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Bgs below traditional diabetes cut offs can cause damage

Tannith said:
I almost never take pre or post meal readings. Haven't done so since around 2017. But my 2 hour ogt is 10.9, JUST below the diabetic level, at the very top of the prediabetic range. I took it recently for the first time in 8/9 months. It is the nearest thing I have to a post meal reading.
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Then I don't understand why you seem to be lecturing us on post meal readings when you don't even know your own. Puzzling.
 
Tannith said:
I almost never take pre or post meal readings. Haven't done so since around 2017. But my 2 hour ogt is 10.9, JUST below the diabetic level, at the very top of the prediabetic range. I took it recently for the first time in 8/9 months. It is the nearest thing I have to a post meal reading.
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Hi,

Who conducted the recent OGT for you?
 
Tannith said:
I almost never take pre or post meal readings. Haven't done so since around 2017. But my 2 hour ogt is 10.9, JUST below the diabetic level, at the very top of the prediabetic range. I took it recently for the first time in 8/9 months. It is the nearest thing I have to a post meal reading.
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But you’ve made a post and highlighted the risks of excessive readings at these times so why do you not take these? It seems illogical, at the very least, not to even do so as a monitoring sample taken occasionally or to establish levels for regular meals.

How about hba1c as these are also used as a measure of risk of complications?

Why only use fbg, which whilst it has its merits also has limitations for interpretation of the overall picture?
 
I have never done an OGTT. I have noticed that when I have had sweets I get a quick spike which starts to go down before the hour mark. If I have other carbs, for example bread, potatoes, porridge the spike happens more slowly and lasts alot longer. This is why pre and post meal readings are important. Not all carbs work in the same way.
 
Antje77 said:
From the first link in Tannith's post:

"At the Mayo Clinic some of these difficulties are overcome. Autopsies are performed within 12 h of death (usually <6 h), including weekends. The Mayo Clinic integrated medical record system allows easy access to the prior clinical records of the cases. As the Mayo Clinic tends to be the primary health care provider for people hospitalized at the medical center for their final illness, most of the autopsy cases have had a general medical examination (including a fasting blood glucose) during the year before death.

In the present study, we took advantage of the unique autopsy material available at the Mayo Clinic to study 124 human pancreata from cases with and without diabetes and matched for obesity. All cases had a well-preserved pancreatic specimen and documented general medical exam, including a fasting blood glucose obtained during the 12 months before death."
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The OP discusses an ongoing time related event of beta cell death apparently caused by glucose levels being either too high or too low. This technique mentioned here is by definition a one shot measurement which references the last recorded FBG which could be over a year previous. it cannotbe used to support the hypothesis that low FBG kills beta cells.

As we have discussed in a previous thread, the OGTT does not indicate beta cell mass or demise. The c-peptide test gives a value for total pancreas output at the time of measurement but this can be affected by insulin resistance and energy expenditure variations, so again is not suitable for determining beta cell health or demise. There is a technique using proton beam resonance scanners, and this can be applied in vivo. We do not know what the italian researchers used, but it is unlikely to be proton beam since this is a rare piece of equipment and until recently was only available in Poland. A conventional MRI scan can be used to estimate pancreas fat content. but not beta cell mass or functionality.
 
HSSS said:
But you’ve made a post and highlighted the risks of excessive readings at these times so why do you not take these? It seems illogical, at the very least, not to even do so as a monitoring sample taken occasionally or to establish levels for regular meals.

How about hba1c as these are also used as a measure of risk of complications?

Why only use fbg, which whilst it has its merits also has limitations for interpretation of the overall picture?
Click to expand...
The FBG reading is directly affected by liver dump / dawn phenomenon, and is also influeced by meals and snacks eaten the previous day, so is no longer used for diagnosis. The HbA1c is the gold standard used now in favour over the FBG.
 
I have not yet found the referenced Italian study, but found this which may be pertinent to this discuaasion
https://link.springer.com/article/10.1007/s00125-013-3098-3
And another italian study that may also be of interest.
https://d1wqtxts1xzle7.cloudfront.net/48403726/dmrr.68020160829-2585-1tckjdc.pdf?1472467465=&response-content-disposition=inline;+filename=Gliclazide_protects_human_islet_beta_cel.pdf&Expires=1635523145&Signature=EVhIdNOKSFzht4LfC09uNrftoGgTUfhT8Khvn3r~A0-dSjX9wyR~KZ7Uw6nK-S7ko7ZAA4OsnbGwQ7kPykUKZI87qmpcLLo0HlzsQZO987dlN6ZqMWCA6wHtL3qzdHBh9uQS0VSLiPFKnoFno~Vl83hj6ccZ2TLilARgxSJnb7jtLwvpA9DzwidLhAjkNrT7~Jneb-HCUkEhw1FY0FjYKgntlFmbJ5~kn3E03vmz7~zZxgZGFs9gYRV7p847nwb5reyW2wUOseDegFb3myGZjZxitTf1tMru3o-ouQRrRVSCmLVilunEEGMGtF89HdRRFX5qNOVgpHS6dsx0jdyOOg__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA
 
Apparently there is a new method being used to estaablish beta cell function.

When the pancreas produces insulin, there ia an intermediate stage of the manufacturing process, where parts of the chain leak into the blood stream ahead of the final output of insulin. This polypeptide molecule chain is identifed as Proinsulin, and it can be measured. If blood samples are analysed then the ratio of Proinsulin to Insulin is a measure of how efficient the insulin process is, and is being used to estimate insulin function in the pancreas in vivo. The amount of Proinsulin that leaks is approx 3% of what gets turned into insulin. It is not accurate but indicative of IR in the pancreas output. I think it requires a mass spectometer to do the measurements, so a home test kit is years away.
 
Oldvatr said:
The FBG reading is directly affected by liver dump / dawn phenomenon, and is also influeced by meals and snacks eaten the previous day, so is no longer used for diagnosis. The HbA1c is the gold standard used now in favour over the FBG.
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Exactly my point. Relying on solely a fbg misses so much extra information that is readily available in hba1c and pre and post meal readings. @Tannith seems to have chosen to ignore my post so we won’t know why these have been omitted
 
Oldvatr said:
And another italian study that may also be of interest.
https://d1wqtxts1xzle7.cloudfront.net/48403726/dmrr.68020160829-2585-1tckjdc.pdf?1472467465=&response-content-disposition=inline;+filename=Gliclazide_protects_human_islet_beta_cel.pdf&Expires=1635523145&Signature=EVhIdNOKSFzht4LfC09uNrftoGgTUfhT8Khvn3r~A0-dSjX9wyR~KZ7Uw6nK-S7ko7ZAA4OsnbGwQ7kPykUKZI87qmpcLLo0HlzsQZO987dlN6ZqMWCA6wHtL3qzdHBh9uQS0VSLiPFKnoFno~Vl83hj6ccZ2TLilARgxSJnb7jtLwvpA9DzwidLhAjkNrT7~Jneb-HCUkEhw1FY0FjYKgntlFmbJ5~kn3E03vmz7~zZxgZGFs9gYRV7p847nwb5reyW2wUOseDegFb3myGZjZxitTf1tMru3o-ouQRrRVSCmLVilunEEGMGtF89HdRRFX5qNOVgpHS6dsx0jdyOOg__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA
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That link doesn't work (for me anyway). Though it might just be my browser.

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EllieM said:
That link doesn't work (for me anyway). Though it might just be my browser.

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Try this hardcopy
 

Attachments

Not the study featured in the OP, but one that supports it in part, but not as it was reported.
https://bmjopen.bmj.com/content/9/7/e026010
As we a;lready knew, bgl levels below the hypoglycemic upper limit of 4,0 mmol/l are associated with adverse outcomes, but normal fbg of 4.6 and above have no increased risk.
 
Don;t believe everything you read . I have just uncovered a study of 3,000 inpateints in an USA hospital who registered a hypo event of 3.9 mmol/l or less (70mmg.dl) and in the follow up part of the study 33% of them had died in the 6 month period. I think this says more about the standard of care rsther than dabetes alone. The conclusion they drew was that hypo's are generally fatal events.
 
Oldvatr said:
Don;t believe everything you read . I have just uncovered a study of 3,000 inpateints in an USA hospital who registered a hypo event of 3.9 mmol/l or less (70mmg.dl) and in the follow up part of the study 33% of them had died in the 6 month period. I think this says more about the standard of care rsther than dabetes alone. The conclusion they drew was that hypo's are generally fatal events.
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It makes me wonder who the participants were, age, type of diabetes, general health and health care.
 
Still searching Google for that italian study referred to in the OP. Gone past page 105 so far and found this . It is chinese, but thankfully written up in English
https://link.springer.com/article/10.1007/s13300-020-00927-6

What we do not know is how these levels were being controlled, and whether hyperglycemic lowering agents were in use. It does not track hypo events for instance. Also, this was a 15 year study, and many of the original cohort may have developed diabetes after the initial FBG was taken, They probably changed diets, and lifestyles in that period too. become smokers or heroin addicts for instance.
 
Of course non-diabetics can have natural fasting BG below 4.
As I have noted from time to time I know an endocrinologist with a FBG of 3.5 who has reached a respectable age with no obvious adverse effects.
I assume that therefore the issue is artificially lowering BG below 4.
 
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