A Case Study in Reducing BG Spikes

Using Fat-Protein Units
to Reduce Post-Meal Spikes from High-Fat Foods

I experienced our family’s third Revolution in Managing Diabetes when I learned about the concept of Fat-Protein Units. What follows below are the actual blood glucose results after my 8-year-old son ate certain high-fat foods…

Not familiar with the concept of Fat-Protein Units? Read background info here:
How Fat and Protein Affect Blood Glucose
How to Deal with Fat and Protein

As part of our learning, we tried different approaches to different foods, all of which had in common their relatively high fat content, and we recorded the results. They are outlined here to illustrate the relative effect (on the blood glucose of one individual with type 1 diabetes) of:

A. High Fat Foods without extra insulin;
B. High Fat Foods with extra insulin, according to the Warsaw School approach; and
C. High Fat Foods with extra insulin, according to an ADAPTED Warsaw School approach.

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A. High Fat Foods without Extra Insulin

Sept 4, 2015: Ate a Kandy Bar ice cream treat (26g carbs; 14g of Fat) as dessert with an otherwise low-fat meal.

NO EXTRA INSULIN was given up-front to cover fat.

Time When was BG Checked? BG (mmol/L)
5:42pm pre-meal 10.1
7.38pm 2hrs post-meal 18.4 HIGH
9:13pm 3.5hrs post-meal 21.2 HIGH

The Results: Despite a correction dose of insulin for the top-of-the-range pre-meal BG, it’s clear that BG still rose dramatically, well above his target upper limit of 10.0 mmol/L.

So we decided to apply the concept of Fat-Protein Units…

B. High Fat Foods with Extra Insulin

According to the Warsaw School Approach

Sept. 5, 2015: Ate the same Kandy Bar ice cream treat (26g carbs; 14g of Fat) as dessert with an otherwise low-fat meal.

EXTRA INSULIN was given up-front to cover fat, according to the WARSAW METHOD, using an equivalency factor of 10 ‘carbs’ per FPU. The bolus was extended over 3 hours, as per the Warsaw School method.

Time When was BG Checked? BG (mmol/L) Comments
5:42pm pre-meal 5.6
7:36pm 2.5hrs post-meal 8.3
8:52pm 3.5hrs post-meal 6.1
10:30pm 5.25hrs post-meal 3.7 LOW 8g of carbs given (usually an effective low treatment; BG came up just above 4.0, but then...)
11:30pm 6.25hrs post-meal 3.7 LOW another 8g of carbs given, BG came up to 4.7
1:56am 8.75hrs post-meal 8.9 out of the woods BG wise
9:13pm 3.5hrs post-meal 21.2 HIGH

The Results: As we soon found was often the case with our son, using the equivalency factor of 10 ‘carbs’ per FPU resulted in persistent lows at about 5 hours post-meal. Note that two low treatments (extra 16g of carbs) were needed to bring his BG back into the safe zone.

To make things more conservative (less insulin), we then tried an equivalency factor of 8…

C. High Fat Foods with Extra Insulin

According to an ADAPTED Warsaw School Approach

Sept. 11, 2015: Ate a burger, McCain’s fries, and raw veggies (total of 47g carbs; 36g of Fat).

EXTRA INSULIN was given up-front to cover fat, according to ADAPTED WARSAW METHOD using an equivalency factor of 8 (instead of 10). The bolus was extended over 5 hours, as per the Warsaw School method.

Time When was BG Checked? BG (mmol/L) Comments
5:21pm pre-meal 6.6
7:21pm 2hrs post-meal 9.6
8:55pm 3.5hrs post-meal 7.8
10:47pm 5.5hrs post-meal 8.8 8g of carbs given (usually an effective low treatment; BG came up just above 4.0, but then...)
1:00am 7.5hrs post-meal 4.6 another 8g of carbs given, BG came up to 4.7
7:17am 14hrs post-meal 6.2 out of the woods BG wise

The results were beautiful! Yes, we still needed to “top up” blood sugar in the night with 4g of carbs, but compared to BG’s in the 20’s (or repeated lows as in (B) above), we count this a success! We could further experiment with the process by reducing the equivalency factor even more, perhaps to 7 or even 6; or we could play with the duration of the extended bolus. But in any case this approach works well most of the time for our family.

Although these examples are far from meeting the experimental method, having too many uncontrolled variables (pre-meal BG, varied high-fat foods, lack of fasting conditions before and after the example meal), the results still have value to show the general relative effect of the different approaches. It’s enough to convince us to continue using an adapted Fat-Protein Units approach!

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