Insulin Dosing for Protein

We know that carbohydrates raise blood sugars. We use a particular insulin-to-carb ratio to cover this macronutrient. But, we also know that protein may also have an effect on blood glucose. While the effect is not as rapid or pronounced as it is for carbohydrates, it can be significant.

These instructions are meant as a guide to get you started to improve post-meal glucose control in the setting of protein intake. As with all adjustments to your diabetes management plan, test out the strategy and adjust as needed based on your own results. Discuss with your healthcare team to ensure the optimal strategy is working safely in your favor.

Protein with a very low carb meal (<15–20g carb)

High-protein meal with a normal amount of carbs (>20g carb) 

Example 1

Joe Burger is eating a meal with 10g carb and 48g protein. His Insulin to Carbohydrate  (IC) ratio is 1:8g.

What will he need to do?

Carb bolus = 1.25 units (10g divided by 8g ratio)

Deliver this dose prior to eating.

Protein = 48g divided in half = 24g

Protein bolus = 3 units (24g divided by 8)

Deliver the 3 units over 2 hours starting at the end of the meal.

Example 2

Julia Fajita is eating a meal with 25g carb, 50g protein and 40g fat.  Her IC ratio is 1:10g.

What will she need to do?

Carb bolus = 2.5 units (25g divided by 10g ratio)

Deliver this dose prior to eating.

Protein = 50g divided in half = 25g

Protein bolus = 2.5 units (25g divided by 10 = 2.5 units)

Deliver the 2.5 units over 2 hours starting at the end of the meal.

What about the fat?

Julia will increase her basal after the meal by 50% for 8 hours to avoid a delayed/sustained rise in BG later that night.

A Simple Guide to Counting Protein Grams

Reference

©Gary Scheiner MS, CDCES – Integrated Diabetes Services. May be reproduced and used for patient education, but not sold.