Hey everyone,
as I see quite some Pizza posts, I thought I share some info from my end that might help "solving the mystery". Not sure how common knowledge that is.
The challenge with pizza is apparently not the carbs, but the fat & protein. Both effect your blood glucose, similar to carbs. Plus, it has quite a time offset.
"Emerging evidence from recent research and the use of continuous glucose monitoring have shown that other nutritional properties of food, including fat, protein, and glycemic index (GI), can significantly affect postprandial glucose excursions." [1]
There was even a study looking at high-fat food, in this example pizza and fried chicken [2]:
This means for us, we have to not only calculate carbs, but also fat and protein.
To achieve this, one can use the "Warsaw formular" [3] [4].
They introduce the "Fat-Protein-Unit" (FPU). An FPU is treated as a normal carb unit (CU), which means when you inject 1 IE for 1 CU, you would also inject 1 IE for 1 FPU.
For the example below, we assume the insulin-to-carb-rate (ICR) is 10 gr carbs need 1 IE insulin.
How to calculate that (it takes some time to get acquainted with it):
- 1 CU = 10 g carbs (at least where I live)
- 1 FPU = 100 kcal protein and fat, where 1 g of fat = 9 kcal and 1 g of protein = 4 kcal
Lets apply that to the pizza from the study:
- 46.8 g of carbs,
- 33.1 g of fat, and
- 25.4 g of protein
We would have 5 IE for the 46.8 g of carbs (I usually round up).
33.1 g of fat \ 9 kcal = 297.9 kcal*
25.4 g of protein \ 4 kcal = 101.6 kcal*
In total we have 399.5 kcal from protein and fat. As mentioned above, 1 FPU is 100 kcal. Therefore we would have additional 4 FPUs for which we would add another 4 IE.
Therefore the total is 5 IE for the carbs plus 4 IE for the fat and protein.
The problem, fat and protein doesn't react as fast as carbs. So the additional 4 IE should not be added directly to the meal shot.
For pump users you can add them over the next 4 hours. The rest of us should wait until the next shot.
The following links contain more information and practical guidance:
https://youngandt1.com/how-to-bolus-for-fat-and-protein/
https://www.practicaldiabetes.com/article/fat-protein-counting-type-1-diabetes/
I hope this helps a bit. It definitely helped me to understand it a bit better. Also in order to get better calculation for my workout protein drink.
Cheers
Tom
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[1] https://care.diabetesjournals.org/content/38/6/1008
[2] Pańkowska, E., & Błazik, M. (2010). Bolus calculator with nutrition database software, a new concept of prandial insulin programming for pump users. Journal of diabetes science and technology, 4(3), 571–576. https://doi.org/10.1177/193229681000400310
[3] Pańkowska E, Błazik M, Groele L. Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study. Diabetes Technol Ther. 2012;14(1):16-22. doi:10.1089/dia.2011.0083
[4] Link to study on Sci-Hub https://sci-hub.tw/https://doi.org/10.1089/dia.2011.0083
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