Food for thought

[DeejayR]

Had a pub meal recently of nut roast with red wine gravy, and mixed veg instead of chips or mash. Two hours later my BS was 5.6 and I'd have been a happy bunny had I not been wearing a libre sensor ... which revealed that an hour earlier my BS had been about 10. It makes me wonder how many times over the years of finger-prick testing at first bite and 2 hours later I've missed the bad news in between. Can't be too bad overall since I'm still prediabetic.
In this case it must have been a combination of sugar and flour in the gravy and being too liberal with the carrots and mashed buttery something – not squash, maybe parsnip. Also, perhaps commercial nut roast hides a multitude of dangers? My own recipe works fine.

 

[DavidGrahamJones]

Your BG before eating will have an effect on that one hour reading. The glycemic index of the food you were eating will also have an effect on that one hour reading. The good news is that the 2 hour reading is good. Googling will show several articles about BG after eating for non diabetics as well as diabetics.

 

[Japes]

My home made nut roast, with no hidden nasties, can send me higher than I want and keep me there for three or four days if I have what I used to consider a normal portion size - not so much if I just have a small portion.

 

[chalup]

A lot of people on this forum advocate testing at 2 hours post meal and that is the information almost always given to new members. I have always tested at 1 hour so I can see the spike. I have seen my numbers go from 5 to 11 at 1 hour and then back to 5 at 2 hours. If I had only tested at the 2 hour mark I would have assumed it was all good. When eating anything out of the ordinary I always test at 1 and 2 hours.

 

[JohnEGreen]

I agree I nearly always test at 1 hour then 2 hours I have at times gone up to 12 at 1 hour and then been at 4.3 at 2 hours the transient short lived spikes can be damaging if you do not watch out for them.

 

[Mr_Pot]

It is often mentioned that we have to avoid spikes in BG. Is there actual evidence that short spikes that return to "normal" within the 2 hours are harmful? After all non-diabetics can have spikes, to about 10 I believe, before their insulin brings it down again.

 

[Bluetit1802]

I always used to test once or twice before the 2 hour mark. My peak is generally between an hour and 90 minutes. Wearing a Libre has confirmed this.

The reason we test at 2 hours isn't to catch a peak, it is to see how well our pancreas has performed in clearing the glucose from that meal. This is dependent on exactly what the contents of the meal were. Any low GI carbs are likely to lengthen the time it takes to return to base as they take longer to digest but won't spike as high to begin with. Similarly how much fat is in the meal will have an effect as this binds with the carbs, helping to keep spikes lower, but sometimes longer.

I also used to test after the 2 hour mark to see exactly when I came back to where I started. Depending on the contents of the meal this can be anywhere between 2 hours and 4 hours, and occasionally there is another bit of a bump during that time. The Libre is a wonderful aid in understanding what is happening.

It's a question of a graph line of either a mountain peak or a long hump back bridge. The area under the line is the important factor.

 

[Kristin251]

I agree I nearly always test at 1 hour then 2 hours I have at times gone up to 12 at 1 hour and then been at 4.3 at 2 hours the transient short lived spikes can be damaging if you do not watch out for them.

Don't you feel weird when you have spikes and drops? I sure do. Hazy eyes , jittery and just a funky feeling

My rise is highest at the two to theee hour but with my high fat low carb diet I hardly see any significant rise or drop. Usually within (10 Us) one way or another unless I over inject like I did yesterday haha. Only 1/2 extra unit so just had a snack. Wherever I am at 3 hours I will only go up as my insulin is gone. This is why I eat 4-5 small snack sized meals as I need insulin every three hours as my basal is long gone in the morning.

 

[Chook]

I usually test before eating and two hours after - the only time I test one AND two hours after is if I've eaten something I've not eaten before or a combination of foods when I haven't eaten that combination before. Occasionally I'll test at three hours if I've eaten something very fatty (for instance, Fat Head Pizza takes three hours to get to the top of its curve - I can't call it a spike because it isn't one.)

I've been doing this so long now that I rarely need to test at an hour after eating.

 

[Chook]

Don't you feel weird when you have spikes and drops? I sure do. Hazy eyes , jittery and just a funky feeling

My rise is highest at the two to theee hour but with my high fat low carb diet I hardly see any significant rise or drop. Usually within (10 Us) one way or another unless I over inject like I did yesterday haha. Only 1/2 extra unit so just had a snack. Wherever I am at 3 hours I will only go up as my insulin is gone. This is why I eat 4-5 small snack sized meals as I need insulin every three hours as my basal is long gone in the morning.

Quick drops - yes - but nothing with the spikes. I don't feel anything when my BG goes up temporarily its only when its gone up for a week or more that I get the usual high BG symptoms.

 

[Kristin251]

Quick drops - yes - but nothing with the spikes. I don't feel anything when my BG goes up temporarily its only when its gone up for a week or more that I get the usual high BG symptoms.

It's the drops for me too. The ups barely at all. That's why I TRY to stay stable and not need corrections but if I do need corrections I'd rather split the dose and take 2 smaller ones than one bigger one. It just makes me hungry so I eat and end up in the same place. Those low doses are much friendlier

 

[JohnEGreen]

I think it's a bit like when on a roller coaster on the big downgrade. I also don't feel much on the spike but that drop is like falling off a cliff.

 

[Bluetit1802]

I have never felt anything at all, either rising or falling, high or low.

 

[JohnEGreen]

@Mr_Pot

"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."

http://jem.rupress.org/content/205/10/2409.short

 

[covknit]

Don't you feel weird when you have spikes and drops? I sure do. Hazy eyes , jittery and just a funky feeling

My rise is highest at the two to theee hour but with my high fat low carb diet I hardly see any significant rise or drop. Usually within (10 Us) one way or another unless I over inject like I did yesterday haha. Only 1/2 extra unit so just had a snack. Wherever I am at 3 hours I will only go up as my insulin is gone. This is why I eat 4-5 small snack sized meals as I need insulin every three hours as my basal is long gone in the morning.

I agree. I get a head which progresses to headache then tired and irritable. In pre diagnosis days I just wanted to stay in bed but I was blaming my ulcer and unhelpfully every symptom was listed as a possible side effect of my eye drops. Nowadays there are times Hubby looks at my face and makes me drink something.

 

[leslie10152]

Had a pub meal recently of nut roast with red wine gravy, and mixed veg instead of chips or mash. Two hours later my BS was 5.6 and I'd have been a happy bunny had I not been wearing a libre sensor ... which revealed that an hour earlier my BS had been about 10. It makes me wonder how many times over the years of finger-prick testing at first bite and 2 hours later I've missed the bad news in between. Can't be too bad overall since I'm still prediabetic.
In this case it must have been a combination of sugar and flour in the gravy and being too liberal with the carrots and mashed buttery something – not squash, maybe parsnip. Also, perhaps commercial nut roast hides a multitude of dangers? My own recipe works fine.

Always best to your own preparation, then you really do know what is in it! No surprises!!

 

[leslie10152]

Don't you feel weird when you have spikes and drops? I sure do. Hazy eyes , jittery and just a funky feeling

My rise is highest at the two to theee hour but with my high fat low carb diet I hardly see any significant rise or drop. Usually within (10 Us) one way or another unless I over inject like I did yesterday haha. Only 1/2 extra unit so just had a snack. Wherever I am at 3 hours I will only go up as my insulin is gone. This is why I eat 4-5 small snack sized meals as I need insulin every three hours as my basal is long gone in the morning.

Likewise, I feel the highs as a sense of weakness and general malaise, the drop is noticable below 4.3.

 

[Mr_Pot]

@Mr_Pot

"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."

http://jem.rupress.org/content/205/10/2409.short

Thanks for the reference. It seems there are indeed negative effects of spikes not captured by HbA1c. Unfortunately the paper is much to technical for me to understand what the effects are, how much of a spike and what duration would be significant.

 

[Bluetit1802]

Thanks for the reference. It seems there are indeed negative effects of spikes not captured by HbA1c. Unfortunately the paper is much to technical for me to understand what the effects are, how much of a spike and what duration would be significant.

This is where the standard deviation comes in.

You can use the standard deviation to look at your overall blood sugar control, or to check on specific times of day such as before breakfast. Just use the rule of thumb developed by Dr. Irl Hirsch, an endocrinologist at the University of Washington in Seattle. His guideline is that the standard deviation multiplied by two should be less than the average blood glucose number.

 

[JohnEGreen]

Thanks @Bluetit1802 good answer what I found of concern in that was the fact that short term episodes of high blood sugars can have detrimental effects that last for days that are not obvious. But can store up trouble for the future.