When not to dose insulin for protein

When you’re eating a very low carbohydrate diet you need to dose insulin for protein. There are however a couple of occasions where you should be careful with this.

One is when you exercise after meals. I like to go for walks after lunch on most days. This means that I don’t take any insulin for the 25g of protein that my meals contain. I always bring glucose tablets in case my blood sugar slumps, which happens surprisingly often. I don’t walk especially fast, but the act of walking itself is enough to cancel the 1,5 units of insulin I would normally take. If you’re taking high insulin doses doing some form of exercise can help you improve your insulin sensitivity.

The other thing you want to look out for is alcohol. When you drink your liver, which is in charge of metabolism, is forced to prioritize detoxification. This means that gluconeogenesis, the conversion of amino acids to glucose, is impaired. As a rule I would never dose insulin for protein if I had more than one glass of wine around dinner time.

Note that even though many diabetics on insulin drink alcohol and do just fine, it can be quite dangerous. I stopped drinking alcohol six months ago, as some of my worst hypoglycemic episodes have happened in connection with alcohol. It tends to drive blood sugar down, and if you go to bed drunk you might not wake up from low blood sugar the way you normally do. As the liver is busy with the alcohol, you have lost your first responder. Also, glucagon kits don’t work when you’re intoxicated. 

I don’t mean to scare anyone, but it’s important to be aware that alcohol and exogenous insulin is not a good mix, and you’re taking a risk when you drink. If it’s worth it or not is up to you.