@kokhongw I cannot see how that chart tells us that after a high spike due to carbs we will crash sharply to hypo levels. . Your chart is simply showing the insulin levels dropping over a period of 2 or more hours.
A crash in BS levels from very high to very low in a short time does happen in Reactive Hypoglycaemia but not normally with diabetics, pre-diabetics, or non-diabetics.
You are probably right that for Type 2 who are severely insulin resistant, no matter how much insulin is secreted glucose remains high for a long time...perhaps even beyond the 5 hour, which is pattern 4. High fasting insulin, delayed insulin response, elevated insulin after 5 hrs. This likely happens when people follow the advice to graze contantly...regular 2-3 hours meals.
However this post meal spike and crash likely happens more often than we all realise. Most of us would simply pass it off as being very hungry...Few except perhaps those on CGM would monitor their glucose response hourly for up to 5 hours. And unfortunately even fewer have access to a insulin assay to match it up.
I have not seen a similar overlay against a glucose response. Dr Joseph Kraft insights was that insulin response provide better diabetes classifications than glucose response.
http://meridianvalleylab.com/wp-content/uploads/2012/08/GITT-Article-Re-type1.pdf
What I see from the chart is that area under the curve remains much higher for patter 2/3. This basically means large amount of insulin remains in our system for up to 5 hours pattern 2 and 3. The difference between 2 and 3 is the delayed insulin response, ie insulin peak after 1 hour and a slower return to normal.
I attribute this delay in pattern 3 to
1) Loss of 1st phase insulin response
2) Increased insulin resistance
This provides the reasons that as we move from pattern 4 towards 2, we will begin to experience more frequent hypos/hunger, because there is improving insulin senstivity but still a mismatch in the level of insulin secreted/signalling...it is a spectrum that may fluctuate between pattern 2 and 3 depending on our diet/exercise/stress etc. This is often interpreted as reactive hypoglycemia.
