The Blood Sugar Guide To High Protein / High Fat Meals

This is by far one of the most difficult topics to address in diabetes management and if we could figure it out with clear certainty, then we would have ALL the answers. While we may not have every answer just yet, there are ways in which we can work around this. Get ready for a thorough discussion on the science behind the impact food has on blood sugars plus a few tips I find useful when trying to bring yourself back into range after eating a high fat/protein meal. 

Let’s break down the science 

While it is important to be able to know how to troubleshoot blood sugars that are impacted by proteins and fats, it is equally as important to understand the reasoning behind it. I do recognize that this may be information overload, so feel free to scroll down and skip this section if it feels overwhelming to you - it will always be here and you can always return to read the background information at a later time.

Fats and protein can delay carbohydrate digestion and absorption - digestion is a break down of carbs into simple sugars, while absorption is the process where these simple sugars leave the gut and are absorbed directly into the bloodstream. The time frame becomes important especially when it relates to our insulin peak time. 

Most rapid insulins begin working within 15 minutes and peak within 1-2 hours, give or take. Despite carbs being delayed in getting absorbed into the bloodstream, our insulin continues to work. What this means is that your blood sugar starts to drop before the carbs have even begun digesting. This leads to a low blood sugar, which you likely treat, prompting a high blood sugar once those carbs do start absorbing since you doubled up on carbs. Or this may look like your trends are staying stable prompting you to ignore your data and/or eat more. You are falsely led to believe that you somehow managed the secret to dosing for your pizza.

Protein itself can spike post-meal glucose - meaning it is harmless at first but if we continue to eat, our baseline blood sugar levels can be impacted, especially since protein slowly over time can be converted by the body into glucose. After all, the body runs on glucose and will do whatever it can to make more of it. This process can happen hours after eating, which will confuse us about why we are having these stubbornly high blood sugars.  I don’t know about you but when I am high, I tend to eat more protein because at least on the forefront, I know my blood sugars won’t spike. The sad reality is that when first diagnosed, we often aren’t taught about this impact protein has and I mean why would we? A new diagnosis of diabetes is overwhelming enough, try to add in these complexities and it would make our brains explode! For simplicity sake educators, myself included, tend to promote protein as a healthy snack to avoid high blood sugars, but it’s almost like a band-aid. We really aren’t thinking about the long term consequences this may be having on our sugars. This doesn’t mean swear off protein but it really does drive home the importance of eating balanced meals AND snacks. 

Now while fat doesn’t immediately raise blood sugar levels the way carbs do, it does contribute to inflammation and insulin resistance, leading to persistently high blood sugars. The interesting thing is that there is a noticeable difference in blood sugars depending on the type of fat you are consuming. 

Less of these:

• Saturated fats - Inflammatory

  • Animal Fats - ALL meats like steak, pork, chicken 

  • Dairy - Butter, cheese, egg, milk, ice cream 

• Trans Fats - INFLAMMATORY - AVOID these as much as possible. These contain fats due to heavy processing of foods! 

  • Fast food especially fried foods and packaged foods 

More of these:

• Monounsaturated - Anti-inflammatory

  • Plant based foods like avocado, nuts (almonds, walnuts, peanuts), olive oil, canola oil 

• Polyunsaturated - Anti-inflammatory. These include omega 3s and 6s which are healthful in the appropriate amounts.

  • Fish (tuna, salmon) and even some dark green leafy vegetables

While this is all important information, it is important to keep in mind that everyone is different and bodies may react differently to certain foods. Until genetic testing is fine-tuned, we unfortunately must make blanket statements at times when discussing nutrition.  

Balancing Blood Sugars & the Foods you Love

I know what you are wondering, how do we side step this issue? It’s not enough to know about it, now we need to know how to manage it. The good news is that there are many techniques you can use to still allow yourself to enjoy these foods whether you are a pumper or on MDIs. 

1. Basal

While your rapid insulin is meant for a meal, your long-acting or basal insulin is meant for the background work. This does not mean that if you increase your basal, or even take an extra shot of basal (if on MDI) that this will take care of your high sugars post-meal, but it should provide you some comfort in knowing that your medical team does have something in place for you. SOME, though not all, of this basal is aiding in lowering our blood sugars behind the scenes. Again, this does not mean go hog wild and eat all the high-fat meals you want, but remember you do have something in the background helping you out. 

2. Pre-Bolus 

If you are unfamiliar with the term, pre-bolusing is when you dose 15-20 minutes BEFORE your meal to allow your insulin to start working. Remember insulin takes roughly 15 minutes to start working, so by dosing it ahead of time, you are allowing your body to catch up. On my recent clinical rotation with an endocrinologist, I learned a new rule about fine-tuning your pre-bolus. He recommends that you check your blood sugar and let’s say it is 180. You are then going to drop the last number, in this case 0, and the number you are left with is how many minutes you should be dosing ahead of time. In this case that would mean you pre-bolus 18 minutes before your meal. While it falls into the realm of 15-20 that is commonly recommended I found this interesting and have even started using it myself. It definitely comes in handy and is one more step to help you avoid high blood sugars after eating. 

3. Exercise after eating 

You don’t have to go run a marathon, but a simple walk after eating is a great way to curb those ever-rising blood sugars. As we have talked about many times, exercise increases glucose uptake by the cells in our body, so if we exercise while high, we are helping prevent that post-meal spike. Of course a few things to consider: if you have had stubborn blood sugars and have been running high most of the day, your body may be making ketones and exercise may make that worse. Consider a 30-minute walk - this allows movement without stressing the body too much and can result in lower blood sugars. The last thing to consider is that if you have insulin on board (IOB) meaning active insulin in your system and then you go to exercise, it may make you drop too quickly resulting in a low. While this may be unlikely due to the heavy meal we’ve just eaten, I do need to warn about this. A simple fix is to bring juice or your glucose tabs with you while walking - no biggie. If you’re unable to go on a walk, I also like to jump rope, ride a bike or even running up and down my stairs 10 times can be a huge help. 

4. Extended Bolus/Dual Square Wave 

While this may seem overwhelming and like too much information to remember, pump companies are savvy and have included certain features in their devices to help us navigate high fat/protein meals. Now of course this section is going to apply only to my pumpers, sorry MDI folks, but don’t stop reading because this may be a good reason for you to look into pumps. 

With Tandem and Omnipod, the feature is called “Extended Bolus” and for our Medtronic people, this feature is called “Dual/Square Wave.” While different in name they both do the exact same thing. They allow you to punch in the number carbs you plan to eat, however gives you the flexibility to deliver that bolus over a certain number hours you would prefer.

For example, let’s say you needed to dose 10 units of insulin for your meal. You can choose to dose 5 units now, immediately without hesitation and then you can punch in the number of hours you would like the remaining 5 units to be dosed. Meaning you could say you would like those 5 units dosed over the next 5 hours which means the pump will deliver 1 unit of insulin every hour. Of course, this is a simple explanation but  I like to make the number easy for the sake of understanding. 

This feature is definitely a learning curve and will take time for you to learn exactly how to use it. Since every meal will be different, and every day with diabetes itself can be different, it may be hard to learn at first. However, using this feature has the potential to prevent that low we discussed at the beginning and takes some of the burden off of you to correct the resulting high blood sugar. During this time you are still receiving your basal insulin without interruption or change. If you are new to this feature, I would recommend being at home and have low treatments close by. While this feature promotes safety with blood sugars, you never know what can happen.

5. Track your Trends/ Use your technology 

Whether you are on pump/CGM technology or utilizing MDI, it is important that you track your trends. This includes a food journal/log to help you remember what foods you ate, plus a brief description of what your blood sugars did when you ate that food. This second part is a bit easier if you are utilizing a CGM, and even if you are on MDI and have the ability to, I strongly recommend wearing a CGM. It tracks your trends just about 24/7, helps your medical team fine-tune your basal, even down to the hour, and can really show us what different foods do to our blood sugars. If CGM isn’t for you, that’s totally fine, but then your journaling and checking of blood sugar will definitely need to be on point to help you figure out these types of meals. 

Not only this but you need to be mindful of all the other meals, activities, etc that you did during the day. All of these are questions you should be asking yourself and habits you are identifying, before attributing your high blood sugar solely to the one meal you ate. Diabetes is multifactorial as you all know and while it is easy to blame one thing, it is important to remember the overall picture. Remember to consider things such as:

• Did I pre-bolus? 

• Did I exercise more intensely than normal? Did I skip exercising today? 

• Did I drink enough water? 

• Am I stressed? Is there something else that is making me different from my baseline?

High Fat/Protein Foods

For quick reference, here is a brief list of foods that are high fat, carb and protein. You may also want to refer back to the beginning of this blog where I listed different types of fats. Pizza, spaghetti and meatballs, lasagna, hamburgers, cheese, cheese, and lots of cheese are just a few examples to name a few. 

It may seem overwhelming and trust me, diabetes is, however you have the control to make the most of it. While this blog contains a lot of information, it is intended to provide you some comfort in knowing that there are simple things you can do to work around these types of high blood sugars and hopefully takes off the pressure of feeling the need to dose for protein/fat. I recommend trying some of these steps slowly and work your way through them. Not only that, but remember to keep a balanced plate as much as possible with whole grains and lots of fresh veggies. It will really make the difference. 

Keep up the fight!

-Taylor, PA-S