I’ve seen many cases where type 1 diabetics try a low-carb diet, but end up with high blood sugars! Why is this? Well, most of the time, it’s because they aren’t taking insulin for protein. I’d say that not bolusing for protein is probably one of the biggest mistakes type 1’s make when going low-carb. Is this news to you? Let me explain.
I thought only carbs need insulin?
When you’re given the typical high-carb guidelines, the doctors will usually say that you need to only take insulin for carbs. In the context of a high-carb diet this makes sense, because carbs raise your blood sugar faster and greater than any other macronutrient. Protein and fat can’t even hold a candle to the rise one gets from carbs, which is why we need to avoid them! But, once you cut the carbs out, suddenly the biggest impact to your blood sugar will be protein.
Why is this? It’s not that a steak is like a cake, that protein simply turns into sugar in your body. It actually makes your blood sugar rise indirectly, by stimulating the release of glucagon. This glucagon brings amino acids (protein) into the liver for gluconeogenesis, and is what causes the rise in blood sugar, slower and later than carbs would. Normally, our bodies make insulin to counteract the effect of glucagon, but since our bodies make none, we have to cover that insulin manually.
Fortunately, covering the rise from glucagon is easy to do, if you know what to do and have the right tools. If you’re just starting out, you’re likely injecting with a rapid-acting insulin such as Humalog or Novalog. These analogue insulins have a very quick activation which matches well with the quick spike from glucose, but doesn’t match well at all with the slow rise from protein. But, fortunately, there actually is an insulin that is very suitable for low-carb, and that is called R (Humilin) Insulin.
R-Insulin is a very old insulin, and is usually more accessible and affordable than the rapid-acting analogues. In the U.S., you can buy it from Wal-Mart over the counter for $25/vial. Yet doctors don’t recommend it, and typically never even mention it, because it works too slowly for a high-carb approach. Fortunately for us, this slow activation is actually perfect for covering protein in low-carb meals! For that reason, Dr. Bernstein recommends using this insulin to cover protein.
How do you use R-Insulin?
This insulin does come with its quirks, and there will be some trial and error in figuring out the right dose. Our bodies have different sensitivities to protein and insulin, so the amount needed varies from person to person. But to start, Dr. Bernstein recommends using 1/2 unit of R per ounce of protein. When starting I tried a little less than that, just to avoid going low, and then tested frequently after to see where my blood sugar ends up. If it goes too high, you know you need to increase the amount of insulin per oz, and if it goes too low, you know you need to lower it.
The timing when it comes to injecting R for protein is very important too. Because R has such a slower activation time, Dr. Bernstein recommends dosing for your meal about 45 minutes before you eat. This, too, will vary from person to person based on their own sensitivity and metabolism. What I did to figure out when to bolus was to take my insulin 45 minutes before, and then test every few minutes. The minute my blood sugar starts going down, I start eating. And whatever that time that is from bolus, be it 15, 30, or even 5 minutes, is how much time I’ll give before eating. If you don’t do this, you may find that you go low and then too high after you eat, which would indicate bolusing too soon. Or, conversely, you may go too high and then too low, indicating that you’re injecting too late.
Lastly, if you eat a delicious meaty meal and realize you forgot to bolus later on, when its well-past the safe window for timing it properly with R, don’t be afraid to use the more rapid-acting insulin! It’s not ideal, but if you time it too late with R you will likely go too high and then too low due to its delayed activation.
Just like how the 3 units of R covers my steak, that about covers the how-to on bolusing for protein. Have any questions, comments, or concerns when it comes to bolusing for R? Send me a message or comment below!