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From Orlando, Florida, USA:

We have a vegetarian patient who consumes meat analogs/soy products who recently started the insulin pump. Are there any special considerations for carb counting with a vegetarian meal plan? We have had difficulty getting a handle on his blood glucose levels - they have been jumping around.


I have not had any experience with a vegetarian pump user. The thing that may be contributing to varied blood sugars may be fiber. Fiber grams may need to be deducted from the total carbohydrate amount in order for the insulin/carb ratios to be determined.


Additional comments from Lois Schmidt Finney, diabetes dietitian:

Usually we only look at fiber if more than about 5 grams is consumed at any one meal. If the person consumes a meal high in vegetables or beans, that amount is easy to attain. Since many of the protein alternatives are higher in carbohydrate than meats, be sure those are figured in the total so the amount of insulin to cover the meal will be correct. It may take some trial and error. Good luck.


Additional Comments from Betty Brackenridge, diabetes dietitian:

As Joyce has pointed out, some meat analogues do have a significant fiber content (typically 3-5 grams per serving) and it may be worth doing an experiment controlling for, or counting this to see if it clears up the problem (we have sensitive patients subtract the indigestible fiber content of any food over 3 grams/serving from total carbohydrate). However, this person would either have to be eating a lot of meat substitutes (large and/or variable quantity) or be unusually sensitive for this to be a likely culprit in my opinion.

If this person has had diabetes for some time, I would consider either problems with delayed stomach emptying or absorption from injection sites to be a more likely source of glucose variability. With pumping, folks are generally doing so much more testing that we feel they often find their blood glucose patterns that have been going on undetected for some time. This is particularly true of postmeal testing. Since tests to confirm delayed emptying are expensive and fairly insensitive, we generally just have folks eat the same meals for several days, and test to try to make the call as to whether food variation or stomach emptying is at the root of their problems. Note that it is important to try to keep blood glucose control fairly consistent -- high blood sugars will transiently worsen any delayed stomach emptying due to diabetes neuropathy. As for the injection sites, we inspect the belly (or wherever for hardness, lumps, etc) then also try another site to see if there is a change in blood glucose patterns.


Original posting 3 Oct 1998
Posted to Meal Planning, Food and Diet


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