a question about post meal readings

Hi Bruce

this is an emerging area . The strictest post prandial levels you want to get under that I have come accross is <8.5 at 1 hour and <6.5 at 2 hours.

Marty B

Bruce,

Its very difficult, if not downright impossible to give a definitive answer. Figures I have seen suggest that a preprandial reading of 6 should result in a rise to no more than 8.5 at one and a half hours postprandial.

But it depends largely on what you have eaten. A meal that is too high in fast acting carbs could give you a much higher reading at 1 hour postprandial, whereas a meal containing largely slow-releasing carbs could give a lower peak but one that was maintained over a longer period.

Whoever said "we are what we eat" must have been an endocrinologist thinking about BG levels.

Hi Boris

I have some slightly different and rather stricter ideas on what numbers you should aim for and also when you should test for them. Note that I am not a doctor, just a type 2 who has tested quite a lot.

Early in the learning process I came across some advice that has worked brilliantly for me. It's called "test, test, test" and you will find it here: http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

In that the author recommends these limits:
Fasting Under 6
One hour after meals Under 8
Two hours after meals Under 6.5

She is, like me, just a diabetic. However, I did a little more research and discovered that at least one major authority, the AACE, also recommends fairly tight limits:

In mmol/L, rounded
...............pre-meal......2hr PP.....A1c
ADA ...........5.0-7.0.......<10.0......<7%
Joslin..........5.0-7.0.......<9.0......<7%
AACE.............<6...........<8.0......<6.5%

I wrote more detail on that here: http://tinyurl.com/35h52s
I also have a friend who has done a lot of reading of relevant papers. She presents a fairly persuasive case to keep your post-prandial numbers under 8 at all times; you will find her here:
http://www.phlaunt.com/diabetes/14045678.php

I tend to think in the long term. I reckon my odds of a long and happy life improve with tighter, rather than looser, guidelines. So I found my peak time, which happens to be at one hour, not two, and after I was succesful in achieving the aim of <8, I re-set my personal goal to <7.

But that's just me. You must do what you and your doctors are comfortable with.

Cheers, Alan, T2, Australia

Welcome to the forum,Alan.Sounds like you've really taken control of your diabetes!Good for you.Look forward to your contributions.

Knowledge is the key to control

Hi Alan and welcome to you,

Those AACE figures are certainly good targets to aim for and to try to maintain. The difficult part is getting there in the first place!

Hi Moderators

Thanks for the greeting.

If you check out the background here http://loraldiabetes.blogspot.com/ you'll find I've been around for a while on various diabetes forums on the net. I don't claim to be an expert, but I am a type 2 with a vital interest in the subject who learned by lots of reading, lots of personal experimentation and lots of discussions with other type 2's. I try to pass some of that on to newly diagnosed people when I can.

I'll try not to ruffle too many feathers, but I do get a little passionate about poor advice from authorities such as the ADA or the NHS. This will give you some idea of where I'm coming from: http://loraldiabetes.blogspot.com/2006/ ... ities.html

I'm afraid I won't be in often. I was told of this forum by Patti at the Diabetes Support Forum, UK: http://diabetes-support.org.uk/index.html and I spend a lot of time on the ADA forum and the anarchy of alt.support.diabetes on usenet.

Time gets to be a problem, but I will try to say g'day to some of the newly diagnosed when I can.

Thanks again.

Cheers, Alan, T2, Australia

Hi Boris

Thanks

I've read a couple of your later posts. I missed where you mentioned your type - you use insulin only once a day so I'm guessing type 2, but please correct me if I'm wrong.

You said <font color="blue">"My readings are staying stable, but still in the 9 - 11 range rather than the 6 to 8 range, but at least that is giving me a bit of confidence that my diet and exercise are appropriate and when the insulin dose is sorted out I will be doing OK. I'll keep on with the Drs instructions until the next consultation next week and find out what the next step needs to be."</font id="blue">

I stress that I am a diabetic, not a doctor nor a dietician. I have no medical qualifications beyond my own experience. But also remember that there is no reason why you cannot do more than the doctor recommends. If in doubt, check with the doc.

Please read that link I gave you: http://www.alt-support-diabetes.org/NewlyDiagnosed.htm
This will show how I applied that myself:
http://loraldiabetes.blogspot.com/2006/ ... djust.html

It is a process of iteration. Do what you do now, but add testing to find out exactly what is happening in your blood. Test, review, adjust. Because you are using insulin you should make menu changes only a little at a time so that you don't risk lows, but you will be amazed at how quickly effective those gradual small changes can be.

Eat, then test after eating at your spike time and if BG’s are too high then review what you ate and change the menu next time. Note that I say to test at your spike time - that is likely to be around one hour after you eat, not two. But you will discover that by testing too.

Then do that again, and again, and again until what you eat doesn’t spike you. You will get some surprises, particularly at breakfast time. The so-called "heart-healthy" breakfasts are NOT for most type 2's. Similarly, you will find variations through the day - the same thing will have different effects at breakfast, lunch, dinner and supper. But I can't say how they will affect others - only how it affected me - which is why we all need to test ourselves.

As you gradually improve your blood glucose levels, review the resulting way of eating to ensure adequate nutrition, fibre etc are included and adjust accordingly.

Then test again.

Test, review, adjust, test, review, adjust until you can reliably predict an acceptable post-meal peak blood glucose level.

Best wishes,

Alan, T2, Australia

I had found tighter advice for PP levels than Alan. I do hope it is worth the effort. Certainly useful for asessing insulin dosing.

Marty B

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
<br />I had found tighter advice for PP levels than Alan. I do hope it is worth the effort. Certainly useful for asessing insulin dosing.

Marty B
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

It works just as well for folks on insulin and certainly gives an excellent control method for adjusting insulin dosage. I have to add that it's largely down to Alan (and one or two others) that I joined the 5% club and have stayed there consistently over the past 4.5 years.

Patti
On Levemir/Novorapid. Last hba1c 5.3

Alan (if you are still with us),

Thanks for the excellent advice and for sharing your experiences. I wonder if you are aware that the ADA have very recently done an about-face on their high-carb diet recommendations for diabetics? It will be very interesting to see whether DA and our NHS follow their lead!

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by Dennis</i>
<br />Alan (if you are still with us),

Thanks for the excellent advice and for sharing your experiences. I wonder if you are aware that the ADA have very recently done an about-face on their high-carb diet recommendations for diabetics? It will be very interesting to see whether DA and our NHS follow their lead!
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">

Thanks for the kind words.

I am very aware of the recent tiny changes in the ADA. I wouldn't quite say "about-face". More like a slight crumbling at the edges of the "low-fat high-carb add meds to compensate for the high blood glucose" paradigm.

There is a long, long way to go yet.

They still have several web-pages promoting "eat more carbs"; here is just one example:
http://www.diabetes.org/nutrition-and-r ... arches.jsp
I read an almost direct quote from that in a new poster on my Australian doctor's wall yesterday (sponsored by a low-GI bread manufacturer).

I'll believe there is a real change in direction when they publicise the Harvard Food Pyramid http://www.hsph.harvard.edu/nutritionso ... amids.html
instead of the USDA one. It still isn't for diabetics but it's certainly better. Or when they actively support and publicise some of the work by researchers they funded but didn't like the results from such as Mary Gannon and Frank Nuttal and the LoBag dietary series.
http://nutritionandmetabolism.com/content/3/1/16
Or when their chief sponsors are the vegetable growers of America and not the pharmaceutical companies, grain growers and Cadbury Schweppes:
http://diabetes.org/support-the-cause/c ... nition.jsp

Pardon my cynicism, but I doubt that they, or the NHS or Diabetes Australia or the world-wide industry of dieticians trained in the low-fat mantra over the past fifty years are going to change in a year, or even a decade.

But I'll keep chipping away at the wall...


Alan, T2, Australia

Everything in Moderation - Except Laughter

FBG under 110
One hour after meals under 140
Two hours after meals under 120
or for those in the mmol parts of the world:
Fasting Under 6
One hour after meals Under 8
Two hours after meals Under 6.5

<b>can I ask what the minimum should be?</b>

Any level that allows breathing and replicating...

Marty B

<blockquote id="quote"><font size="1" face="Verdana, Arial, Helvetica" id="quote">quote:<hr height="1" noshade id="quote"><i>Originally posted by martinbuchan</i>
<br />Any level that allows breathing and replicating...

Marty B
<hr height="1" noshade id="quote"></font id="quote"></blockquote id="quote">
I'd agree with that

I think I'd add "without discomfort". For me, that's above approximately 4 mmol/l.

Alan, T2, Australia

Everything in Moderation - Except Laughter