How should blood glucose levels raise and fall to glucose?

I'm not sure if anyone has a clue, but everyone has an opinion.

Basically this discussion is "how tight do you go?". Individual views have different criteria than public health views.

Individuals might say, aim for non-diabetic blood glucose levels.

Public health bodies look at lots of factors, look at it statistically and in terms of health economics, and make interpretations on a relatively small number of major studies.

Hence different public health bodies set different targets at different times. And public health bodies make recommendations for large groups of diabetics as a whole, sometimes making worst-case or median-case assumptions about patient motivation, compliance, awareness, intelligence even.

You want to aim for non-diabetic BG levels and you want to know the numbers for that?

EPhantom said:

Um... What I mean to say is... for a person that doesn't have any BG issues, what would happen in the different stages after they eat. Would they get some kind of spike, would they never go above a normal level. Or even... is a 2hour goal "good enough" to prevent insulin resistance.

Maybe I'm still wording it wrong... or that there isn't a real answer... idk.

Click to expand...

Yes they would spike, what sets them apart is that they return to 'normal' very quickly. My opinion (and it IS only my opinion) is that aiming for normal 2 hours after eating is how I'm going to deal with this, what happens in those 2 hours I can only control to a certain extent....

This is a good question as something I've been pondering over for quite some time ... also, we're told to test before meals and 2 hours after ... so say you tested before breakfast and 2 hours after and didn't eat til lunchtime, do you need to test again before lunch, say as at 3 or 4 hours after breakfast?

Also, what happens to me generally is I tend to eat say 9am, 11am and 1pm ... if I skip 11am and go thru to lunch and just have coffee, my bs is higher than if I'd have had a snack at 11am.

I just wish I could get my head around this stuff .. I need to go to 'blood sugar school'

This is an American site that is very helpful re ideal BG values and how to achieve them:
http://www.phlaunt.com/diabetes/14045621.php

EPhantom said:

I've been to that site... sadly I do not trust it one bit. MANY people from diabetic forums here quote from that site like it's the bible... but it's all from someone who has no medical practice what-so-ever, who is also attempting to sell a book. This kind of action makes me completely unable to trust a word she says, I see it as just another way to get a dollar.

Click to expand...

Everything in her book is also at the website which is free. Amazes me why people think everything in life should be free and that people shouldn't be able to charge for their hard work/research. Just because someone publishes a book doesn't automatically make them a money-grubbing capitalist. She started out as a forum member and blogger just like many other respected sources on any number of different topics. But if you want to write her off without doing any research into her background, your choice/loss.

The research that's referred to by Jenny Ruhl in her take on what are normal levels came from a lecture but the final research was published here
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769652/?report=reader#!po=52.7778
. Fig 2 shows a representative profile (much like the one on her site)

However, in this paper there are also representative profiles for glucose levels after 4 different meals (ie fast and slow absorbing meals)
meal composition table 1 (all had around 50g carbs, fat, protein and fibre was different )


The profiles show differing characteristics (fig 5)
eg:
A meal with kidney beans, wholemeal bread, cheese and salami had a relatively flat profile,
A meal with , toast, jam, curd cheese and orange juice had a much higher spike.

The time to peak glucose varied between meals and a lot between subjects. (table 4)
eg:
The average time to peak for the kidney bean meal was 57 min but this was+/- 24 min
By contrast a meal with rice pudding, sugar and cinnamon had an average time to peak of only 43 min , +/- 10.8min

That particular study had quite young subjects and just a few days.of monitoring
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769652/

When they were doing the research on how HbA1cs reflected average blood glucose, they also did a lot of continuous monitoring of normal subjects. with subjects wearing the device for an average (median) of 230hours so much longer than in the study above. These were also wider group of people from various countries, with an older average age of 41. . They defined normal as having no history of diabetes, a fasting glucose of below5.4mmol/l and an HbA1c of below 6.5%
Unfortunately they do not report similar profile graphs. What they describe are the periods of time spent above various cut off points.


There were 8 people who spent longer than 2 hours a day above 7.8mmo/l. They were older (average age 55), 6 out of 8 were women, 6 out of 8 were non white, they had a BMI above 29 and an average HbA1c of 5.7% and fasting glucose of 6.1 mmol/l There were 3 people who spent 5 hours a day above 7.8mmol/l . These had an HbA1c of 5.4-5.% percent

If you look at the discussion section you will see they say that they say it is possible that some of the people could have had impaired fasting glucose but also that in general the average HbA1c was well below a diabetes cut off level. They also say that the general pattern reflects that found in other studies and gives some figures for them.
(the other studies are behind pay walls )
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892065/


The studies together seem to show that most spend some time over 7.8mmol/l . The first shows that the time to peak glucose varies, even in these young people between individuals and the type of meals eaten. The peak seems to be probably somewhere between 45mi and 95min. How long it stays up again depends on the meal and the individual response. The younger people in the first study were at higher levels for less time than older people in the second.

Personally, because the general 'safe' maximum level of BG is 140g/dl I would prefer to not go above that mark, or at least not for too long. I feel that the +1, or +2 marks are basically irrelevant, because it totally depends on when the peak from the food occurred. Many fruits will peak at only 35 mins, whilst other starchy carbs may not peak until 2hr 30 mins, both these would miss entirely the 2hr bench mark and appear totally 'normal and acceptable', but the peak could well be up to 240mg/dl which is 100 mg/dl over that 'safe' cut off. A piece of fruit will not raise a truly normal persons BG to anything like that level, neither would a couple of slices of bread. So, its very much down to testing, testing, testing, to find what specific foods do to you, and eat accordingly. I don't think that occasional brief excursions above 140 would do you any harm, but you wouldn't want to be doing it every meal for a couple of hours at a time. Most people on here do feel that the levels set by the various health organisations are way too high, these are set as 'achievable levels' for diabetics, not necessarily 'desirable, or normal levels' No doubt that a perfectly normal person who consumes large quantities of starchy and sugary foods stuff, plus sugary beverages in one go, could well get a truly high reading, even their systems will reach an overload that they struggle to cope with.