Insulin Pumps and Low Carb

[v-effect]

This is in response to a thread begun on the "Discouraged" thread, where someone brought up pumping and lc-ing. I have been pumping for 5 years and lc-ing for 12 (since I was diagnosed). Here's what I find. Protein. Does. Translate. and I have to bolus for it over long periods of time. This makes the pump key- I use the square wave constantly. But figuring out how much insulin to give and over what time period is challenging. I can only report that at present, I give 1 unit for every 20 grams of protein. I may stretch that out over an hour (nuts, for example) or over 4-5 (a large bison burger with cheese and bacon). There is always the danger of overestimating (esp when you are out and without a scale) but usually I underestimate and have to correct.
Without knowing this about protein, I found that I thought my *basals* were wrong- why was I always spiking at night? But fasting proved that protein will eventually produce a bg excursion- it is food, not too little basal that is the source of the spike.
There is a method for figuing all this out, called TAG, or total available glucose. It goes like this:
1) Start with the Carb Count, subtract the Fiber to get Effective Carbs from
Carbohydrates
2) Multiply Proteins by .58 to get Effective Carbs from Proteins
3) Multiply Fats by .10 go get Effective Cabs from Fats.
Add 1) 2) and 3) together to get Total Effective Carbs
You then use your standard carb to insulin ratio to bolus for the TAG. Has anyone tried this?

I *wish* there was a program that could calculate it.

V.

[dancinbr]

You are saying that .58 of proteing results in effective carbs !!

Wow.

I would have to see more on this to fully understand this.

Protein has always been 0 grams carbs, but you are saying sooner or later it does translate into BG and that makes sense, but it must do so very gradually.

Is there a reference where I could learn more about this.

For people with pumps I would guess that you can adjust easily, once you know, for this.

What you are saying is if I have a lot of protein I should include it in my carb calculation for my Novolog R injection before meals.

OK, I will look into this.

But again, some reference would be interesting.

I will even go back and relook the subject in Dr. B's book.

I may have gone right over this.

Thanks,

Ralph

[RobLL]

I thought that 50% of excess protein converted to glucose. It is new information that 10% of fat converts. Heck! They all are hydrocarbons, protein with a little nitrogen added.

[eddiemcm]

Protein and fat contribute to carbs?
I had a cheese omlet and 3 strips of bacon for breakfast this
morning.A 7 point glucose spike after first hour.Down to 2 after
second hour.I will check at hours 3 and 4.Maybe the glucose
conversion takes significant time.
Eddie

[Korban]

I have heard too that a gram of protein converts albeit slowly to either 0.56 or 0.58 grams glucose... sometimes slowly enough that basal may take care of some or even most of it depending on the individual.

Fats - triglycerides - convert to fatty acids and gylcerol (glycerin). The glycerol component (a multi-alcohol) can then be metabolized to glucose. It represents only a relatively small proportion of the total grams of triglyceride (fat). The glycerin component + fatty acid is dynamic though (in the body) and it will "re-combine" to form triglyceride --> then hydrolyze to form fatty acid, etc. I don't have references at the moment but will get them for you unless someone else does... gotta go for now...

I can't verify the 10% number but have no reason to doubt V, but I do believe that it does contribute to the overall glucose at a low level (again basal may cover depending on the individual)... to measure is to know. etc...
/smile

[Korban]

One reference only follows re: protein to glucose (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20) - comments are interesting though -

"It has been known for many years that 50–80 g glucose can be derived from 100 g ingested protein (2 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R2)). The amount of potential glucose produced depends on the amino acid composition. For beef skeletal muscle protein, this has been calculated to be 56 g glucose/100 g protein (2 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R2)). [Emphasis added by me] However, it also has been demonstrated that ingestion of proteins results in little or no increase in circulating glucose concentration in nondiabetic people or in people with type 2 diabetes mellitus (3 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R3), 4 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R4), 5 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R5), 6 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R6), 7 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R7), 8 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R8), 9 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R9), 10 (http://jcem.endojournals.org/cgi/content/full/86/3/1040%20#R10)). [Emphasis added by me] The reason for this remains unclear."

I personally know of a long time Type 2 that will bolus at a rate of 2 g protein = 1 g glucose or a 50% conversion rate... YMMV

/smile

[dancinbr]

Good information.

Protein has little or no effect for me on BG in circulation.

It has to be a very slow process as it is digested.

If you are very sensitive, then it now makes sense to me how a person on a pump that has basal going in on a continuous, albeit slow rate, must include it in their calculation to determine their proper flow; especially if you are T1.

Ralph

[janeff]

Thank you all for the input about protein and fat conversions! Really thank you a LOT,helps to dimish the "lonelies"
I have just managed to stabilize the fasting blood sugar and am (as of today) working on the morning basal rate. I haven't yet done a detailed view of protein conversion rates,but reviewing my notes from the very beginning (about a month ago) when I was testing every two hours I didn't see much of an effect by the protein. I'm going to aim first for the basal rates and then start studying the protein and fat effects.
Do any of you tune into the Teleseminars that Dr. Bernstein organizes? I listened in via computer and found it interesting and encouraging..although there was nothing about insulin pumps and their use. His overall message about pumps is negative...not necessary.
Thanks again.

[dancinbr]

Thank you all for the input about protein and fat conversions! Really thank you a LOT,helps to dimish the "lonelies"
I have just managed to stabilize the fasting blood sugar and am (as of today) working on the morning basal rate. I haven't yet done a detailed view of protein conversion rates,but reviewing my notes from the very beginning (about a month ago) when I was testing every two hours I didn't see much of an effect by the protein. I'm going to aim first for the basal rates and then start studying the protein and fat effects.
Do any of you tune into the Teleseminars that Dr. Bernstein organizes? I listened in via computer and found it interesting and encouraging..although there was nothing about insulin pumps and their use. His overall message about pumps is negative...not necessary.
Thanks again.

Hello,

Have you a copy of Dr. B's Diabetes solution?

When you read about insulin there is so much information.

The issues he has with the pumps is so many things can go wrong that can create problems.

He prefers multiple needle sticks during the day, which is what I am doing.

I have a friend using an insulin pump. For whatever reason, it was the only way she was able to gain good control of her BG.

Ralph

[v-effect]

I have to say: Dr. B is wrong about pumps. He is unfamiliar with the latest generation of pumps and cgms technology.
Just my two cents. They really work for low carb- for example, I lower my basal rate and no having to eat glucose before exercise! Just one example- I'm not sure why he is so old fashioned about this.

V.

[Lottadata]

I have to say: Dr. B is wrong about pumps. He is unfamiliar with the latest generation of pumps and cgms technology.
Just my two cents. They really work for low carb- for example, I lower my basal rate and no having to eat glucose before exercise! Just one example- I'm not sure why he is so old fashioned about this.

V.

Remember that Dr. B only sees patients who are desperate and in bad shape. His services are not covered by insurance. He explains insurers will not pay for diabetes eduction from an M.D. and he puts in a lot of time with patients. But because it is so expensive to see him, he sees the people who can't get control and are desperate.

He says he sees a lot of Type 1s who were on pumps and ended up with big scarring problems that keep the insulin from absorbing, and that is why he doesn't like pumps. So those people exist, and they do have real problems.

But I think the self-selected nature of his patients means he doesn't see the people who are doing really well with less extreme diets than he describes and with newer insulin regimens. Or those who pump and are not having problems.

He is REALLY wrong about the different analog insulins which he says are all the same. But he also says he hasn't used them, so he is just assuming that. Big mistake. I can inject Apidra at meal time and cover carbs adequately. Not with Humalog, though, and Humalog is what he uses exclusively.

But we have to have huge respect for the guy. He was the ONLY voice calling for normal blood sugars for a decade before DCCT. And he was the only one telling people that they could lower blood sugars by lowering carbs. When I started low carbing in 1998 he was still being treated as if he were a dangerous madman by a lot of doctors and people with diabetes.

All those years of fighting stupidity have to have made him harden up around his attitudes, and sometimes I think that he doesn't realize that things are changing and a lot of us are on his side now.

[dancinbr]

I agree with Jenny.

Yes, perhaps you are doing well with your pump and it sounds as if you are.

Yes, Dr. B sees some very serious issues with patients who have not been able to control their BG successfully for a myriad of reasons.

As many folks say YMMV.

My friend has had little to no issue with her pump. You must be disciplined.

I thank you for the thought about lowering basal when you exercise.

I am realitively new to using basal and fast acting insulin. I am doing well now with my average sinking below 100 and heading toward my target of 83.

I know I am fine with readings as low as 70 and know that if it is heading down to 60 I need to do someting. I have had readings below 60, as low as 45 and these occurred after exercise, long exercise. I learned that I need to consume either glucose tabs or a treat that equates to a glucose tab in its ability to keep my BG up above 70. The idea of lowering basal on a day I know I am going to walk 9 holes of golf, for example, is something I am definitely going to try and see what results I get.

Thanks,

Ralph

[janeff]

This is in response to a thread begun on the "Discouraged" thread, where someone brought up pumping and lc-ing. I have been pumping for 5 years and lc-ing for 12 (since I was diagnosed). Here's what I find. Protein. Does. Translate. and I have to bolus for it over long periods of time. This makes the pump key- I use the square wave constantly. But figuring out how much insulin to give and over what time period is challenging. I can only report that at present, I give 1 unit for every 20 grams of protein. I may stretch that out over an hour (nuts, for example) or over 4-5 (a large bison burger with cheese and bacon). There is always the danger of overestimating (esp when you are out and without a scale) but usually I underestimate and have to correct.
Without knowing this about protein, I found that I thought my *basals* were wrong- why was I always spiking at night? But fasting proved that protein will eventually produce a bg excursion- it is food, not too little basal that is the source of the spike.
There is a method for figuing all this out, called TAG, or total available glucose. It goes like this:
1) Start with the Carb Count, subtract the Fiber to get Effective Carbs from
Carbohydrates
2) Multiply Proteins by .58 to get Effective Carbs from Proteins
3) Multiply Fats by .10 go get Effective Cabs from Fats.
Add 1) 2) and 3) together to get Total Effective Carbs
You then use your standard carb to insulin ratio to bolus for the TAG. Has anyone tried this?

I *wish* there was a program that could calculate it.

V.
Hello V.
Thanks for your response about protein conversion to glucose...I will watch that as I proceed. I am curious to know how many grams of carb people are consuming and still considering themselbes to be following Dr. B.'s protocol? Is 50gm over the top or is it more a question of not over-eating and also restricting the fast carbs? (I ate a few small pieces of potato the other day and whew what a reminder...up fast and long went the bg levels).
I am in Canada and would dearly love to hear from a fellow Canadian...especially because I am running into terrible resistance to even the idea of a lo carb diet,let alone help in making adjustments with the pump and just talking about it. I had one dietition stand up and stamp her feet and wave her hands about in warning that if I didn't consume at LEAST 130gm/dya I was risking severe malfunction.!!! That was after about a year of Dr. Bernstein levels....sigh. Anyone from Ontario on this board?
All the best. It is a pleasure to be able to chat.Thanks
Thanks one and all.
Jane :wave:

[eddiemcm]

Nothing magic about Bernstein's 6-12-12.
Choose what works best for you.
I average about 50G per day and do fine.
Eddie

[Cajunboy47]

I agree with Eddie that we should adjust diet, supplements and/or medications to what makes us comfortable.

I average between 100-150g of carbs, use herbs and other supplements, no medications, but could not have dreamed of doing this a year ago.

Four days ago, I lowered my supplements and herbs that control my diabetes and noticed slightly higher glucose numbers, but I haven't had to adjust my carbs yet, just monitoring closely and my choice is increase herbs or reduce carbs if I'm not comfortable with my BG numbers in the next week or so, but either way, I'm not going to stress over it.

Diabetes is controllable one way or another, and I take comfort in knowing that.............

[lowcarbUgh]

Hello V.
Thanks for your response about protein conversion to glucose...I will watch that as I proceed. I am curious to know how many grams of carb people are consuming and still considering themselbes to be following Dr. B.'s protocol? Is 50gm over the top or is it more a question of not over-eating and also restricting the fast carbs? (I ate a few small pieces of potato the other day and whew what a reminder...up fast and long went the bg levels).

I find the potato the gift that keeps on giving :lol:

I'm eating about 40 g of CHO right now. I know some other type Is on Berstein's plan eating about 60 g CHO to avoid losing too much weight.

I had one dietition stand up and stamp her feet and wave her hands about in warning that if I didn't consume at LEAST 130gm/dya I was risking severe malfunction.!!!

As a type 1 of 30 years, all I can say is run like hell from dieticians and never look back. They want you to drink grape juice. :o

Cheers,

Susan

[janeff]

Thanks. I feel most comfortable around 46-50 gm a day,but am starting to miss some of those starchier goods....carrots and butternut squash. It has been cold here and I want heavier, creamier foods.
One time I spoke to Dr. Bermstein and he was adamant that 60 gm a day was not low carb,but didn't have the time to explain...the book doesn't explain this. If I am eating only slow carbs and not pasta etc., how much difference can this make? (type 1 on an insulin pump).
Still curious if anyone knows any medical types in Ontario who are supportive of Low carb use with this disease? I'm in Eastern Ontarion and would be happy to hear.

[janeff]

What does progress signify in the upper right corner> Progress towards what? Forgive me, I am new to this and am pleased to be able to register for the forum and then get back to it.
jff

[janeff]

Thanks Susan,heard from my mother-in-law yesterday who was told by a dietitian to exclude ALL fat,buy frozen vegetables and use lots of margarine. Where have they been? Oh yes, and don't worry about carbs,she was told!
I agree with you...I would really like to find an educator who would support this and help with pump use as the insulin needs drop. If back to injections,so be it,but my bet is,I can do low carb and insulin pump AT THE SAME TIME!

[CarolynC]

What does progress signify in the upper right corner> Progress towards what? Forgive me, I am new to this and am pleased to be able to register for the forum and then get back to it.
jff
Welcome! Progress refers to weight loss. You are starting at 116 pounds and your goal is 110 pounds. You're currently at 113 pounds, therefore you're 50 % of the way to your goal.

[v-effect]

Hi there Jane,

It is nice to have another T1 pumper on this board! Welcome. I do not eat 6-12-12; but I do stay around 60 carbs a day. Again, his method is not designed for pumpers who count carbs and adjust insulin accordingly. I also do quite a bit of serious cardio; I find I just don't have the energy to do a long run if I don't carb load a bit.
Again- I feel that *protein* is the most difficult to account for, not carbs. I am noticing with my CGMS that it *does* slowly convert to glucose over a long period. But I find it difficult to "eyeball" the protein in order to use the formula I previously mentioned.
Note, too, that I just went back on symlin- so I am *really * appreciating the extended bolus on the pump.

V

[Lottadata]

Thanks. I feel most comfortable around 46-50 gm a day,but am starting to miss some of those starchier goods....carrots and butternut squash. It has been cold here and I want heavier, creamier foods..

Jane,

60 g is most definitely low carb for me. I'm eating it and getting blood sugars Dr. B would approve of completely--80s mostly and I've dropped my insulin down to 2 - 5 units a day.

The healthiest approach is to focus on the goal--normal blood sugars without hypos. However you work it out if you can do that, you should have the same health as anyone else.

I believe based on the research I have laid out on my bloodsugar101.com web site that normal means going up no higher than 140 and ideally 120 and returning to the 80s for baseline.

With a pump and good knowledge of food values people do that with more carbs than you'd think, but it takes study to really get to where you know what you are eating.

I cover occasional non low carb meals with insulin and as long as I'm LC most of the time, I don't go over 140.

I've spent many years with LC, eating extemely low, moderatley low, not low and back again and for me I do have to go back and forth to keep myself from burning out. But I don't compromise with the blood sugars.

Thank goodness for insulin!