Suggestions on handling higher protein dinners?

I try to keep a balanced diet - some carbs, some protein, some veggies, etc. For the most part, I’m on the same exchange-based meal plan that I start with over 30 years ago. But I’ve noticed that protein digests slowly for me. If I eat a little too much at dinner, I can be high all night.

I’ve tried compensating for that with extra insulin at dinner time, but even with my pump set to do an extended bolus over 2 hours, that tends to have me on the low side at bedtime and then up around 250 in the middle of the night. It’s a bigger swing than even Control IQ can handle (though it does handle it a little better for me than the 670g did).

I’ve tried having a small bedtime snack and taking extra insulin with that (on the theory that it would prevent my going low in the short term while still keeping extra insulin in my system for the next few hours), but that hasn’t worked, either.

Obviously, smaller portions are the best option. But if I slip or overindulge or whatever… Any thoughts or suggestions on how to better handle it?

I do better when I have low fat dinner with simple carbs. by 9-10 pm everything is completely flat and predictable. I swap the higher fat and mixed carbs between lunch and dinner. (simple philosophy, have the pizza at lunch time) High protein/low fat (think plain chicken) doesn’t do this to me. High protein with fat does. I go with a 4+ hour square wave or a temporary basal (I am not on a feedback pump). both work but you are risking an overnight low, based on my bs and trend at 10 PM. .

Last night (lower graph), I had veal parm and pasta for dinner. A little light on the pasta, a little heavy on the veal. (The veal was fried, but not that fatty.) I went low after dinner (left edge of the graph), had a very light snack, went to bed at 12, and was over 200 all night.

Tonight, I had chicken and rice. A little light on the chicken, a little heavy on the rice. Sugar level dipped, was up around 150 and rising at bedtime (which was around 2 today). I took a small correction bolus and went to bed. Sugar level kept going up, plateaued at 190, and started coming back down a few hours later. Right now, it’s the middle of the night (I have a circadian disorder, so my schedule does not line up with my physical time zone) and I’m 89 and dropping. I’ll need to have a snack before I try to get back to sleep. (I don’t know what woke me up this time. Not blood sugar. Might have been the apnea. Or just one of those nights.)

It’s fairly consistent. If I have too much protein (regardless of how fatty it is) I’m high all night. Not enough, and I drop low in the middle of the night when the carbs run out.

I am having the same issue. I have yet to come up with a solution. It seems that if I have any protein/fat for dinner I am over 200 after midnight. I can go to bed at 10:00 at 135 and still go over 200 at midnight, 6 hours after I eat. I have a hard time giving myself insulin at bed time to treat a high that is a few hours away. Frustrating. I guess I may have to limit my protein/fat at dinner.

Any real intake of carbs after about 7pm will cause me fits about 1am with an extended high bg readings. I have just turned my lunch and dinner menus around , I consume the bigger meal earlier in the day and I go very low carb for dinner now. Altering my diet was the only fix I could find to prevent the dreaded 1am bg spike. So if you happen to come across something that works for you please share your findings.

It is such a balancing game. In the case of chicken and rice, it may be that chicken has less protein than veal. Your sleep schedule sounds like it must be awful!! Kudo’s to you for being able to function at all!!

I have some questions that are a little late. What kind of pasta do you generally eat? What kind of rice do you usually eat? I personally just use regular pasta and white rice most of the time, but I do notice that my blood sugar is more stable when I eat brown rice (No difference in which pasta I eat). I know that is the low glycemic index idea that people talk about, but everyone is a little different. The other thing that helps me if I have a protein heavy meal for dinner I find some light exercise to do. I do some house work or I go for a short walk at a mild pace. I do not want to overdo too close to bed, or I will wake up low, but I find that it just helps me to digest and absorb things a little quicker. Even if I am still high, I find that my highs will show a little earlier and I can treat before bed. I don’t know if that is something you already do or if that is something possible.

I don’t do it all the time, but if I eat a burger or a fattier protein, I do that to get my blood sugar to increase a little sooner instead of 5 hours later.

Regular pasta. White rice. Whatever the family is having. I aim for mostly complex carbs with relatively little sugar, but I’ve been at this long enough to know how to handle both.

Besides diabetes, I’ve got non-24, fibromyalgia (hypersensitive nerves, which makes everything painful - I haven’t been pain-free since 1993, although severity and location vary more or less randomly), chronic fatigue syndrome (does what it says on the tin), hypothyroidism (we keep that under control with a simple pill every morning), alopecia (my immune system destroyed all my hair), and two types of sleep apnea (I stop breathing when I’m deeply asleep, which then partially wakes me up). The fibro also makes it harder to get deeper sleep - it takes longer for me to get to lower sleep stages, and I come out of them more quickly and jump further up to lighter sleep stages). Basically, my immune system has spent most of my life trying to find ways to mess with me. (Although the doctors can’t figure out why my adrenal system is intact when everyone in the textbook who has a similar set of conditions has that, too.)

I just have to do my best to keep everything under control. But exercise isn’t really an option when you’re constantly exhausted and it hurts to move and standing still is exhausting but the impact from walking (and the random spikes of joint pains, lasting seconds or hours) makes that rather difficult.

Sugars last night were pretty good, though. I’ll see what the doc has to say next week.

It is a miracle that you can do anything at all!! I would probably just do nothing. I remember on some of your posts, you talked about some of your other conditions, I couldn’t remember if you said exercise was an option or not, so I thought I would just put it out there. I am glad that your sugars were pretty good last night, I hope you can find something to help with your questions!! Good Luck!!


Update: I talked it over with my endo. She looked at my graphs, and the pattern (though unusual in her experience) was clear enough. So we adjusted the pump correction factor when I sleep (I have to manually set that because I keep unpredictable hours), and so far it seems to be working great.

Great news, but don’t keep us in suspense: what was the pattern? How have you been managing those meals with extra protein? We’re very much still learning our way, and we’d love to benefit from any insights you’ve gained…

The pattern is simply that my BGs are usually on target during the daytime but tend to be high for extended periods at night. Which is the opposite of what my endo is used to seeing from other patients. We increased the correction factor on the pump so that it’s giving me more insulin when that happens, and that’s so far kept my BGs more in range. I have had a couple of lows, though (one in the middle of the night after I’d had a somewhat smaller dinner, one early in the morning when I should have been having breakfast if I’d been able to sleep normally), so we may have to tweak it a bit. So… not really an insight. Just acknowledging that I’m running high at those times and permission to get more insulin to compensate. If I eat less, I go low. If I take more insulin at dinner time I go low at bedtime and then the insulin runs out but I’m still digesting dinner so I go high a few hours later. Taking an extra bedtime bolus is risky and doesn’t really work, either. But the pump’s control IQ is designed to handle that as it happens, so it just came down to telling it I’m insulin resistant and need more of a correction.

Got it. So you “just” (because being your own pancreas is totally no big deal, right? :wink:) needed to change your correction factor overnight, because it’s taking more insulin to bring you down to target overnight than it does during the day?

And is that actually overnight, or are you using the word as a stand-in for “when you’re sleeping,” whenever on the clock your biorhythms have you doing that on that particular day?

Seriously, thank you for sharing. This really is how we learn…

The latter. Nice perception. My schedule is completely divorced from my physical time zone, so I use “nighttime” to mean “when I’m sleeping.”

I can’t eat much when I first wake up, even if I wait an hour. So I only have a light breakfast. And I’m not able to move much due to my other disabilities, so I don’t need much for lunch. Dinner is my main meal, and it digests slowly. I need to have enough so I won’t go low before breakfast, but not so much that I’m running high all night and gaining weight. This seems like a better balance so far. We’ll see how it goes. I’m supposed to email my endo later this week so she can review and we can tweak the settings if need be.

Well, that makes sense to me, since supposedly our bodies do all our healing and repair work while we sleep, which requires more insulin — and it makes sense to me that what matters there is that you’re sleeping, not what time it is on the clock. But then why would it be that most patients your endo sees tend to need less insulin to correct overnight? Is this the difference between having a higher basal rate in general (to do the repair work) versus needing more insulin to correct X mg/dl over target during that window?

It’s just because you’re not eating or exercising, and your metabolism is slowed. So typically you’d expect a relatively steady BG.

Huh. My perspective may be skewed — I only know our experience, after all — but my daughter’s basal insulin needs are literally double at night versus during the day, and they’re far from stable, either. Some nights she has a lovely straight line (the result of a series of staggered basal rates we’ve honed over time with the CGM), and when that happens, I’m thrilled. But there are still plenty of times when she goes high or low overnight. Some we can peg to food choices or activity levels earlier in the day, but our endo blames the otherwise-unexplained ones on puberty. Growth spurts and hormone surges happen while we sleep, too, and of course they’re unpredictable. So if she’s going to have one of those, then she needs more insulin. And if she’s not getting enough, then she’ll go high in the middle of the night. But if she IS getting enough to handle that on a night when she doesn’t have a growth spurt or hormone surge, then she’ll go low.

Anywho, it just means I’m surprised to learn most of your endo’s patients need less insulin at night. Even if they’re not adolescents/menopausal, there’s still the normal maintenance-type repair work happening during sleep. I get that they’re not bolusing for meals, but I’d have thought most people needed more basal, anyway, when they were sleeping compared to when they’re awake. Not true?

I’m not sure. I know my own body. I know what my endo said. I know the Tandem manual says the parameters set for sleep mode are based on the assumption that you’d have moderate steady BG levels in your sleep. But we’re all different and I’m not sure what’s actually common (if there is such a thing). Anyway, I’ve got a better handle on what I need. Glad you’re keeping on top of your daughter’s needs, unpredictable as they can be.

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