Are occasional bgl spikes a problem?

Kentoldlady1

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Hello all.

My question is in the title. If your hbalc is ok, at non diabetic levels, does it matter if you sometimes have a high carb spike?

I am sure that I have read somewhere ( now can't find it) that it is the bigger rises of over 2 that will do the most damage. Is this still the case if the rest of your day is low?

If your hbalc is fine, do you not have to worry about each spike? Even if you have a more than 2 mmol spike each day? For example, if you do omad, most of your day will be fasting. So you could have a higher carb meal that raises bgl from 4 to 9 and back to 5 within 4 hours. So a big spike but presumably an ok hbalc.

Hopefully my question makes sense. Thanks!

Should say I am t2d, so look at most things from that pov. But of course all knowledge is welcome.
 
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I don't think anyone has a definitive answer to your question. It is true that high levels of sugar in the blood can cause damage but it does not seem to be immediate damage. It seems you have to put in quite a bit of spike time for there to be a problem. That's why complications can take years to develop. The cumulative effects of poor glucose control over a period of time is the problem.

In addition to my opinion above, your levels don't seem that onerous and probably fall within the official 8.5 after two hours. For what it's worth I don't think you have much of a problem with what you are achieving.
 

Kentoldlady1

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I don't think anyone has a definitive answer to your question. It is true that high levels of sugar in the blood can cause damage but it does not seem to be immediate damage. It seems you have to put in quite a bit of spike time for there to be a problem. That's why complications can take years to develop. The cumulative effects of poor glucose control over a period of time is the problem.

In addition to my opinion above, your levels don't seem that onerous and probably fall within the official 8.5 after two hours. For what it's worth I don't think you have much of a problem with what you are achieving.

Hi, thanks for the reply. These aren't my levels, sorry, should have made that clear. I am just curious about high spikes.

So you are saying that high spikes do no damage in themselves, its how long you stay too high thats the problem? I understand that non ds will have spikes, but presumably will return to a lower range more quickly. But for us this will not happen. So your hbalc will be fine, but you could still be spending to much time with a raised hbalc.

My last hbalc was 39, so I am happy with my levels. I am just wondering if sudden high spikes very occasionally , maybe a couple of times a week which have no impact on hbalc do have an impact on health. Perhaps retinopathy/neuropathy? I don't do this, but wonder if we put too much faith in hbalc or if we worry too much about eating to the meter?
 
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Like I said I don't think there is a definitive answer since I know of no information about what area under the curve causes how much damage. It seems to be a problem if you are persistently high or frequently high.

I think we are debating whether going high causes another hole in the lace curtain and will it heal up or not when you go low. Probably in the early days it does but when damage reaches a certain point like when your pancreas is affected then you will go high more often with possibly more damage.

It could be a cascade effect. The short answer is I don't know for sure but it seems logical if the progression of the disease is slow at first and then speeds up.
 

Bluetit1802

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I don't know the answer, but I have read that a high spike can't be negated by subsequent low levels. Glucose will bind to the haemoglobin and won't fall off because we are then low for a long time. It stays there until those haemoglobin cells die off naturally.
 
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Grateful

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My question is in the title. If your hbalc is ok, at non diabetic levels, does it matter if you sometimes have a high carb spike?

There is quite a lot more about this in the thread linked by @Brunneria.

Ever since I joined this forum about a month ago, your excellent question (the one that heads this thread) has been topmost for me. That's because I don't self-test my BG levels, which seems to be contrary to the generally accepted wisdom on this forum. Instead, I rely entirely on (1) the A1C test every three months, and (2) closely watching my weight, using it as a primitive (and quite likely misleading) proxy for how well I am doing with the low-carb and exercise regimen.

This seems to work for me. However, I am almost certain that on a daily basis I must be eating some foods, or drinking some drinks, that spike my BGs quite a lot. My reasoning is that I don't care, because the periodic A1C tests have been fine ever since I've been doing diet/exercise (see signature). Another thought is that even non-diabetics can get quite large daily BG spikes.

My procedure is in line with conventional medical advice, and also in line with my doctor's advice -- and I trust him because he is the one who put me on this low-carb/exercise regimen in the first place. I am ready to switch to self-testing if my A1C worsens appreciably, or if diabetes complications appear.

It is a calculated risk -- because nobody really seems to know the answer to the question in the thread title. It is partly a personality thing; I tend to obsess over things and worry that self-testing would feed that personality trait. I do agree that, in the current state of knowledge (or rather, ignorance!), if you believe in "better safe than sorry" then you should self-test.

I don't know the answer, but I have read that a high spike can't be negated by subsequent low levels. Glucose will bind to the haemoglobin and won't fall off because we are then low for a long time. It stays there until those haemoglobin cells die off naturally.

If you can find the source, it is something I would love to consult.
 
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Bluetit1802

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Resurgam

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I suspect that no one really knows - it is not allowed to experiment on humans to find out when they start to be damaged - it can happen by accident but you can't intend to do it.
Personally I try to keep from spikes as when I am eating what makes me feel good I don't go high - these days even a couple of slices of watermelon do not put my BG over the 8mmol/l I decided was a good top of range when first starting out.
I don't try to get away with eating high carb foods - I know I don't need them, and if they are sugary, they make me feel sick as soon as I taste them.
I think that the way that doctors and nurses describe testing as obsessive is down to their attitude to patients taking a hand in their treatment - we are not supposed to be too clever by half and so remove the authority they seem to crave.
I have a distinctly obsessive attitude about being around to see my grandchildren grow up and only be slightly embarrassed by my presence - I am waiting for my hair to go white so I can colour it more easily - I was thinking purple.
 

Grateful

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There are doubts about relying solely on the HbA1c tests in medical circles. These links are just a few of many on the subject.

Many thanks!


Summary: In non-diabetic people, red blood cells live longer than in diabetics (as long as 146 days). This can drive up the A1C to mistakenly high levels in non-diabetic people. The converse is true for diabetics, whose red blood cells live for as few as 81 days. This leads to falsely low A1C levels in diabetics. Post-meal home glucose tests are a much better indicator.

My reaction: This seems to raise more questions than it answers. If the readings are "falsely low" in diabetics, and if this is a general problem, surely the cutoff level of 6.5% takes that into account? The A1C test has been standardized since around 2009 (the article dates from early 2011).


Summary: Situations where the average red blood cell lifespan is significantly less than 120 days will usually give rise to low HbA1c results because 50% of glycation occurs in days 90-120.

My reaction: Same as previous article. I honestly do not understand this point at all.

Summary: The test is unreliable in patients whose BG oscillates between very high and very low. In these cases the A1C should be supplemented by home BG tests.

My reaction: Now we are getting somewhere! Mind you, the question of whether very high and very low spikes are bad in themselves (even with a good A1C) is not tackled directly. But it makes sense to me that very large daily spikes could be dangerous.


Summary: Similar point to previous two articles. A1C can be artifically low because diabetics' red blood cells have shorter life. I still do not understand this point at all! Additional (already well known) points: the test can be unreliable in the presence of anemia, or for certain ethnic groups, or in the presence of certain genetic factors.


Summary: A controlled trial, comparing the A1C method with the CGM (continuous glucose monitoring) method. It was found that, "not infrequently," A1C and CGM gave different results. "Thus, a patient’s CGM glucose profile has considerable value for optimizing his or her diabetes management."

Reaction: This is much better evidence, since it is based on a controlled trial. I would love to know what "not infrequently" means. The trial consisted of 387 people and the article is recent (published this year). I have only consulted the free summary. Unfortunately, to see the actual data costs $35 for a one-day peek. Has anyone seen the full data and can tell us what is meant by "not infrequently"?


Summary: A1C will vary between individuals because of various factors. This makes it unrealistic to apply a "one size fits all" diagnostic level for diabetes, for all individuals. Factors such as anemia make a difference. Plus, in any case, a given A1C test should be considered to be accurate to no better than about plus or minus 0.5 percentage points (which is quite a range!).

Reaction: Fair enough, but already widely known. To me what matters is the personal trend. I know where my A1C started, at diagnosis. If I can lop off "X" percentage points with diet/exercise, that is what matters to me, without obsessing too much about the absolute level. Concerning the second point (the margin of error on each A1C test). Personally, I don't obsess about a 0.5-percentage-point shift up or down. On the day of my diagnosis, the first thing I looked up was the margin of error: with my reading of 8.3%, I was obviously diabetic even if the reading had been erroneously high by 0.5 percent.

______
From reading the above articles, I emerge somewhat more convinced of the usefulness of self-testing on a daily basis, after meals, and so forth. However none of them really answers the question, "are daily (or occasional) spikes dangerous, as long as my A1C is under control?"
 
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Bluetit1802

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Kentoldlady1

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Well, thank you all. I guess what I can get from that isthat no one knows!

I will err on the side of caution and try and keep the spikes as flat as possible. Hopefully, in time we will know the answer and it maybe that we can manage a few highs with no problems. Until then, I will keep the spikes flat.

I do self test, but I know that I have placed a great deal of faith in the hbalc. I was so very pleased to get a 39 a couple of weeks ago but it occurred to me that I didnt really know why I was so happy about it. I think its because it came from the "doctor"!!!. I already knew it would be ok because my bgls were fine.

I have not read all of the research above, but will try and get through it. But until I see anything to the contrary I think I will continue to self test and be guided by that. As already said, no one really knows if very high spikes are dangerous or not.

With all things, its a balancing act. The need to live as good a life as possible within the bounds within which we find our selves confined. I dont really like my gp and am happy to go there as little as possible. And I am.sure they will not miss me!
 

Kentoldlady1

Well-Known Member
Messages
733
Type of diabetes
Type 2
I suspect that no one really knows - it is not allowed to experiment on humans to find out when they start to be damaged - it can happen by accident but you can't intend to do it.
Personally I try to keep from spikes as when I am eating what makes me feel good I don't go high - these days even a couple of slices of watermelon do not put my BG over the 8mmol/l I decided was a good top of range when first starting out.
I don't try to get away with eating high carb foods - I know I don't need them, and if they are sugary, they make me feel sick as soon as I taste them.
I think that the way that doctors and nurses describe testing as obsessive is down to their attitude to patients taking a hand in their treatment - we are not supposed to be too clever by half and so remove the authority they seem to crave.
I have a distinctly obsessive attitude about being around to see my grandchildren grow up and only be slightly embarrassed by my presence - I am waiting for my hair to go white so I can colour it more easily - I was thinking purple.


I am.having my hair.dyed lavender next week!
 
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