Blood Sugar Spike

Listen to your gut @valuator it talks a lot of sense

I can't help with the question as I would never eat pasta in the first place because it is not something I need to think about as being food - I just do not have grain on the menu - I do eat bread with 4 gm of carbs a slice, but very rarely - so far this year I have eaten 5 slices of it.
I look for under 7mmol/l after eating, at the 2 hour mark but I just do not consume foods which spike my BG.

valuator said:

OK, let's pick a different example. Go from 5.5 to 7.5 after two hours. But with a considerable spike showing on my Libre during that time. Are we concerned about being high for 2 hours or just where we end up?

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Obviously its better to avoid the spike completely by not eating food that causes it..

Peaks and valleys aren't good, especially in the higher ranges. Sustained higher levels are worse, but large ups & downs really need to be avoided where possible. Then of course there's the rarely discussed factor of insulin toxicity if you are always overproducing, but that isn't measurable at home. The safest strategy is to not consume food that causes spikes, but that is a very personal thing and no one can make those choices for you.

valuator said:

So they put it into the "safe" category. Is this correct even if there was a larger spike within that 2-hour window?

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No. It's the maximum you should be concerned with, whether it peaks at 60 minutes or 180 minutes. However, if it falls quickly that is at least a half-decent sign.

valuator said:

I fear I am not asking the correct question. Is something that causes a rise of no more than 2 mmol at the 2 hour mark "safe" or "not safe"? I feel like the Libre is maybe giving me too much info and causing me to over-think?

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Personally I'd say not safe. And your experimenting ain't helping your health much either..

The reason you won't get a straight answer (I suspect) is because: no-one knows. There is no research or data on this. The majority of the research dealing with long-term complications (which is the thing we are all trying to avoid) looks at HbA1c, not Libre readings.

However, common sense would suggest that avoiding spikes would be a good thing, and a low carbohydrate diet would be good.

Going forwards, it might help you to keep a detailed log of Libre readings (spikes and all) and see how this correlates with HbA1c in 2-3 months' time.

It might be (for your body) that one big meal and one big spike a day does not really affect the HbA1c, in which case I wouldn't worry too much about it. However, if you are having 5 smaller meals and 5 small spikes a day, this may represent an overall greater exposure to sugar and cause the HbA1c to rise, and this would clearly be riskier for you.

A two-hour reading is sometimes recommended, but measuring every 30 minutes or continuously, as you do, is better. Surely, you do not want the spike at any point.

I'm not expert but here's my understanding. The "no more than 2" rise criteria is about how your body responds to the food intake. A rise of more than 2 means your body is not dealing with the incoming macros quickly enough and that's not good, so the glucose lingers in your blood for far too long.

Completely separately a rise form 6.5 to 8.5 is within the "+2 limit" so you could argue it's okay. I would argue it's not okay, but I would suggest that the 6.5 is the real problem, not the +2. To me being 6.5 before eating suggests insulin resistance.

I have no idea if the height of the spike is concerning or relevant. I would assume that non-diabetics can have very high spikes depending on what they eat, so I personally would be careful about giving too much significant to what happens in that 2 hour span. There's a reason they recommend a 2 hour reading.

But this is hypothetical. In reality what your goals ought to be will depend on whether you are insulin sensitive or insulin resistant.

Personally, for me, the best way to flatten the graph is Intermittent Fasting (IF). There's just nothing like it.

I have now worked my way up to "one meal a day" (OMAD) and once a week maybe I have "one meal every other day" (OMEOD). It takes time for the physical, mental and psychological adaptations to occur, but it is well worth it and a journey worth pursuing. I lost a lot of weight with IF and my HbA1c came under control.

I've always wondered about this as well. It would seem that even non diabetics have some type of spike after high carb meals. I try not to eat foods that spike me too much, but like Jim mentioned, I take it as a good sign if it at least comes back down fast.

My DBN says I should not worry about the spikes in between the two hours after eating as this would happen to non-diabetics also. I had a Libre sensor for my first 6 months after diagnoses and done the same thing as you. I experimented with trying all these different foods in the hope there was still something from my old diet I could eat. I'm now 1 year in and have finally realized that it's all about reducing the Carbs at every level. Giving up on treats just isn't enough, the sensor has made me realize just how much change was needed.

Funny, because I put a new sensor in for the first time in 6 months this week as I felt my levels were getting out of control again. This has helped me regain the focus needed for healthy eating as I can constantly read my BG. Can turn into a bit of an obsession though!

I would be interested to know more about spikes in between meals! They can't be good though!!

Came across this may be pertinent.

"The current goal of diabetes therapy is to reduce time-averaged mean levels of glycemia, measured as HbA1c, to prevent diabetic complications. However, HbA1c only explains <25% of the variation in risk of developing complications. Because HbA1c does not correlate with glycemic variability when adjusted for mean blood glucose, we hypothesized that transient spikes of hyperglycemia may be an HbA1c–independent risk factor for diabetic complications. We show that transient hyperglycemia induces long-lasting activating epigenetic changes in the promoter of the nuclear factor κB (NF-κB) subunit p65 in aortic endothelial cells both in vitro and in nondiabetic mice, which cause increased p65 gene expression. Both the epigenetic changes and the gene expression changes persist for at least 6 d of subsequent normal glycemia, as do NF-κB–induced increases in monocyte chemoattractant protein 1 and vascular cell adhesion molecule 1 expression. Hyperglycemia-induced epigenetic changes and increased p65 expression are prevented by reducing mitochondrial superoxide production or superoxide-induced α-oxoaldehydes. These results highlight the dramatic and long-lasting effects that short-term hyperglycemic spikes can have on vascular cells and suggest that transient spikes of hyperglycemia may be an HbA1c–independent risk factor for diabetic complications"

https://rupress.org/jem/article/205/10/2409/47044/Transient-high-glucose-causes-persistent