If you or your loved one with diabetes is lucky enough to have an insulin pump, congratulations, again. Too few insurance providers recognize the superior results of insulin therapy using just the “fast” insulin. There are cases, though, where digestion takes a while, and the mealtime bolus is used up or is otherwise inadequate to aid digestion of non-carb foods. This applies in particular to a high protein meal, described elsewhere as “above 80 grams” of protein.

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You’ll find your own rules and your own ratios, but it’s suggested that those who are on pumps with fast insulin plan on a second bolus 90 minutes to two hours after eating a big meal. This isn’t to account for the actual sugars you’ve eaten (carbs) but to account for sugars generated in the digestion of protein. The suggested ratio is one third to one half of your carb ratio for every gram of protein. My son has great results with a one third ratio, and he triggers the protein bolus one hour after starting the meal. This has been the last piece of the puzzle to get really good blood glucose numbers. His A1C was an enviable 5.5 his first test after learning of the effect! His subsequent A1C’s have been lower, still, but this is not a contest. Best of luck to you.

Some quick math – in trying to keep your carb intake low, your strategy may involve double burgers or some other way to get more protein without adding carbs. A fairly lean 4 ounce burger will have 18 grams of protein. A bun will have about 4 grams of protein, and a generous slice of cheese another 4. If you’re having  the equivalent of a double burger, a single and two buns, that’s around 60 grams of just protein, certainly approaching a big meal for anyone. Your meal bolus would be for the 40 or 50 grams of carbs in the buns and condiments. The Mass Effect – the sheer mass of protein to be digested and generating sugars – well, that would require additional insulin equal to 20 or 30 grams of your carb ratio,  taken about 90 minutes later.

This greater awareness of protein has led to the realization that lean poultry is an amazing source of protein. So great that the odds of having digestion issues are much more likely! Just be aware before you slam back that turkey breast sandwich!

As with any medical therapy, ask your doctor, but once you have the go-ahead and you’re experimenting with times and ratios, drop us a line! Pumps themselves, and the fastest new insulins, are both new-enough that this Mass Effect strategy is not well documented. We’d love to get a statistically-meaningful data set from readers and help formalize some best practices for folks with type 1. Again, good luck!