When it comes to blood sugar management for people with type 1 diabetes, health care providers put much of their focus on carb counting. However, some people may still see wacky number appearing on their glucose meter despite diligently following everything by the book.
Before laying the blame on them, you should know this: it might not be their fault.
Did you know that protein and fat can also affect blood sugar levels?
A 2015 systematic review published by Bell and associates warn that fat and protein can have an impact on postprandial glycemia in people with type 1 diabetes.
The Study
Because fat can delay the time for foods to leave the stomach, the peak of glycemia may be postponed at a later time after a high-fat meal. After-meal hyperglycemia could arise after more than three hours. Some researchers hypothesize that the presence of fatty free acids induces insulin resistance. Accompanied by a release of glucose from the liver, this combination could explain the late rise of blood sugar after eating a high-fat meal.
“Addition of 35 g fat can increase blood glucose by 2.3 mmol/L, and in some individuals, 50 g of fat can increase insulin requirements by twofold,” according to the review.
Like fat, protein appears to delay the peak of blood sugar. Protein is a bit particular since consuming it with and without carb lead to different results. Adding 12.5 to 50 g of protein to a meal does not seem to affect the blood sugar. On the other hand, 75 g to 100 g of protein causes a rise in glycemia 5-h after meal time, an effect that is similar to eating 20 g of carb without insulin. According to the studies reviewed, ingesting protein without carb increases glycemia in approximately 100 minutes while ingesting protein with carb causes a rise in glycemia after three to four hours.
What This Means
These findings suggest that carb counting may not be enough to control postprandial glycemia; meal composition (protein and fat) can also have an influence on it. However, even by knowing this, determining the time of injection and the type and amount of insulin is not evident. Simply giving more insulin can likely reduce the delayed postprandial hyperglycemia but puts a person at greater risk for early hypoglycemia.
If you suffer from low/high glycemia despite eating appropriate amounts of carb, you may want to look into the composition of your meal.
This study is published in the journal Diabetes Care.
