Short high(ish) spike vs longer lower spike?

[Sirzy]

After reading about how almonds can reduce spikes if eaten just before a meal, I thought I'd give it a go with my breakfast, as this is when I tend to get my spikes, it doesn't matter what I eat, I always end up spiking after breakfast

I had half an once of almonds with my usual breakfast (couldn't manage a full ounce it's just way too many to manage first thing)! After an hour, which is usually my highest reading, I was almost 1mmol below my normal reading, which was great, but my 2 hour reading was a bit higher than normal and remained slightly elevated, whereas normally it would've dropped every hour after eating. I put this effect down to the high fat content in the nuts causing the carbs to be released more slowly from my stomach.

So my question (sorry for asking it in such a roundabout way!) is, is it better to have a high(ish) peak that only lasts for an hour, or a smaller peak that might go on for an hour or two? :?

 

[sugarmog]

Although I understand your question, I'm not sure that it reflects your experiment. From your description it appears that the almonds gave you a longer, higher spike, not a longer smaller spike.

 

[borofergie]

It's a good question, and one I've often pondered myself.

We're often told that it's the spikes that do most of the harm, which would suggest that the longer lower spike would be less harmful. The geeky engineer in me tells me that there is an exposure element to this too. If I had to chose, then I'd go for the spike that has the smallest area under the curve.

This is one of the reasons that I'm not so keen on the whole low-GI thing. I'd rather get my spike out of the way than have it lingering for hours.

 

[Sirzy]

I was thinking along the same lines, surely getting the spike over with quickly is better than prolonging it over several hours. Plus, if my bg is raised all morning it then affects my bg for the rest of the day by running into lunch time, etc.

 

[smidge]

Hey Guys!

I've been pondering this very question for the last few months! With LADA, my after food spikes are pretty difficult to control. Even after a chicken salad lunch (virtually no carbs) I'll often go from low 5s to mid 8s. If I have starch carb in my meal (maybe 2 Tbs of basmatti rice), the timing of the Apidra is difficult to avoid the early spike without having a hypo later and then another spike a bit later. So, my HbA1cs are always pretty good (5.9 for the last one), but this hides a multitude of spikes and relative lows (e.g. 4.1) (which I keep a spreadsheet of, calculate month on month averages for before food, after etc and chart trend lines - I know, but i find it interesting :lol: ). I asked the consultant about standard deviation from mean and whether someone with a good average, but highs and lows within it are at any greater risk than someone with a good average that is consistent within it. He said that it is the HbA1c that matters and it is that measurement that increases or decreases risk. However, I wasn't convinced because he couldn't point me at any research or evidence of this. My own view is that the higher the spike the more pressure that must be put on the body trying to process that, so i think I'd prefer constant 5.5 - 6.0 readings than before food 4.1 with the after food 7s and 8s even if it averaged the same - if you see what I mean. I really would like to know for sure though!

Smidge

Smidge

 

[Grazer]

I read a research article (but typically can't find it now!) I think from Professor Christianssen from the copenhagen summit on diabetes. He suggested that high spikes IN THEMSELVES cause a degree of damage, with platelets attaching to arterial vessels and causing a degree of cardio damage with each high spike. Thus, lower and longer would be better.
This article says much the same:-
"One Hour OGTT Result over 155 mg/dl(8.6 mmol/L) Correlates with Markers for Cardiovascular Disease
A study published in November of 2009 linked blood sugar readings one hour after ingesting glucose with high fibrinogen and leukocytes count (WBC), which point to subclinical inflammation, and with abnormal lipid ratios, and insulin sensitivity in a population of 1062 participants with normal glucose tolerance or prediabetes. "Normal" glucose tolerance as defined by doctors and researchers means a 2 hour blood sugar reading of under 140 mg/dl on an oral glucose tolerance test.

This study found
Elevated 1hPG [one hour plasma glucose] in NGT [people with normal glucose tolerance] and pre-DM subjects is associated to subclinical inflammation, high lipid ratios and insulin resistance. Therefore, 1hPG >155 mg/dl could be considered a new 'marker' for cardiovascular risk.
This strongly supports the message I have been emphasizing on this web site since 2004 that it is essential to keep one hour blood sugar reading after meals under 140 mg/dl.

The reliance of doctors on two hour glucose tolerance test results allows people to live for years with blood sugars high enough to promote complications long before they are diagnosed even pre-diabetes." Full link:- http://care.diabetesjournals.org/conten ... 2.abstract

Further stuff I read suggested that Beta cell death occurs with peaks :-
"Beta Cells Die Off in People Whose Fasting Blood Sugar is Over 110 mg/dl (6.1 mmol/L)
An intriguing study shows the severe organ damage experienced by people whose blood sugar falls into a range most doctors consider to be near-normal. A team of researchers autopsied the pancreases of deceased patients who were known to have had fasting blood sugars that tested between 110 mg/dl and 125 mg/dl within two years of their deaths. The researchers found that these patients, whose blood sugar was not high enough for them to be diagnosed as diabetic, had already lost, on average, 40% of their insulin-producing beta cells.


Since the American Diabetes Association believes that a fasting blood sugar level of 100 mg/dl to 125 mg/dl corresponds to a 2-hour glucose tolerance levels of 140 mg/dl to 199 mg/dl, this suggests that patients whose post-meal blood sugars rise only to the non-diabetic "impaired" level may be well on the way to losing as much as 40% of their beta cell mass. It also suggests that people with abnormal glucose tolerance who wish to avoid further beta cell loss should try to keep their blood sugars under 140 mg/dl at all times."
For the geeks, this is the full link for this article http://diabetes.diabetesjournals.org/cg ... l/52/1/102
Those with a nervous disposition shouldn't read some of the other related links! :thumbdown:

 

[Sirzy]

I've been doing a bit of reading about this today and there doesn't seem to be any consensus about this question, however, I did come across a paper which suggest similar things to the links posted by Grazer (excellent as always Grazer, loving your work :wink: ). This study (wished I'd saved the link!), suggested that even short spikes can cause macrovascular damage, (no mention of micro damage or what is classed as a 'short' period of time). With that in mind, I may give the almonds another go tomorrow morning!

Smidge, as regards the A1c test, I'm still fairly new to all this, but from what I've read, the A1c only gives an overall average and doesn't take into account any highs (or lows) that happen on a daily, and hourly basis. For me, I think regularly checking with a meter (despite it's low accuracy) is what is best to identify fluctuations. BTW, I love your commitment with the graphs, etc, I'm well on the way to doing this sort of thing myself, I already have an excel spreadsheet with all my meals and BG readings in it. Do you use a specific type of diabetic software? Diabetes is a frustrating but fascinating disease, I just wish I wasn't my own guinea pig :cry:

 

[borofergie]

I love your commitment with the graphs, etc, I'm well on the way to doing this sort of thing myself, I already have an excel spreadsheet with all my meals and BG readings in it.

Never, I said NEVER ask Grazer to show you his spreadsheet. :shock:

Don't encourage the Geek.

 

[Grazer]

Never, I said NEVER ask Grazer to show you his spreadsheet.

Don't be so personal! I don't Spread my Sheets for just anyone "ewe" know!

 

[Sirzy]

Oo-er, this thread's getting a bit saucy!!

Seriously though, can anyone recommend any good software (preferably free or fairly reasonably priced!), or are people mainly sticking to good old excel?

 

[chocoholicnomore]

I would also be interested in any good preferably free software

 

[sugarmog]

I seem to have got a bit confused with your original almond experiment. Can you confirm that after eating the almonds the highest peak of your readings was lower than usual, and by how much. I would be very interested to know, as I always have almonds as part of my breakfast and they are also one of my favourite snacks.

 

[Grazer]

Sugarmog, nuts not only have a low GI themselves, but also lower the GI of any food they're eaten with. This means the sugar spiked are lower but may go on longer. This is generally taken as beneficial, giving a slower but longer release of energy. This will happen with all nuts, but hazelnuts and walnuts are particularly good. Cashews are worst; they aren't really nuts but shoots from bean pods.

 

[carbman]

Look into Macadamia nuts, chock full of healthy fats and nutrients and very lowcarb.

 

[phoenix]

I asked the consultant about standard deviation from mean and whether someone with a good average, but highs and lows within it are at any greater risk than someone with a good average that is consistent within it. He said that it is the HbA1c that matters and it is that measurement that increases or decreases risk

Several methods of measuring glucose variability. * (see link) When compared they don't seem to show very different results.
With continuous monitoring then we can get better information than studies that have used multiple finger pricks ... but who is going to fund the necessary long term studies?
In animal studies and some short term studies with T2 patients, high glucose levels (spikes) have increased the oxidative stress that is thought to cause damage but in humans experiments have had inconsistent results .
So far the long term evidence , mainly in T1 and mainly from the DCCT shows, that it is the HbA1c that is most crucial as an indicator of possible future microvascular problems and it doesn't matter how that was achieved (ie from a flat profile or one with lots of highs and lows). Variability between HbA1cs is much more important... ie not good to have a high HbA1c followed by a good one and then back up again.
For macrovascular risk it wasn't the HbA1c that was most indicative but the average glucose level. (people with the same HbA1c can have very different average levels)
This is from a summary of the evidence (* also summary of methods used to calculate variability)

a relation between short-term glucose variability and microvascular or neurological complications has not been proven in type 1 diabetes patients and has not been investigated in type 2 diabetes. Second, no studies have been performed investigating the influence of glucose variability on macrovascular complications and death in either type 1 or type 2 diabetes patients, but the HEART2D trial suggests that lowering glucose variability does not improve cardiovascular outcome in type 2 diabetes patients after acute myocardial infarction. In contrast, glucose variability is clearly related to mortality in critically ill patients without diabetes, but intervention trials are still lacking

According to the literature we may conclude that glucose variability seems related to oxidative stress in in vitro and animal studies and, although not consistently, in an experimental setting in type 2 diabetes patients. In a clinical setting, glucose variability is related to mortality in nondiabetic, critically ill subjects and is associated with (severe) hypoglycemia in insulin-treated diabetes patients. However, at this time there is no supportive evidence for targeting glucose variability separately from mean glucose and/or HbA1c values

http://edrv.endojournals.org/content/31/2/171.full
If you want to research further E Kilpatrick has done a lot of analysis of data in this area.(mostly in T1 from the DCCT)
E Monnier has done shorter term research on glucose spikes and oxidative stress in T2
there is a report from a few years ago of a debate between these 2 researchers who speak from opposing views)

 

[smidge]

Hi again all!

Fascinating subject!

Phoenix - thanks for the research refs - very interesting. My consultant is definitely from the HbA1c/average is the important factor school. I'm not so sure :? Both my HbA1c and average are good, but my spikes are higher than I would like. I think consultant's view is that those with higher levels of glucose attaced to their red blood cells are at higher risk regardless of how the glucose got there! He doesn't believe deviation from mean is relevant to risk factor.

Sirzy - I use Excel at the moment for recording everything and have 2 years of info averaged, graphed and trended (if there's any such word :lol: ). I record all food eaten with weight if I know it, with all readings/times and units of my two insulins; Fasting (F), Before food (B/F), After food (A/F), Night (N) and any random tests taken (G)eneral). I average these daily over the course of a month and graph the output with a trend line superimposed. (I have my favorite recipes in another spreadsheet with the carb calculation broken down by portion. You'll probably all stop talking to me now but I work in IT so the Geek factor appeals to me )! I think Excel can do everything you need, but I agree it would be better to have a program written for this purpose - I just couldn't find one two years ago when i was diagnosed. I'm currently looking at an App on my iPad. It's not free, but only a few pounds, so i'll let you know how I get on with it in a couple of weeks! I have to say, it is amazing to look back on two years of data and see my progress.

Smidge

 

[Arik]

This is, I think, one of the most crucial issues for people with LADA. Unfortunately, these excellent studies that have been linked to in the thread don't really answer my question:

Do spikes contribute to the loss of beta cells?

Frankly, the answer seems to be probably yes, but there are a few reasons why we're not likely to know for sure.
Firstly, most of these studies (rightly) deal with T2 patients and look at indicators like target organ damage - and then conclude that spikes aren't as important as A1c. No surprise there, but it doesn't answer my own question.
Secondly, the studies are pretty small - Bardini et al used 1062 patients, but were only looking at inflammation markers. Where are you going to find so many LADAs?
Thirdly - and this is a problem we come up against with a lot of GPs and even endocrinologists - the two hour glucose is the only measure that has any kind of accepted reference values. Try to tell your doctor that you spiked 300 mg/dl one hour after a meal and you'll likely just get a blank look. Until enough data is gathered on normal and abnormal one hours glucose levels, it's not likely to become an accepted tool for assessment.

All the serious endocrinologists I've spoken to have said that avoiding spikes is probably important, and that's one of the reasons for giving insulin in early stage LADA.

If there were a couple of hundred insulin treated LADA people on the board, it might be interesting to do a study on spike levels.

Arik

 

[Sirzy]

Great comments everyone, I'm still unsure if almonds should be added to all my meals, but I tried it again this morning with breakfast and got similar results, a smaller spike that was more prolonged. As this now takes me under the magic number I've set for myself, which is 6 in the mornings, I'm convinced that the almonds are probably a good idea. I've also tried half an ounce with my lunch today to see what kind of affect this might have. Just for comparisons sake, I tried my breakfast without almonds yesterday morning, I had the same fasting number today and yesterday, and the spike was almost 1mmol higher yesterday.

Smidge, that's so organised of you!! But your background in IT kind of explains your geekiness :wink: As I tend to eat the same meals throughout the week, my spikes tend to be similar most days, so I can tell from looking at my records in excel what my BG should be at most times of the day, I plotted a graph last night, just to have a look at it though, seeing it laid out that way really brings home the ups and downs of the day, and made me realise my breakfast spike is something I really need to deal with :?

Sugarmog, yes my spike was lower than usual, by around 0.7mmol, so I've gone from mid 6's to mid to high 5's, however, I now stay at this number for the following 3 hours, rather than decreasing every hour following the initial spike, which is why I was wondering what caused the most harm an initial high spike or a prolonged lower one. BTW, I understand that my numbers are probably considered good enough, even with the spike into the 6's, but I'm trying to get as low as possible, not Bernstein low, but under 6 at least during the morning

 

[Sirzy]

Smidge,

On a completely different topic, I tried your cheesecake receipe over xmas, (I tweaked it a bit, used low fat cream cheese, soya spread instead of butter and added some melted high cocoa choc to the cream cheese mix), and it was really lovely, to be honest it was much nicer than the shop bought cheesecakes I used to buy in my pre-db days! Hardly budged my bg too It was so nice to have a treat over xmas and not feel guilty about it. I make the biscuits regularly now to, and add some choc chips to the mix, they're great with a cuppa in the afternoon. So just wanted to say ta very much for that

 

[Helenababe]

I've learned from personal experience that it would be better to have a lower spike that would come down slowly over time, rather than what happens to me, where my spikes come down very quickly.

I have a problem with this, which apparently is rare but my doctors don't know why it happens. I go very drowsy after each meal, and very often go into one of, what I call, my 'diabetic sleeps'. I also feel very ill when I first wake up.

The drowsiness is the effect of my sugar dropping too quickly. It happens no matter how many carbs I eat. As soon as it starts to come down, I get drowsy. So, even if I have a low carb meal, the small spike still comes down too quickly, and I get slight drowsiness, and of course the higher the carbs the worse the drowsiness.

It's awful to live with. My GP is puzzled as is my DN, and the only explanation my GP can come up with is that as my sugar is coming down it is sending my blood pressure down, or, something about too much water is being taken out of my blood.

With my spikes coming down quickly, you would have thought it would protect me more than if they lasted longer but I think I've already, perhaps, answered that one as I already have background retinopathy.

My GP's answer to my problem in the end? Don't eat any carbs at all, then you won't get drowsy, then you can come off all your tabs!!!?
And that came from a doctor!

Helena