Navigating The Tricky Road To Protein Counting

It is pretty safe to say that people living with diabetes are quite aware of the relationship between consuming carbohydrates and their effect on glucose levels. In fact, educating individuals living with type 1 diabetes to adjust their insulin dose based on the amount of carbohydrates consumed during mealtimes [carbohydrate counting] has been a part of diabetes management for many years.

However, have you spared a thought of how protein could affect your blood glucose level and, in turn, impact your insulin dosing?

Well, it can. In simple terms, consuming protein tends to reduce the glucose spike just after a meal, but causes a glucose surge a few hours after. The tricky parts are that it depends on the quantity of protein consumed and whether it was eaten together with carbohydrate and fat.¹

First, about Protein

Protein is an essential source of nutrition. It is the building block of our cells, tissues and organs, and plays an important role in various physiological activities. Adding protein into our diet also helps us stave off sugar cravings and keeps us full after a meal.¹

Food sources of protein can be plant or animal based. Some of the healthier sources of protein are:

• Beans, peas and lentils
• Soy foods
• Nuts and nut butters
• Fish
• Lean meats, e.g. chicken and turkey

Let’s Talk Protein and Type 1 Diabetes

An article exploring various studies that determined the effect of proteins in meals on blood glucose levels in persons living with type 1 diabetes, informs that:²

• Consuming protein leads to an increase in insulin requirement.
• Protein causes a delayed and sustained increase in blood glucose levels.
• This increase in blood glucose levels is not seen immediately after a meal but occurs between 1.5 – 4 hours after.
• The effect varies depending on whether protein is eaten alone or with carbohydrate and fat:
  • When a meal contains only protein [e.g. a piece of steamed fish], a more considerable amount of protein is needed to cause the delayed increase and sustained glucose level [~ 75g of protein].
  • When consumed together with carbohydrate and fat [e.g. steak and chips], a smaller amount of protein is enough to create this effect [~12.5g of protein].
• The impact that protein has on blood glucose levels after meals [postprandial glucose level] varies from person to person.

So, what does this mean for you?

Protein Counting, is it a Thing?

Researchers are still trying to determine if protein counting can be practically be included into the daily life of people living with type 1 diabetes. Protein counting isn’t as clear cut as carbohydrate counting because its effect on the glucose level depends on the type of meal and the individual.

There are various insulin dosing algorithms available, taking protein consumption into consideration. Since protein counting can be complex, it isn’t incorporated into daily practice very often.³

The American Diabetic Association recommends checking the glucose level ≥ 3 hours after a meal to determine if further insulin adjustment is required.⁴

Any decision must be discussed and planned with your diabetes healthcare team, as it requires careful glucose level monitoring. The adjustment to your insulin dose will rely on the type and method of insulin delivery.

So far, no guidelines recommend protein counting as part of diabetes management. However, the guidelines encourage healthy eating habits and educating persons living with type 1 diabetes to monitor their glucose levels and adjust insulin doses depending on their food intake.⁴

Some suggestions from us that you could consider are:

• Work with your diabetes healthcare team to create a nutritious and balanced diet plan.
• Monitor your blood glucose level ≥3 hours after a high-protein meal.
• Stick to healthier protein sources [usually plant-based] and enjoy lean meats or fish two or three times a week.

Final Thoughts

Though proteins can impact blood glucose levels after a meal, they are still an important nutrient to include in your daily diet. It is good to be aware of its potential effect and we encourage you to work with your healthcare team to learn more about managing insulin. Moderation is always important, and often times we tend to forget that. So, count your carbs and enjoy proteins as part of a well-balanced and nutritious meal!

Reference

1. Oberg E. Type 1 diabetes diet food plan guidelines. https://www.medicinenet.com/. 2020 Available at: https://www.medicinenet.com/type_1_diabetes_diet/article.htm. [Accessed September 2021].
2. Evert AB. Factors beyond carbohydrate to consider when determining meantime insulin doses: protein, fat, timing and technology. Diabetes Sprectr. 2020;33[2]:149-155.
3. Herron A, Sullivan C, Brouillard E, Steenkamp D. Late to the party: importance of dietary fat and protein in the intensive management of type 1 diabetes. A case report. J Endocr Soc. 2017;1[8]:1002-1005.
4. Evert AB, Dennison M, Gardner CD et al. Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care. 2019; 42: 731-754.