Interesting BG levels... What do you think...

[andcol]

Hi all, No lectures please just discuss

I went out for lunch today to a restaurant and ate:
Half Roast Chicken, Chips (left the salad as it had a horrible dressing on it - can't believe they ruined the flavours)
Large portion of Bread and Butter Pudding with custard
2 glasses of diet coke and I ate a whole lime from my glasses and my wife's drinks

A pretty standard fat boy meal for a norm... so what happened to my BG levels (I have seen this pattern before)

at 1.25 hour I was 8.1 mmol/l - Was pretty happy with that as a peak
at 2 hours I was at 8.1 mmol/l - shame would have liked to be lower
at 3 hours I was at 8.1 mmol/l - now this is strange a complete flat top
at 3.5 hours I was at 5.1mmol/l

What I think is happening is my body has control over the rate my digestive system allows glucose to be released into my blood stream such that my pancreas can handle it. Not sure the mechanism here. The last time I saw this flat top was after another very large meal.

Has anyone else come across this before?

 

[AndBreathe]

Andrew, you don't say where you started, on your way to 8.1, but, purely personally, I would have felt very uncomfortable with the two and three hour figures. I seem to have self-conditioned myself to rail against those sorts of numbers.

I haven't had pasta for a while. It's not an enormous favourite (although my OH does a mean Mac & Cheese, with bacon and lots of garlic), so leaving it be doesn't feel too much of a sacrifice. But last I had pasta, I rose slowly, but it also lingered, and although I returned to a decent range around the same time as yours reduced, my numbers were up on my then average for a couple of days afterwards.

I'd be interested to hear if your returning numbers really get back to your usual lower numbers soon (if not already), and how tomorrow's numbers go.

Will you ever be hungry again after that lot?

 

[Lamont D]

As AB said it would be interesting to see your before level. Have you tested again? What is your normal before? I couldn't do 8s! Mind you I would have the salad! Asked them to change it!!
The only times I have flatlined is after 3 hours after glucose test before I hypo and when I fast to get back into control and the levels are around 4-4.5.

The slow movement of carbs digesting is probably the mix of the meal rather than just one particular thing!

I've always hated bread & butter pudding!

 

[andcol]

My starting level was my normal cold hand and feet 4 to 5 - I don't bother testing that any more.

I am not worried about 8s any more they are normal and transient just as they are in my non-diabetic family. What I find interesting is not the level but the sustained level without variance. There must be some systemic control but I haven't found any literature around this. I could be looking in the wrong place of course.

I will let you know tomorrow but I was at my cold levels again before eating tonight although I didn't eat much (a couple of carrots and some nuts and raisins)

Out of interest I worked from home on Friday and tested at an odd time, because I had my meter with me, at 4pm - don't normally get home and eat until between 7pm and 8pm. I was at 3.8 Now I understand why I am always hungry around that time at work.

 

[Lamont D]

Just a couple of thoughts,

If you hadn't eaten for a few hours and you usually don't eat till normal tea time meal, that is why you are hungry, you should always eat a little something mid afternoon to avoid going too low.
The other thought is called an afternoon slump. Many people suffer from this and it can also affect non diabetics as well! You would probably get different readings before eating if you haven't 'snacked'.
A fluctuating blood glucose level usually causes symptoms. I know I've had them all!!!!!!!!

 

[andcol]

What is more interesting nosher is that if I eat at about 4pm whether it is fruit, a cake, a biscuit, nuts (tried them all) I am always between 4.8 and 5 when I get home and I feel the liver dumps in the coldness of my tootsies. I normally have a liver dump on the way home as I go from numb toes to warm toes.

BTW I have been pushing the bounds further and further and never go over the 8.1 now. The last thing for me to try is 4 slices of white bread and a couple krispy kream doughnuts

 

[Lamont D]

Wow!
Your sending me into realms of fantasy with them snacks!
Still my treat is a couple of pieces of 85% chocolate and my Greek yoghurt!
I've never experienced the liver dump in my feet!!
What I do get, and my bloods are just up around 5.8 is when I am not working after doing a few days in, then because I'm not particularly doing anything strenuous my (I think) liver dumps around 9am - 10 am. That's the signal to take the dog out again!
As my job is active and I'm always walking I need to snack all the time and as I have very few carbs, it can be boring!
Keep pushing! You never know! The only way you find out is testing and experimenting. I have slowly tried mixing low and medium carbs but only small portions! Not yet had any success! Ho hum!!!!

 

[andcol]

Yes I have been lucky and beginning to think that I never had insulin resistance but a failure of my digestive system to control its rate of digestion. All my issues started at the same time I became hyper sensitive to bananas and I was sent to see a consultant in case it was cancer. I still have issues with bananas as they go straight through me washing out my whole system (if you get my drift).

Well I have found this piece of information in some medical texts: seems that there is a negative feedback loop from the digestive system to the pancreas to stop further digestion.

Pancreas's exocrine function owes part of its immaculate function to bio-feedback mechanisms controlling secretion of its juice. The following significant pancreatic bio-feedback mechanisms are essential to the maintenance of pancreatic juice balance/production:[3]

• Secretin, a hormone produced by the duodenal "S cells" in response to the stomach chyme containing high hydrogen atom concentration (high acidicity), is released into the blood stream; upon return to the digestive tract, secretion decreases gastric emptying, increases secretion of the pancreatic ductal cells, as well as stimulating pancreatic acinar cells to release their zymogenic juice.
• Cholecystokinin (CCK) is a unique peptide released by the duodenal "I cells" in response to chyme containing high fat or protein content. Unlike secretin, which is an endocrine hormone, CCK actually works via stimulation of a neuronal circuit, the end-result of which is stimulation of the acinar cells to release their content. CCK also increases gallbladder contraction, resulting in bile squeezed into the cystic duct, common bile duct and eventually the duodenum. Bile of course helps absorption of the fat by emulsifying it, increasing its absorptive surface. Bile is made by the liver, but is stored in the gallbladder.
• Gastric inhibitory peptide (GIP) is produced by the mucosal duodenal cells in response to chyme containing high amounts of carbohydrate, proteins, and fatty acids. Main function of GIP is to decrease gastric emptying.
• Somatostatin is a hormone produced by the mucosal cells of the duodenum and also the "delta cells" of the pancreas. Somatostatin has a major inhibitory effect, including on pancreatic juice production.

 

[Lamont D]

That is interesting! Had to read it three times to get my head to it.
So much to go wrong in the digestive system and endocrine system and the importance of the liver in all aspects of how we function through eating and the millions of chemical interactions every time we eat!
Is it any wonder a lot of doctors struggle with diabetes and how to treat the various forms of the condition.
You are different (and special!!) like me, to have a condition that isn't typical, as you digest at different rates, that's why you eat (and get away with) snacking high carbs
If only I could!!
You know what to do if you are constipated! Load the banana and fire!
Stand well back as this could be lethal to any one passing!! Lol!

 

[andcol]

My banana effect

Steatorrhea. This condition causes your stool to contain an abnormally high level of fat, causing it to take on a yellow color. Those that suffer from celiac disease, inflammation of the pancreas or pancreatitis can develop this condition. If you have steatorrhea food will move too quickly through the digestive system so the body will not be able to absorb the nutrients from the food properly before it is expelled.

So my next question is why bananas? The thing is I can eat them now and again without difficulty but if I have one a day then I suffer. There must be some build up of something. May have found a link http://www.jiaci.org/issues/vol15issue03/12.pdf - interesting article which sheds a little further light

With a disturbed pancreas who knows what happens to the balance of the whole system

 

[Lamont D]

Never heard Of streatorrea!
Could it be the high level of pottasium that's in bananas?

I had a test to diagnose pancreatic and pancreatic cancer, so many tests!!!

I like the description 'a disturbed pancreas'

Has it been on holiday or lazing around getting on with life til - !!!

 

[andcol]

lol disturbed - not sure why my brain chose that word in the cold light of day

@AndBreathe this morning my BG level was my normal 5.0 mmol/l So nothing out of the normal there. Oh BTW I remained a couch potato yesterday for the whole day.

 

[AndBreathe]

lol disturbed - not sure why my brain chose that word in the cold light of day

@AndBreathe this morning my BG level was my normal 5.0 mmol/l So nothing out of the normal there. Oh BTW I remained a couch potato yesterday for the whole day.

I'll have to re-read your findings, regarding digestive pausing to get my head around that concept further. I suppose a counter argument could be that the pancreas, rather than pausing, isn't quite throwing out enough insulin to bring the levels down faster. I guess I'll we pondering on this today, and trying to find more about normal pancreatic function when faced with carb load. I don't suppose you've had any tests relating to your endogenous insulin? (I haven't.)

For me, I've got so used to the lower numbers, I can't decide if I'm doing myself a dis-service by almost running in flat-lining mode.

It would be an utterly fascinating subject if it didn't involve "us".

 

[AndBreathe]

And I'm not surprised you were a couch potato yesterday. I wouldn't have been able to move after your lunch!

 

[andcol]

I'll have to re-read your findings, regarding digestive pausing to get my head around that concept further. I suppose a counter argument could be that the pancreas, rather than pausing, isn't quite throwing out enough insulin to bring the levels down faster.

I pondered this too but then decided that if that was the case then I would not be flat lining at 8 for a period of time and would have just gone high. Now there could be a combination going on here which is reduced pancreatic insulin production along with gastric pausing is retaining my numbers correctly at 8 but the pause is longer than it could be as I am not processing all that glucose fast enough and therefore digestion is taking longer. More experiments required I think.

Now do a thought experiment and extrapolate that to eating like that everyday and I can see how it would edge that HbA1c up just a little until the pre-diabetic levels. Could this be one of the processes that goes wrong?

So I am going to have to do another experiment and add a little exercise in with a huge amount of carby food again. I am pretty sure I have seen this pattern though where the exercise drops it down and then 30 mins later it pops back up

 

[andcol]

And I'm not surprised you were a couch potato yesterday. I wouldn't have been able to move after your lunch!

Nah just because I was playing the new patch of world of warcraft and then cities in motion. Didnt really feel bloated or anything.

 

[AndBreathe]

I pondered this too but then decided that if that was the case then I would not be flat lining at 8 for a period of time and would have just gone high. Now there could be a combination going on here which is reduced pancreatic insulin production along with gastric pausing is retaining my numbers correctly at 8 but the pause is longer than it could be as I am not processing all that glucose fast enough and therefore digestion is taking longer. More experiments required I think.

Now do a thought experiment and extrapolate that to eating like that everyday and I can see how it would edge that HbA1c up just a little until the pre-diabetic levels. Could this be one of the processes that goes wrong?

So I am going to have to do another experiment and add a little exercise in with a huge amount of carby food again. I am pretty sure I have seen this pattern though where the exercise drops it down and then 30 mins later it pops back up

When is your next HbA1c due? I seem to recall you're on longer intervals already? That said, I doubt (unless you're seeing these numbers all the time) you'll be nudging to the numbers too far, if at all, bearing in mind you have encountered a few 3s these days.

On an aside, I was interested to read your comment yesterday about Friday's late afternoon test, and the low score you returned. I have been having rather a lot of liver dumps of late - several a day - to the extent I have been experimenting with a bit of cheese about 15:30-ish, to ease the dip. I don't mind some liver dumps, but several times a day hasn't felt that fab, to be honest.

My OH is back middle of next week, so there'll be a few changes, just because he's here. (I can't wait. )

 

[phoenix]

The pathways are all very complicated with so many feedback loops aimed at restoring homeostasis (not just for glucose)
You mentioned GIP (gastric inhibitory peptide), that probably doesn't actually inhibit gastric secretion at the levels it is normally produced at in the human body.
Nowadays they use the same acronym but it stands for glucose-dependent insulinotropic polypeptide something that plays a very important part in glucose homeostasis It is one of two known incretins in the stomach that respond to glucose arriving there They act to cause the pancreas to produce more insulin (this is independent of glucose that has been released into the bloodstream)
This feedback system has been found not to work well in many people with T2 diabetes (some of the newer diabetes drugs act either to mimic incretins or to stop naturally produced ones being broken down)
http://www.glucagon.com/incretineffect.html

What was your glucose this morning? Your meal was probably quite fatty which would have slowed absorption. However there is also the possibility of a much later increase in glucose levels due to the fats in the circulation increasing insulin resistance.
One study using pizza and a closed loop system with T1 diabetics to deliver insulin found increased insulin needs five to ten hours after eating. This was attributed to the effect of the fat on insulin sensitivity
http://care.diabetesjournals.org/content/36/4/810.full#ref-18 ) Of course if your natural insulin release is good enough to overcome this then you might not see a problem.

 

[andcol]

I like the feeling I get with a liver dump - like a warm flush through my whole body. Does yours feel different?

My next HbA1c should be late November early December but I have recently had one with my op which was 35

@Pheonix my morning number was bang on 5 right in the middle of my 4.8 to 5.2 range (unless I have lots of beef when I turn in a 5.4-5.6) and it remains at that level for a long time (longest after a glutinous banquet was until 11AM - that is my protein to glucose rate I think)

Yes the meal was quite fatty (what with the chicken thigh and leg and then the B&B pudding so was expecting the 3 hours but was surprised at the 8.1 flat line

From an article: GIP is secreted normally or hypersecreted in type 2 diabetes; however, the responsiveness of the endocrine pancreas to GIP is greatly reduced.

How did the body come up with such a complex feedback on feedback on feedback. Hass nature never heard of KISS. Just goes to show it is a chaotic system really

 

[phoenix]

No, not at all simple. I think 'evolution' just keeps adding on bits or adapting things so there is never a going back to first principles I was going to find a complicated human metabolic pathway diagram to demonstrate but somehow this one caught my eye.
http://www.potatometabolicpathways.webs.com/