For last week’s practice question, we quizzed test takers on the impact high-fat meals have on post-meal glucose. This was a tough one, since only 40% of respondents chose the best answer. We want to share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: MJ is on an insulin pump and takes 1 unit of insulin for every 15 gms of carb.  For a meal with 5 ounces of steak, medium baked potato with sour cream, asparagus, and salad, MJ bolused 3 units of insulin to cover carbs. What might MJ expect to happen 3 hours later?

Answer Choices:

• A glucose spike
• Hypoglycemia
• Blood glucose in target range
• Need to consume more carbs

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As shown above, the most common choice was option 1, the second most common answer was option 3, then option 2, and then finally option 4.

Getting to the Best Answer

Answer 1 is correct. 40.29% chose this answer, “A glucose spike.” Great job, this is the best answer! Even though MJ gave 3 units of bolus insulin to cover the carbs from the potato, there will be a secondary glucose spike about 3 hours later from the meat protein and the sour cream. There is a growing understanding (as noted in ADA Standard 5) that people with type 1 diabetes need to not only cover for carbs in the meal, but many times they need to include a small amount of bolus insulin to cover for high fat and protein sources. The delayed post meal glucose elevation is secondary to gluconeogenesis as their body converts some of the digested fat and protein into glucose. For people using insulin pump, they can use dual wave bolus, so they get some of the bolus initially and the rest a few hours later to coincide with the second glucose spike. People on insulin injections could also inject a small amount as they see their secondary glucose rising as protein and fat impact blood sugar levels.

Answer 2 is incorrect. 22.34% of you chose this answer, “Hypoglycemia.” This is a juicy answer, but the 3 units is just the right amount to cover for the potato, veggies and salad. Plus, with the additional protein and fat consumption, MJ is unlikely to experience hypoglycemia.

Answer 3 is incorrect. 24.88% of respondents chose this answer, “Blood glucose in target range.” MJ blood sugar could be in target range one to two hours post meal, but given the additional consumption of 5 ounces of protein plus sour cream, it is likely that around hour three, MJ will experience a glucose spike.

Finally, Answer 4 is incorrect. 12.49% chose this answer, “Need to consume more carbs.” This is a juicy answer, but the 3 units is just the right amount to cover for the potato, veggies and salad. Plus, with the additional protein and fat consumption, MJ is not likely to see blood sugar drop to the point where they would need to consume more carbs.

Want to read more about his topic?

Beyond Carbohydrate Counting: Utilizing Nutrition Factors to Optimize Insulin Dosing | On the Cutting Edge| 2021 Volume 42 | No 4 – Subscription only

Benefit of supplementary fat plus protein counting as compared with conventional carbohydrate counting for insulin bolus calculation in children with pump therapy – Article

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this important learning activity!

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Want to learn more about this topic?

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Virtual DiabetesEd Specialist Conference Basic | 30+ CEs

Deluxe Option for $499: Virtual Program includes:

• Q & A Session with the instructor after each webinar.
• LIVE Presentations by our team of experts.
• State of the art review of current diabetes care and technology.
• Resources for each session.
• Access to free podcasts and video recordings within a week of each live session for one year.

Don’t worry if you can’t make it live. Your registration guarantees access to the recorded version in the Online University.

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