By Gary Scheiner, MS, CDE
Q: I am on the keto diet and having difficulty managing my glucose on the pump. Is there a guide for the amount of insulin to use for the proteins and fats to prevent lows and/or highs?
A: Many people are giving the ketogenic (very-low-carb, high-fat) diet a try…some with more success than others. One of the biggest challenges from a blood sugar standpoint is that our body needs a certain amount of glucose each day in order to function properly. What we don’t get from our diet is manufactured by the liver (from protein and other sources). So, when having low-carb meals, we have to start considering protein intake and dosing for some of the protein as if it was carbohydrate. Many people on very-low-carb diets start out by bolusing for 50% of their protein grams. Best to give the protein bolus after eating, since protein will take longer than carbohydrate to raise the blood glucose level.
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The effects of dietary fat are a little different. Fat does not turn into glucose, but when there is a great deal of fat in a meal, it can slow down the rate of digestion. Delaying the bolus or using an “extended” bolus can help prevent post-meal lows followed by delayed highs. Large amounts of fat can also cause the body to become insulin resistant for the next eight to 12 hours. When this happens, more basal insulin is needed to keep glucose levels stable. Pumpers sometimes raise their basal rate (using a temp basal increase) to offset this effect.
Want to learn more about the keto diet? Read “Keto Diet for Diabetes: Help or Hindrance?” “Keto Diet May Help Manage Type 2 Diabetes: Study” and “Keto Diet and Diabetes, Healthy Frozen Food and More.”
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