plunge in adding more insulin for high fat meals but I have a couple of questions...
I'm using my Tyson Breast Tenders (Chicken Nuggets) box as an example.
Are you using the Total Fat off the box nutrition facts?
This one is
Total Fat 12g
Saturated Fat 2.5g
Trans Fat 0g
Polyunsaturated Fat 4.5g
Monounsaturated Fat 4.5g

So you use 12g for the fat total? Why don't the numbers add up to 12g?

We've been experimenting with the dual wave and testing every hour after the meal do adjust the insulin dosage, so I assume these "tests" I'm doing is garbage if I start adding more insulin? Each time you test the object is to be keeping them in range each time you test.

What does protein have to do with it? I'm at a loss understanding this.

And what are you basing the LENGTH of your dual wave/square wave bolus on?


This is the info I copied from another thread.
High Fat Meals
There's an old Minimed formula we've used with success. However, we've since discovered it usually turns out to be about 30-40% more. Here's the formula:

Carb amount of meal, PLUS
fat grams in meal x 10%, PLUS
protein grams in meal x 60%

Example:

Costco pizza = 70 grams of carb
Fat content = 28 grams of fat
Protein content = 64 grams

28 grams of fat x .10 = 2.8
64 grams of protein x .6 = 38.4


70 + 2.8 + 38.4 = 111.2

So, for a piece of this pizza, we'd bolus for 111 instead of 70.

Of course, this is a combo/dual-wave bolus. We do 70/30 over 6 or 8 hours.

I know it sounds scary to bolus for that much more but it really works well for us. The first few times we checked her BG MANY times during the combo--I was so afraid she'd go low! But she never has.

7. Some Suggestions
· Several sources, among them, "The Insulin Pump Therapy Book: Insights from the Experts," MiniMed Technologies, 1995, p. 79, suggest multiplying the number of protein grams by 0.6 and bolusing for that number as if it were carbohydrate.

· If you want to account for fat in the same way, multiply the number of fat grams by 0.1 and treat them as carbohydrate as well.

From what I've seen personally and anecdotally, covering the protein and fat in your pre-meal bolus may cause you to go low 2 to 3 hours after eating. Many people have success by covering the protein and fat using an extended bolus several hours after the meal.

For example, suppose you eat an 8 ounce steak. That includes 7 grams of protein per ounce, or 56 grams. Multiply 56 by 0.6 to get about 34 grams. Fat is also about 7 grams per ounce, or 56 grams. Multiply that by 0.1 to get about 6 grams. Add those together for a total of 62 grams and cover them as carbohydrate using one of the strategies below.

· Some people use the square wave bolus, dual wave bolus, or a bolus combined with a temporary basal rate to cover excess protein or fat. The idea is to deliver enough insulin to cover most of the carbs immediately, then deliver enough to cover the high-protein/fat effect over the next several hours. The timing and duration of the extended bolus will depend greatly on how your body reacts to fat and protein. You'll need to experiment to find what works well for you.

· Some people simply calculate the total bolus and split it, taking half before the meal and half an hour or more later, depending on when they see the spike. Generally, if you're taking this route you should schedule the second bolus an hour or so before you expect the spike. The timing depends greatly on how quickly you react to insulin.

Remember, I am not a doctor, nor do I play one on TV. These are only methods that some people have found useful, not medically qualified advice. Before changing your treatment always consult with your physician and diabetes management team.

[Mary Lou]

Hi Lanae,

I haven't tried this yet, either, but have been mulling it over since reading the post.

We have, however, and do, bolus for protein in high-protein meals. Our endo explained it like this:

Your body turns everything into carbs eventually. Protein is converted into carbs at the rate of .6 (as described in the formula on your post). 1 ounce of meat has approximately 7 grams of protein, so a 6 ounce steak would have: 6 x 7 = 35 x .6 = 21 (equivalent carbs). We would then add the 21 into the carb value for the meal and bolus normally.

This works for steak and other red, fatty meats, but doesn't work for chicken or fish. At least it doesn't for us. I don't understand it fully, but if we forget and the kids chow down on ribs or steak, they will definitely spike later.

I dont' know if I've muddied the waters for you or helped you understand the protein bit.

I've been tempted to order a pizza and give the formula a whirl. Maybe when everyone is healthy :D

[frizzyrazzy]

its enough to make me never ever ever ever want to visit mcDonalds again. that's our one high fat downfall meal and luckily it's maybe once every 2 months. Just to also muddy the waters, we don't have any trouble with something like homemade mac and cheese which is SOOO full of fat. So its not all high fat foods, at least not for us.

[kel4han]

I have added the protein from the cheese in pizza for myself and Maddison with success. I have yet to do anything with fat, but what worked a few times was not counting fat grams but square or dual wave a longer duration just because of the fat content. We didnt seem to need more insulin in the end (like adding fat grams to the bolus) but it did prevent the early low and the later high just by extending the square amount. How did I determine the length of the square? I guessed silly! :p I know Maddison would be high at hour 4, but not much higher after that, so if our insulin lasts 3 hours I just waited the extra hour to bolus the remainder (or square waved it)

[cgates]

OMG my head is spinning with all of this.

Please let me know how it works out.
I'm really interested in this, as you know from my previous dual-wave posts. We've never really gotten the dual-wave to work so maybe we need to consider the fat/protein content.

Thanks for posting this!
--Charles

[momtojess]

We dont have issues with fat..

Our one and only problem food is oatmeal (even the low sugar kind). I cant figure out a good ext bolus for this...or even what causes this one thing to give us fits.

Good luck.. I will be interested in seeing what others do

[caspi]

We dont have issues with fat..

Our one and only problem food is oatmeal (even the low sugar kind). I cant figure out a good ext bolus for this...or even what causes this one thing to give us fits.

Good luck.. I will be interested in seeing what others do

We've never had any issues with fat, either. If anything it helps keep Cameron level. Go figure!!!! :rolleyes:

[Ali]

This may or may not help. I am an adult. For may years teen and until last five years added no insulin for protein or fats. For me I ate small amounts of fat and low protein meals ( less than 30 gs fat a day and typically less than six ounces of protein per meal. But-I now just add another .1 or .2 units of insulin for fat or protein if it is more than typical or a restaurant meal. For me it is processed so slowly that unless I raise by basal by a small bit for several hours ( which I do for Mexican food) it is hard to adjust my basal for it. I know the dual wave, etc. basically do this so if you can figure it out good luck! Ali

[BrendaK]

I would only start with the foods that you know are the hardest to manage. Instead of factoring in protein and fat for every bolus. For us, the biggest problem is pizza -- you probably read my post on the other thread. We didn't even do the correct math, we just added 35% to the bolus.

Since that is the only problem food for Carson (well, not the only problem food, but the main one), we just started there.

As the old saying goes, don't fix what isn't broken. (Is that the saying, or am I off?? It's late here :o)

[twodoor2]

its enough to make me never ever ever ever want to visit mcDonalds again. that's our one high fat downfall meal and luckily it's maybe once every 2 months. Just to also muddy the waters, we don't have any trouble with something like homemade mac and cheese which is SOOO full of fat. So its not all high fat foods, at least not for us.

McDonalds is probably full of trans fats, and those don't break down in the human body in a normal healthy way, maybe that's why the "frankennuggets" don't digest as easily. :D

[staciebco]

I just posted a question asking for this formula. Lanae was kind enough to post it for me. I've used it twice this week once for pizza and once for chocolate milk, made with whole milk. By using this formula, I bolused in a combo bolus 60/40 over 4 hours. I couldn't have been happier with the result. At 2 hours, Caleb's bg was 195 and at 3 hours 145. We rarely, if ever, see numbers like that after a high fat meal.

If your having problems with fat, I highly recommend this formula!

[Twinklet]

I'm prepared to take the plunge in adding more insulin for high fat meals but I have a couple of questions...
I'm using my Tyson Breast Tenders (Chicken Nuggets) box as an example.
Are you using the Total Fat off the box nutrition facts?
This one is
Total Fat 12g
Saturated Fat 2.5g
Trans Fat 0g
Polyunsaturated Fat 4.5g
Monounsaturated Fat 4.5g

So you use 12g for the fat total? Why don't the numbers add up to 12g?

We've been experimenting with the dual wave and testing every hour after the meal do adjust the insulin dosage, so I assume these "tests" I'm doing is garbage if I start adding more insulin? Each time you test the object is to be keeping them in range each time you test.

What does protein have to do with it? I'm at a loss understanding this.

And what are you basing the LENGTH of your dual wave/square wave bolus on?



It does add up to 12 grams. Well, 11.5, which rounds to 12. ;)

I'd only use the high-fat formula if this food typically causes highs later.

When we do pizza here, we combo/dual-wave it over 6-8 hours. If she hasn't eaten in awhile I do 6 hours, figuring it will digest more quickly that if she already has some food in there. If that makes sense!

Regarding your tests: If you're adding more insulin each hour, the test isn't working. You need to leave the high number for a few hours and see how it pans out in the end. If she's high after 2 hours, you need more insulin up-front and less as a square wave. You'll have to tweak it a bit to make it work for you.

[frizzyrazzy]

McDonalds is probably full of trans fats, and those don't break down in the human body in a normal healthy way, maybe that's why the "frankennuggets" don't digest as easily. :D

oh you're probably right. I'm just glad my kids don't particularly care one way or the other about them.

[LJS118]

i've tried dual wave boluses in the past and have had no luck with figuring it out so ryan's not too low or too high hours later. i'm interested in seeing how this works for you. i've given up, but maybe i'll try it again if it works for you