18 Responses

  1. Allison
    Allison February 21, 2014 at 5:48 am | | Reply

    I hope that counting protein as well as carbs is being taught to newly-diagnosed diabetics… I had to learn this stuff on my own and it IS tough! :)

  2. David
    David February 21, 2014 at 9:58 am | | Reply

    Tx, very helpful info. This comports with my vague experience that protein only matters if above a certain point and I will try the 20g rule. I am still debating whether protein in excess of 30g in any one meal provides any nutritional value but that is a different question.

  3. Alex
    Alex February 21, 2014 at 11:30 am | | Reply

    It is tough when you have to involuntary change your whole way of eating. I don’t have diabetes, but I did fall off and back on numerous different diets for health & weight control. It wasn’t an overnight thing, I had to do it bit by bit. I’d say it would be a shock to have to do it all at once.

  4. steve
    steve February 21, 2014 at 11:40 am | | Reply

    IMHO you are making this way too hard. I was a pumper for about 7 years, and finally tossed that pain in the a**. Lantus and Novolog work better for me without the hassle of reservoir and site changes, not to mention the significant cost advantages of multiple daily injections. I am an engineer, so I am driven to find a mathematical answer to my diabetes management. There are too many variants to represent this with an absolute equation using carbs and protein and converting grams consumed to insulin dosages. Daily activity, sleep levels, and even weather can affect your numbers. Check before and after meals, and adjust your dosages to maintain blood sugars. It is an exercise in futility to try and make diabetes management plug and play.
    FYI, my last A1-c was 5.8, and I have been a Type-1 diabetic (don’t call me a PWD! it sounds lame) for 32 years with no complications.

    1. Dan
      Dan February 21, 2014 at 9:10 pm | | Reply

      Way to go Steve. You are correct. Any of these people who think they can tell each person how to manage their diabetes using a formula is out of their minds. Now, there is some math that needs to be done, for example we are not going to shoot insulin without thinking about the numbers. However, carb and protein counting is far from exact.

      I too ditched the pump. Pumps are too unstable for me in insulin delivery.

      I also follow a low carb diet. However, the menus given above have too many carbs.

      Here is the problem for most type 1 diabetics: we are intolerant to carbs.

      So, we are better off eating fat as a primary source, and moderate amounts of cabs and protein. For example, I eat two eggs with onions and red peppers scrambled with a side of bacon and sausage. I use a tablespoon of olive oil to scramble the eggs. Now that is low carb.

  5. Nanci
    Nanci February 23, 2014 at 4:43 pm | | Reply

    Amy, thanks just doesn’t seem quite enough for your having shared this about protein, carb counting and extended bolus. I have never counted protein in excess of 20gr as carb and have never been directed so specifically on how to do the math. For a so called non-math person, you did a pretty fantastic job! I tried this for the first time today and my numbers so far have basically flatlined. This is unheard of for me! My cgm trend line has looked like the Himalayas for longer than I want to admit. Hard to believe I was never shown or encouraged to use the extended bolus function.

    Thanks again. I’m looking forward to trying extended bolus with other meals that aren’t as protein heavy. I believe this just may be what has been missing in my diabetes management all along.


  6. steve
    steve February 25, 2014 at 11:58 am | | Reply

    Hello Amy. I call People With Diabetes… Diabetics. what does everyone else think? I’ve never taken offense to being called a diabetic. I’ve never actually had anyone identify me as a PWD. It sounds contrived, and as if you may be trying to call attention to yourself. Have you heard of Histrionic Personality Disorder? My 14 year old daughter doesn’t like PWD either. She rolls her eyes and says, “Why would anyone call me THAT?!”. But, if you wanna be called a PWD, go for it. I’m a diabetic.

  7. John U
    John U February 28, 2014 at 5:09 am | | Reply

    Seems there should be an easy app for all these calculations. Perhaps someone out there can develop it?

  8. Ingrid Glass
    Ingrid Glass February 28, 2014 at 5:31 am | | Reply

    Hi Amy, thanks for sharing this. As a very math(s) person = PWM?!! = mathematician, I love doing all the number crunching associated with diabetes & pumping lol!!

    I’m also vegan & trying to be low carb, so the whole area of how to account for protein is really interesting to me. Currently, I typically bolus for the carbs and then double my basal for 4 hours, it mostly works spot on for me. And is not really based on the math(s) behind the protein.

    I’ll give this 20g rule a try & see what happens cos I’m intrigued, but the 2 hour extension and the amount of extra bolus probably won’t be enough for me. But you never know til you try. I am lazy too, I hate looking up carb/protein values & sometimes wing it. I do think you need a sound foundation to start from, and it is important to know these values for what you’re eating, but I agree with the other poster/s here that it is such an inexact science, this diabetes control lark, and has so many other factors influencing it, that in the end you try, you see what works best for you, and you test, test, test!

    Thx for the post and follow up comments, all useful tools.

  9. Dmom
    Dmom February 28, 2014 at 7:35 pm | | Reply

    You state that counting protein should be like counting fats. does this mean to bolus for anything over 20 gms of fat as well, or is there a ” magic number” for fats?

  10. Joanne Milo
    Joanne Milo February 28, 2014 at 10:27 pm | | Reply

    MOST excellent, Amy. I’ve been thinking that I really have lost touch with tweaking my pump and carb counting. I’ll be doing a trial on the Asante Snap pump … entering all my settings which haven’t been revised in many years. Hmmmm. Do you live near Integrated Diabetes Services or did you do this all by email and phone?

    I’m passing this along on my blog as well as the support group I run in Orange County … I’ll pass along any feedback.

    MANY THANKS … joanne

  11. Scott K. Johnson
    Scott K. Johnson March 8, 2014 at 9:17 pm | | Reply

    Thanks for the mention, Amy, much appreciated.

  12. corinn
    corinn March 13, 2014 at 11:41 am | | Reply

    Ha, so there’s a method to my madness! I found out by trial and error that I should bolus an extra 2u to cover the animal protein in my typical meal (like a chicken breast)- and this usually works. Had no idea how many grams of protein are in, say, 8oz of chicken. I just looked it up on wiki.answers. 8oz chicken is about 56 g protein. So if the math holds true, I’ve been doing it right! (for me, 1u = 15 g carbs). However, I haven’t been tracking all the protein (like beans, dairy, etc). and I eye-ball the animal protein I feel like eating….

  13. TaviaV
    TaviaV March 19, 2014 at 4:26 am | | Reply

    I look forward to seeing an update from you, Amy, in awhile. After you get to try it out over time I’d love to know if the extra calculations and smoothed out Dexcom lines post meals trump the daily grind of life and “close enough” mindset many of us have. Since life is full of idiosyncrasies, it’s always an individual balance of how much time and energy should I (we) invest and how much benefit do I receive. Is it worth it? Probably varies from one person to another. (LOL on the varied opinions on what to call ourselves. YMMV as they say!)

  14. Robin
    Robin May 1, 2014 at 9:33 pm | | Reply

    Thanks, Amy. I read this again as I’m trying to figure out the cause of delayed BG rise after dinner – I think the protein may be the culprit. I just started working with Gary’s team again as well after a few dreadful BG weeks and a generally lackluster year failing to get my A1C where it should be. Less than 3 years in and I’m already really tired of the whole business, but that attitude will not get me where I need to be!

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