January 4, 2001
Meal Planning, Food and Diet
Question from Dallas, Texas, USA:
At our recent appointment, the dietitian talked about differences in absorption of carbs, fats, and proteins. She said the body coverts all of them to glucose, but fats and proteins are absorbed and converted so slowly that they have less of an effect on blood glucose. My daughter is a picky eater and while we do our best, her diet consists mostly of carbohydrates (cereal, milk, breads, fruits, etc). She also said something that seemed to imply eating fats or proteins prior to carbs, would slow the absorption of the carbs too (I think she gave the example of chocolate not being good for treating lows because of the fat content). My daughters numbers seem to spike very high after meals and then drop quickly. She sometimes feels low an hour before lunch, but then tests in the 200s mg/dl [11.1 mmol/L]. 45 minutes later, she tests and it is 50 mg/dl [2.8 mmol/L]. I have been told her symptoms are probably from the change in her glucose (dropping fast) and not the absolute number (in the 200s mg/dl [11.1 mmol/L]). This seems to go along with the numbers we see shortly after she eats being very high(300-400s mg/dl [16.7-22.2 mmol/L]). I am thinking that having her eat or drink something high fat or high protein immediately before her meal, may slow her absorption, which might then prevent the high numbers afterward and the following drop with symptoms. Is there any sense to this? Can you point me to any further info?
Answer:
The information your dietitian provided is correct. Fats do not get converted to carbohydrates at all, however, but they do significantly slow down the absorption of carbohydrates of all kinds. Therefore, ice cream (high fat not low fat) at bedtime is an excellent way of providing a slowly releasing food for many hours and may help prevent nocturnal hypoglycemia. Protein is slowly converted by the body (via the liver) to glucose for energy or storage. Using high fiber foods and/or fatty foods may help slow down immediate rising blood glucose levels from “too fast” absorption. One of the best reasons, in my opinion, to favor using Humalog or Novolog insulins is to provide coverage for such immediate post-prandial glucose rises. Both analogs work quickly, reach a peak and then disappear more quickly than Regular insulin and would likely avoid the problems you !are describing, without having to do battle over food preferences.
I would suggest you go back and have another session or two with your daughter’s dietitian so that you can clarify what works based upon your observations, some pre and postprandial glucose testing and a detailed problem solving review.
SB