Taming Spikes – A Case Study

A Case Study in Reducing BG Spikes caused by high-fat food

Michelle MacPhee
D-Mom, Creator/Co-founder of WTD

When our family learned about the concept of Fat-Protein Units several years ago, it changed the way we manage blood glucose around food. Instead of tolerating huge BG spikes after pizza, ice cream or a fast food burger and fries... instead of getting up several times during the night to correct high BG... again!... we learned a proactive method to deal with fat and avoid those BG spikes in the first place. What follows here are my then-8-year-old son's actual blood glucose results after eating high-fat foods - I recorded them while we learned this method, and I share them here in hopes that they may help your family to get off the rollercoaster and eat the food you love again.

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

As I shared in Our Family's D-Revolution: 3 Keys to Managing BG & Food, in the first several years after our son was diagnosed with type 1 diabetes at just over a year old, I came to dread (and actively avoid!) a frozen treat on a hot summer day, Friday Family Pizza Night, or an afternoon at the Play Place, munching on fries. All because of the price we would pay later in huge BG spikes, in repeated correction doses that didn't work, in frustration and anxiety. Yet I struggled with the idea that my son was missing out on these typical kid treats. I resented the idea that our family’s activities were being controlled by diabetes. Then we learned about the concept of Fat Protein Units and our family's quality of life improved dramatically.

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 for fat;
B. High Fat Foods with extra insulin for fat, according to the Warsaw School approach; and
C. High Fat Foods with extra insulin for fat, according to an ADAPTED (more conservative) approach.

A. High Fat Foods without Extra Insulin

Sept 4, 2015: Our 8-year-old son ate a Kandy Bar ice cream treat (26g carbs; 14g of Fat) as dessert with an otherwise low-fat meal.

We pre-bolused more than 15 minutes for the carbs in the supper and ice cream, and gave the usual correction dose for the above-target, pre-meal blood glucose.

NO EXTRA INSULIN was given to cover the 14g of fat in the Kandy Bar.

5:42pm pre-meal 10.1
7.38pm 2hrs post-meal 18.4 (way above target!)
9:13pm 3.5hrs post-meal 21.2 (way, WAY above target)

 

The Results: Despite a correction dose of insulin, his post-meal 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.

We pre-bolused as usual, for the carbs in the supper and ice cream. No correction insulin was needed, as his pre-meal blood glucose reading was on-target. 

EXTRA INSULIN was given to cover fat, right after eating, 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 method.

5:42pm pre-meal 5.6
7.36pm 2hrs post-meal 8.3
9:13pm 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

 

The Results: It was clear that using the equivalency factor of 10 pseudo-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 a carb-equivalency of 8 (instead of 10)…

C. High Fat Foods with Extra Insulin According to our ADAPTED Warsaw Approach

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

We pre-bolused as usual, for the carbs in the supper and ice cream. A very small correction dose was given, as his pre-meal blood glucose reading (6.6 mmol/L) was very close to target. 

EXTRA INSULIN was given to cover fat, right after eating, 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.

5:21pm pre-meal 6.6
7:21pm 2hrs post-meal 8.3
8:55pm 3.5hrs post-meal 7.8
10:47pm 5.5hrs post-meal 8.8
1:00am 7.5hrs post-meal 4.6 4g of carbs given
7:17am 14hrs 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 we count this a success compared to BG’s in the 20’s without a fat-bolus as in (A) above, and compared to repeated lows that we experienced when we used the regular Warsaw approach as in (B) above.

After this experience, we continued to further experiment with the process by reducing the equivalency factor to 7, but found that the post-meal spikes weren't well enough managed with that tweak. We found more success with shortening the duration of the extended bolus in order to avoid low blood glucose.

Other Ways to Adapt the Process

On an ongoing basis, our family "adapts" the Warsaw method to best match the conditions of the day:

  • if our son was more active than usual, we use a lower carb-equivalency factor (8)
  • towards the end of a school break (like spring vacation) he tends to be less insulin sensitive due to the lower level of activity, so we use carb-equivalency factor of 10 at those times
  • we make the extended bolus shorter or longer based on past experience with certain foods and how quickly they impact blood glucose
  • we add more insulin for very high amounts of fat, as we've found that double the fat requires more than double the insulin in our son's case
  • if this is the second high-fat meal in the day (think nachos for lunch, then burgers and fries for supper) then we add more insulin for the second meal, as the insulin-resistance due to fat is compounded

The Bottom Line

In most cases, this approach works very well for our family, helping to prevent post-meal blood glucose spikes and eliminating the frustration of soaring blood glucose.

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!