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Case Study:Reduce Spikes

High-Fat Foods: A Case Study - Using Fat-Protein Units to Reduce Post-Meal Spikes

If you have not done so already, we recommend that you read the following WaltzingTheDragon.ca pages as background for the information that follows:

I experienced our family's third Revolution in Managing Diabetes when I learned about the concept of Fat-Protein Units. 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...

Here are those actual blood glucose results after my 8-year-old son ate certain high-fat foods. which we outline 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,


A.
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
2 hrs post-meal
18.4 HIGH
9:13pm
3.5 hrs 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.
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
5:16pm
pre-meal
5.6
 
7:36pm
2.5 hrs post-meal
8.3
 
8:52pm
3.5 hrs post-meal
6.1
 
10:30pm
5.25 hrs 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
6.25 hrs post-meal
3.7 LOW
another 8g of carbs given, BG came up to 4.7
1:59am
8.75 hrs post-meal
8.9
out of the woods BG wise
 

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.
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
5:21 pm
pre-meal
6.6
 
7:21 pm
2 hrs post-meal
9.6
 
8:55 pm
3.5 hrs post-meal
7.8
 
10:47 pm
5.5 hrs post-meal
8.8
 
1:00 am
7.5 hrs post-meal
4.6
4g of carbs given
7:17 am
14 hrs post-meal 
6.2
 

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!


Any comments? Questions? Feel free to Contact Us.



This material has been developed from sources that we believe are accurate, however, as the field of medicine (in particular as it applies to diabetes) is rapidly evolving, the information should not be relied upon, as it is designed for informational purposes only. It should not be used in place of medical advice, instruction and/or treatment. If you have specific questions, please consult your doctor or appropriate health care professional.


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