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Protein is a relatively ignored nutrient in Type 1. Most people with Type 1 diabetes are advised to consume protein ‘in moderation’ (whatever that is). Protein in advanced diabetes complications is restricted because of renal disease, but for the vast majority of people, protein should be consumed freely. It isn’t easy to make general recommendations. But unless you have very severe kidney problems, then if you are feeding children, teenagers, or people recovering from a serious illness, there is no need to restrict protein at all. The same goes for those looking to gain muscle mass.

Specialist opinion is quoted for keto diets as 1-2 grams of protein for every kilogram of ideal body weight.

Protein raises blood glucose in Type 1. Glucose rises in most, but not all people, so experimentation is necessary to find out. Typically, the glucose rise caused by protein is less sharp than for carbs but may be prolonged. And take longer to appear, usually 2-3 hours after a meal. If you are eating a lot of carbs, then this process is going on, but it will be masked by the substantial effect of carbs.

It will be necessary to inject insulin to allow for the protein in your meal. So, as well as counting carbs, it will be required to calculate the protein in the meal as well. But don’t worry, it soon becomes a habit and easy to learn which of your foods contain protein and how much protein is in the meal.

Some people find that a delay in some of their meal-time insulin injection or pump setting helps. They use a small dose of insulin for the carbs in the meal and another dose a bolus later for the protein.

Others can balance a single bolus dose of insulin to cover both carbs and protein. As a rough guide, the calculation, for protein, it is usually half of the amount of bolus insulin that you would use for carbs. So, if your insulin to carbohydrate ratio is 1 unit to 10g, then your insulin to protein ratio can start at 1 to 20. Refine the insulin dosing as you gain experience.

If you do delay fast-acting insulin injections for protein, you should be aware of insulin stacking. Insulin stacking is when two or more doses of rapid insulin are taken within 5 hours. This means that these doses might be active at the same time, and their effects overlap one another. For this reason, if you need to take a dose between meals, be aware of the chance of a hypo. It’s recommended to test your blood glucose between each meal to spot and prevent any low blood glucose that might result from insulin stacking.

New fast-acting insulins are designed to be used with high carb foods. They have not been designed for a ketogenic diet. Rapid-acting insulin still suits a lot of people. Every Type 1 must understand the characteristics of their own insulin brand. Sometimes people change to a less aggressive profile, such as found in the older human insulins, sometimes called soluble or regular insulins, for example, Actrapid or Humulin S. Their delayed action might be better for picking up the protein rise. It is all about getting the best profile for your particular metabolism. Anyone can adapt their timing of injections to whatever insulin they have. People on pumps can delay bolus injections or do dual wave blousing. It is best to discuss the dosing with your specialist insulin pump team.

It is essential to collaborate with your diabetes specialist in all aspects of diabetes management.

Share examples of your test results and a diary of the food you ate to show your diabetes specialist the effect that protein is having on your diabetes if you choose a ketogenic diet.

Again, share examples of your test results and a food diary to show your team the effect protein is having.