Protein, Carbs, Whatever…

Sometimes you just don’t know what spikes your blood sugar. So you’ve been a “good diabetic” and gone low-carb and high protein all week long, and you’re STILL running over 180 too much of the time? Aaack!

As I was complaining about this lately, a number of commenters jumped in to point out that some of the protein we eat gets converted to glucose as well. Turns out this is correct, but with a number of caveats, that make it unlikely to be the cause of an SUS (sudden unexplained {blood glucose} surge).

Lowcarbpyramid

In particular:

* protein can convert to carbs in your system through a process called called gluconeogenesis. This takes place in your liver, and to a smaller extent, in your kidneys, I’ve read. But this process is generally kicked off only in extreme cases of glucose debt, such as during fasting, starvation, or intense, prolonged exercise (none of those would be me)

* according to blogger/diet expert Jimmy Moore, people on extreme low-carb diets do experience BG spikes for just this reason. “If protein is consumed in excess of energy needs, then some of that extra glucose that is created by the liver through the breakdown of protein can indeed lead to the same kind of spike in blood sugar as eating a slice of white bread or white sugar would,” he tells me.

* but it takes much more protein (in terms of grams) to raise your blood sugar than it does carbs. I really don’t eat THAT much protein, in terms of pure volume of food…

* and if you eat protein along with carbs (as I typically do), the GI impact of those carbs is reduced by the slower-absorbing protein. So why should I spike so much after just a few mostly-protein meals?

* sometimes the fat’s at fault. “For example, if you ate pizza the previous night. The fat causes a delayed rise in glucose that could last until the next day, yes,” my co-author Dr. Jackson tells me. That seems like an awfully long lag time!

OK, so I get it: “A high-fat diet, in the absence of carbohydrates, typically results in weight loss. Yet your blood glucose does not drop too low, because your liver continues to convert some of the dietary protein into glucose.” But since my diet is not consistently low-carb/high fat, and I’m bolusing painstakingly what feels like 14x/day, what is UP with the highs? I know I should be more consistent with my meals, but what’s a busy and active PWD to do out in the Real World?

Some sensible advice:

“Opt for a healthy ratio of 30% protein, 15% fat, and 55% complex carbohydrates.” Because too much protein may affect your kidneys. (Authorities claim there is simply not enough information about the long-term effects of a high-protein diet.)

Man, all this data is creating some diet anxiety over here. As usual, Dr. J had a nice way of bringing the whole discussion down to Earth: “Just think about it in a food sense, think about meals with a little bit of each type of food. You eat the calories, your body makes glucose, and that’s the energy you run on.”

“Yes,” I replied. “That sounds simple — if I just didn’t need to dose for every gram of carb!!”

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12 Responses

  1. Kathy
    Kathy March 20, 2008 at 9:31 am | | Reply

    Interesting. Out in the non-PWD world, they’ve named another eating disorder:

    http://redeye.chicagotribune.com/red-032008-orthorexia-main,0,5722253.story

    Sounds like the everyday life for any one of us, if you ask me :(

  2. Romeo Thibert
    Romeo Thibert March 20, 2008 at 1:08 pm | | Reply

    Sometimes it is the effect of the infusion site. For no apparent reason some sites absorb better than others with a result of unexplained highs. I have to be careful when this happens as I can later get a big low which is even worse.

  3. saramy
    saramy March 20, 2008 at 4:55 pm | | Reply

    In addition to the infustion site, it could be the insulin. The potency is not the same in every bottle. agh….another variable.

  4. Florian
    Florian March 20, 2008 at 7:45 pm | | Reply

    And how about the time it takes for the absorbed insulin to be distributed throughout your body so that every cell can take up the glucose in your blood?

  5. whimsy2
    whimsy2 March 20, 2008 at 8:12 pm | | Reply

    55% carbs? Puhleeze! That sounds like the old ADA advice. But contrary to popular opinion, we do NOT need carbs for energy. And 55% carbs means you need more insulin or more pills. And as Richard K. Bernstein, M.D. says, in his book “Diabetes Solutions,” “Small doses, small mistakes.” It simply doesn’t make sense to eat so many carbs then dose more insulin (or take more pills) to bring BGs caused by eating all those carbs. Much better to not eat so many in the first place.

  6. Chris
    Chris March 20, 2008 at 8:14 pm | | Reply

    Gluconeogenesis isn’t as exceptional as you make it out to be. Chances are after you’ve gone a few hours without significant carbohydrate, it’s already started, e.g. before waking up, or after one low-carb meal. I should know, since I’m a type 1 who eats low-carb, and most of the insulin I take is to cover protein. If I dose low, I can easily soar from 80 to 180, even up to 250, with certainly no more than 6-10 g carbohydrate, though this only happens once every two months or so.

    But don’t pay attention to what I say, you can find out for yourself. Wait AT LEAST 5 hours after your last meal, then have one big meal with almost no carbohydrate, maybe just a small salad and 50 g protein from meat. Don’t bolus at all, or just go by what your insulin-to-carbohydrate ratio tells you, which should mean almost nothing. See if you like what happens to your blood sugar. (Note that you may have to try a water fast in a similar situation to rule out basal issues.)

    As for those authorities that claim a high-protein diet may cause kidney problems, please look at the DCCT (Diabetes Complications and Control Trial), which showed high blood sugars definitely cause kidney problems. If a high-protein, low-carb diet is what it takes to control your blood sugar (and it certainly helps), then you’ll be doing your kidneys a world of good.

  7. AmyT
    AmyT March 20, 2008 at 9:33 pm | | Reply

    Hey Chris,
    Been there. Done that. My point was that even after the salad & meat meals I sometimes spike — why, oh why?

    Anyway, I love the diversity of responses I get here. Just the other day, a commenter was stating that “Low carb diets are not ideal for diabetics… Fruit? No problem… My A1cs have never been better on a vegan, high-carb diet.” (!)

    YMMV, obviously — as mine does.

  8. Kristin
    Kristin March 21, 2008 at 12:48 am | | Reply

    I also experience spikes from no carb meals, but four-six hours later! For me, this is too unpredictable!

    Also, without too much scientific knowledge on the topic, if a high-protein diet puts more stress on the kidneys (exactly one of the organs we are trying to protect), then controling your diet with a moderate amount of carbs seems reasonable to me.

    I am able to eat 40-60g of carb with no spike in my blood sugar if I give humalog 15-20 minutes before eating. So it will be hard to convince me to go NO carb.

    Perhaps this is just my internal way of justifying my actions based on my love of pasta, rice, and potatoes. But I guess, as always, different strokes for different folks!

  9. tas
    tas March 21, 2008 at 12:43 pm | | Reply

    From the RedEye article, do you think orthorexia is a health concern or hype?

    http://weblogs.redeyechicago.com/wordonthestreet/2008/03/word-of-the-day.html

  10. Chris
    Chris March 21, 2008 at 1:25 pm | | Reply

    Well, my point was that after that sort of meal, my blood sugar will soar every single time (wouldn’t call it a “spike,” since it takes several hours). It might help to say exactly what’s going on.

    Gluconeogenesis is governed by hormones, in fact, the same familiar ones that always affect blood sugar, insulin and glucagon. In addition to putting blood sugar into your cells, insulin also tells your liver not to turn protein into sugar.

    When you eat a high-carb meal, you’re forced to take a bunch of insulin, which prevents gluconeogenesis, so you only have to worry about carbohydrate. With less carbohydrate, you won’t have enough insulin to prevent gluconeogenesis, so your blood sugar will rise from both carbohydrate and protein.

    The effect is that your insulin-to-carb ratio doesn’t work anymore. What used to be a line when you graphed it now curves at the bottom. You could eat a zero-carb meal and your blood sugar would still go up, and you’d still have to take insulin: everyone, always.

    I can sympathize with wanting to eat carbohydrate most of the time, but “taking a meal off” once in a while by not eating so much, so you get a more reliable blood sugar reaction. But as I noted, the formulas change, and you’ll have to figure out how to handle something new.

    Dr. Bernstein’s low-carb diet handles this by eating the same amount of carbohydrate AND PROTEIN at corresponding meals every day. That makes it easy and reliable since you use a constant dose, not a formula. To be more flexible, you could probably make up a formula with some experiments. Up to you. :)

  11. whimsy2
    whimsy2 March 21, 2008 at 3:47 pm | | Reply

    I wish there was some mechanism so that I could respond to a post here if I wanted to.

    In this case, I just want to thank Chris, for his/her excellent post. I wish we could have an online discussion about it here.

  12. AmyT
    AmyT March 21, 2008 at 6:17 pm | | Reply

    Whimsy,
    Thank you so much for asking for that! That’s one of the big motivations for me working with Diabetic Connect, which will launch next month. See:

    http://www.diabetesmine.com/2008/03/jumping-in-with.html

    That site will offer an extension to the online discussions started here!

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