The first time I heard the term gluco-neo-genesis, I had no idea what it was and I had already been a type 1 diabetic for 11 years.
11 years… as a T1D (Type 1 diabetic) and no doctor, no diabetes nurse, no dietician, no diabetic educator ever told me about it! Why?
I was hearing a few other T1D’s using low carb diets and “looping” with insulin pumps talking about it, but couldn’t find any really good information. I went through all the information I had gotten from the hospital at diagnosis and no mention of it there either.
So what is it?
Gluconeogenesis (GNG) is a metabolic pathway that results in the generation of glucose from certain non-carbohydrate carbon substrates. From breakdown of proteins… Gluconeogenesis is one of several main mechanisms used by humans and many other animals to maintain blood glucose levels, avoiding low levels (hypoglycemia). – Wikipedia
Simple version – your body turns protein into glucose. It converts at a slower rate than carbohydrates which means you need to bolus insulin differently for it. This is very important if you are trying to have steady blood glucose levels. You need to factor this in and bolus for it.
My blood glucose levels had improved substantially when I reduced my carb counts below the 20 Total per day, but I was still noticing another rise in my blood glucose (bg) 4-8 hours later – usually in the middle of the night. This rise was from the slow breakdown of protein turning into glucose from what I had eaten at dinner.
So, how much insulin do I bolus for the protein I eat? I talked to other T1D’s who were blousing for protein and asked a lot of questions and did a lot of research on my own. Then, I made sure that my basal rates were good and I started with a protein only meal (steak only) and watched how my blood sugars responded over the next 8 hours. The next day, I repeated the same meal and added an extended fast acting insulin bolus (I use Humalog) for the protein using the calculations others had given me, and watched again over the next 8 hours. After a few times of doing this, and some adjustments, I started to learn what worked for me.
I found that different types of protein – steak, eggs, chicken, fish all affect me differently. The amount of fat with the protein affects the timing as well. Currently, I multiply my total protein grams by 50% and count that number as a carbohydrate. I enter that number into my omnipod insulin pump as a carb count and do an extended bolus with a delay of 2-6 hours later depending on the fat content and type of protein. As an example: 4 g of protein x .50 = 2.
I would then enter an extended bolus for 2 carbs. The delayed bolus catches the delayed rise in blood glucose created from the protein. Here is the fun part….. all of this varies from person to person. Digestion rate, insulin sensitivity, type of insulin used etc. – it is different for everyone. This formula is just what works for me personally.
One of the best resources of information on this subject is the book Diabetes Solution by Dr. Richard Bernstein, MD. He goes into great detail about all of this. If you are a diabetic – no matter which type you are, I highly recommend that you get this book and read it. Dr. Bernstein discusses the types of insulin, the timing of insulin, scheduling, the use of Regular (R) insulin for protein boluses, proper amounts to eat and medical concerns to be aware of. Most of the T1D’s I gathered my information from, got their knowledge from this book.
One very important thing that will help anyone trying to control blood glucose levels, is accurate knowledge about the food you are eating. I am always looking up food information and weighing my food. It is a huge “must” for me and I keep a really good food scale on my kitchen counter all the times and food apps on my phone get used daily. Guessing carb counts and protein amounts will not get you to your best blood sugars. You need to know what you are putting into your mouth.
Like all things relating to diabetes, insulin and blood sugars, this is complicated and you need to get it right. Educate yourself as much as you can and talk with your personal health care provider for guidance.