How to Bolus for Fat and Protein!

Ever wondered how to bolus for fat and protein? Here is some great information that was recently shared with us!

How protein and fat can contribute to the rise in blood sugars and how one might handle that with a pump

We have known for a while that fat and protein can have an effect on blood sugars, but we have never been able to quantify it very well. Recently there have been some studies that have given some insight into how one might consider the amount of extra insulin for high fat/protein foods. This is based on the “Warsaw Method”… ( Pankowska et al. Pediatric Diabetes. 2009; 10(5): 298-308.)

1 FPU (fat/protein unit) = 100 kcal of energy from fat/protein (you need to get this from the internet or nutrition label)
1 FPU = 10 gms of extra carb added to total carb count

Give usual carb count as Normal bolus
Give extra FPU carb amount as extended based on the chart below

Extend bolus over:
3 hrs for 1FPU
4 hrs for 2 FPU
5 hrs for 3 FPU
8 hrs for >3 FPU

***1 gram of protein = 4 kcal of energy
***1 gram of fat = 9 kcal of energy

Example : One hotdog with bun :
(look at nutrition label)
– Carbs: 30 gms
– Protein: 16 gms (x 4 kcal = 64 kcal)
– Fat : 28 gms (x 9 kcal = 252 kcal)

Total kcal from FPU = 316 kcal , therefore, that would be an extra 3 FPU or extra 30 gms spread out over 5 hours. (I might suggest just starting conservative with 1-2 FPU spread over 4 hours)
For the hotdog:
You could try to bolus 30 gms of carb (bun) as a normal bolus
20 gms of carb for the FPU extending it for 4 hours

There are other things to consider… like are the basal rates and carb ratio fine tuned, is the carb count accurate, do you usually eat high fat foods and does basal compensate for it

Really, it just shows how complex it all is!!!

Extra references for further reading:

Heinemaan,L (2009) et al
Pankoska (2009), (2012)
Kordonouri (2012)
Pankowska + Blazik (2010)
Wolpert (2012)