Covering Meals with Insulin

By Dr Morrison

lamb shankBolus insulins are given to cover your food and also to correct high blood sugars at meals and other times.

The total amount of carbohydrate and its rough glycaemic index, fat content, protein content, and  the presence or absence of delayed stomach emptying  all affect the speed and duration of blood sugar rises after meals.

If you are on the strict end of low-carbing most of your meals will be meat/egg/fat/low starchy vegetable combinations which take longer to digest than if you were eating sugary or starchy foods such as breakfast cereal and milk.

Match Insulin To The Meal

The techniques you use to cover different kinds of meals will therefore vary.  You are doing your best to match the insulin to the meal. The sorts of meals you will be choosing to eat will depend on your goals for your blood sugars and your health.

We will be discussing techniques to cover several types of meals.

Dr Bernstein’s strict low carb meals at 6-12g of low glycaemic carb, moderate protein and high fat.

This is the gold standard of the low carb diabetes diet. It can give you truly normal blood sugars over the entire course of the meal when optimal insulin techniques are used. All diabetics need to seriously consider how far they could adapt themselves to this diet for the long term prevention and indeed reversal of complications.

Dr Jovanovich’s typical low carb meals at 13g-30g of mixed glycaemic carb, moderate protein and high fat.

Low Carb Diet Books

burgerThis is the typical diet that most low carbers and lower-carbing diabetics use. All of the popular low carb diet books by the likes of Dr Atkins, Drs Eades, Barry Groves, Dr Agatson, Drs Allen and Lutz, and Dr Annika Dalquhist are in this meal range.

It gives you more variety in fruit, vegetables and grains, but probably not completely normal blood sugars. You may get some blood sugar spiking at meal times but are likely to have a normal blood sugar by the time the next meal comes with the appropriate insulin techniques.

If you are in transition from the high carb so called, “Healthy Eating Plan” this is where you want start.  This gives you time to:

  • Adjust your insulin or oral medications downwards slowly and safely.
  • Helps reset your “Hypo clock” downwards.
  • Helps prevent a deterioration in retinopathy from too rapid blood sugar improvements.
  • Gives your lenses in your eye time to adjust to lower sugar levels.
  • Gives you time to learn new low carb baking skills and improve on your range of meat, egg and vegetable dishes.
  • Gives your family time to adjust to a new eating routine.
  • Gives you time to organise your planning, shopping and meal preparation times.

Dr Morrison’s techniques for dealing with higher carb meals of 40-90g are a useful addition for times when you are having a planned indulgence or when your food choices are  extremely limited.

Eating meals with this carbohydrate content approaches what many consider to be “normal” eating. The problem is that if this is done too frequently it will certainly have an adverse effect on your diabetes. Blood sugars at meals will spike and for some time afterwards, but you are likely to have normal blood sugars when the next meal comes.

Why do I have to change my eating and insulin routine?

  1. If you have been doing what you have most likely been told at your diabetes clinic you will be here for a very good reason. It isn’t working.
  2. You are looking for solutions to your blood sugar problems:
  3. Too high. Too low. Too wide blood sugar swings. No idea what number that meter will show next.

The techniques I will describe in the other sections are often seen by newcomers as a bit of a drag. All those blood sugar tests! All those injections! All those donuts I’ve to bin! But persist, and they will reward you with better blood sugar levels and improved well-being.