janeecee said:I am inclined to think that the ketones were showing because of too few kcal. I was in 800-900 kcal range at the weekend and although I don't pay attention to calories I use MyFitnessPal which adds them up automatically. My assumption is that too few calories meant that I had to get fuel from somewhere ie fat or even muscle.
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gezzathorpe said:
Hi, I get the point that spikes and fasting levels are higher with diabetics according to the charts . The charts how that non-diabetics can also have spikes, so is it the 'spikyness' that causes damage or the period of persistently high bGs which is not shown in the charts for either diabetics or non-diabetics. And where is the evidence to show that the diabetic pattern on the charts is damaging?
Yorksman said:gezzathorpe said:
Hi, I get the point that spikes and fasting levels are higher with diabetics according to the charts . The charts how that non-diabetics can also have spikes, so is it the 'spikyness' that causes damage or the period of persistently high bGs which is not shown in the charts for either diabetics or non-diabetics. And where is the evidence to show that the diabetic pattern on the charts is damaging?
It is the area under the curves that is important. The area, between the zero baseline and the blue curve is less than the area between the zero baseline and the red curve. The difference between the two areas represents the extra glucose in the blood, in this example, throughout the day. If the pattern is repeated day after day, that is what is called hyperglycemia, a condition in which an excessive amount of glucose circulates in the blood plasma.
Overall lowering of glucose is of pivotal importance in the treatment of diabetes, with proven beneficial effects on microvascular and macrovascular outcomes. Still, patients with similar glycosylated hemoglobin levels and mean glucose values can have markedly different daily glucose excursions. The role of this glucose variability in pathophysiological pathways is the subject of debate. It is strongly related to oxidative stress in in vitro, animal, and human studies in an experimental setting. However, in real-life human studies including type 1 and type 2 diabetes patients, there is neither a reproducible relation with oxidative stress nor a correlation between short-term glucose variability and retinopathy, nephropathy, or neuropathy. On the other hand, there is some evidence that long-term glycemic variability might be related to microvascular complications in type 1 and type 2 diabetes. Regarding mortality, a convincing relationship with short-term glucose variability has only been demonstrated in nondiabetic, critically ill patients.
phoenix said:Whether spikes cause damage over and above their contribution to overall glucose levels is something that is hotly debated amongst researchers.
There are lots of papers on both sides
Here, about halfway down is the summary of a debate in 2008 from two with opposing views. (Kilpatrick and Monnier)
http://care.diabetesjournals.org/conten ... /2965.full
and here: a summary of the evidence in 2010.
http://edrv.endojournals.org/content/31/2/171.long
Overall lowering of glucose is of pivotal importance in the treatment of diabetes, with proven beneficial effects on microvascular and macrovascular outcomes. Still, patients with similar glycosylated hemoglobin levels and mean glucose values can have markedly different daily glucose excursions. The role of this glucose variability in pathophysiological pathways is the subject of debate. It is strongly related to oxidative stress in in vitro, animal, and human studies in an experimental setting. However, in real-life human studies including type 1 and type 2 diabetes patients, there is neither a reproducible relation with oxidative stress nor a correlation between short-term glucose variability and retinopathy, nephropathy, or neuropathy. On the other hand, there is some evidence that long-term glycemic variability might be related to microvascular complications in type 1 and type 2 diabetes. Regarding mortality, a convincing relationship with short-term glucose variability has only been demonstrated in nondiabetic, critically ill patients.
gezzathorpe said:The problem with that chart is that the time values are not constant, 06:00-12:00-14:00-18:00-22:00. I wonder how many people on this site are between 180 & 210 (10-11.7 mmol/L) for three hours in the afternoon bottoming out at around 7 mmol/L? In my case, I have no excess glucose for 20 hours in every day. Are the remain 4 hours split across the day enough to cause problems? This chart visually gives the impression that there is almost always excessive glucoze in the blood and is misleading if you don't look at the X-axis carefully. It also shows the margin of error marks for diabetes but not for normal and so, for some reason, is incomplete. Allowing for the same margin of error the 'gaps' could be smaller. Do you agree?
gezzathorpe said:This chart visually gives the impression that there is almost always excessive glucoze in the blood and is misleading if you don't look at the X-axis carefully.
Yorksman said:gezzathorpe said:The problem with that chart is that the time values are not constant, 06:00-12:00-14:00-18:00-22:00. I wonder how many people on this site are between 180 & 210 (10-11.7 mmol/L) for three hours in the afternoon bottoming out at around 7 mmol/L? In my case, I have no excess glucose for 20 hours in every day. Are the remain 4 hours split across the day enough to cause problems? This chart visually gives the impression that there is almost always excessive glucoze in the blood and is misleading if you don't look at the X-axis carefully. It also shows the margin of error marks for diabetes but not for normal and so, for some reason, is incomplete. Allowing for the same margin of error the 'gaps' could be smaller. Do you agree?
You'd have to source and refer to the original article in MedScape for the details of both the subject and diet from which the measurement is taken. The horizontal axis does not need to be linear. It usually is in simplified graphs but it is by no means universal. This one is arranged to show meal times. Uniform makes it easier to calculate the area under a curve using calculus but this is only used for the purposes of explanation for which, presumably, you'd have to refer to the text. The lines you refer to are arrows, not error bars. Error bars have terminals at either end. If you zoom in, you can see the arrow points.
gezzathorpe said:This chart visually gives the impression that there is almost always excessive glucoze in the blood and is misleading if you don't look at the X-axis carefully.
There is in most diabetics, that's why diabetics have higher HBA1c readings. Glucose does not bind easily to haemoglobin and only eventually binds because of constant high plasma levels. Even high spikes of short duration wouldn't do it.
"Hyperglycemia, or high blood sugar is a condition in which an excessive amount of glucose circulates in the blood plasma. A subject with a consistent range between 100 and 126 (American Diabetes Association guidelines) is considered hyperglycemic, while above 126 mg/dl or 7 mmol/l is generally held to have diabetes. Chronic levels exceeding 7 mmol/l (125 mg/dl) can produce organ damage. Chronic hyperglycemia can be measured via the HbA1c test."
phoenix said:Whether spikes cause damage over and above their contribution to overall glucose levels is something that is hotly debated amongst researchers.
gezzathorpe said:If they are not error bars then what are they saying? It's very frustrating to read charts which are not self-explanatory.
A picture is supposed to paint a thousand words .... (Bread ... sixties I think?)
Yorksman said:gezzathorpe said:If they are not error bars then what are they saying? It's very frustrating to read charts which are not self-explanatory.
A picture is supposed to paint a thousand words .... (Bread ... sixties I think?)
The chart tells you that the reference is Polonsky KS et al in the New England Journal of Medicine, 1988 Volume 318 pages 1231 to 1239.
Mr Happy said:Viv - of course T1's can reduce their insulin intake, but we also could by drinking whiskey to excess, not sure that's advisable either. The point is that it is by no means a cure!
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Just remember, Pharmaceutical companies never want to cure you of anything. Everything they do is to keep you living longer so someone has to keep paying for the medication.
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