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Is a good HbA1c all that matters?
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<blockquote data-quote="phoenix" data-source="post: 682576" data-attributes="member: 12578"><p>Going back to your original question, do spikes matter ?</p><p>The answer is that no-one has the real answer, or at least no-one has any real evidence that they matter more than the average glucose levels in the long term. It is a matter of huge debate and too complicated to answer in a quick post.</p><p>If your spikes lead to higher overall glycemia then they must be detrimental. If your average levels are higher than you 'want' then focusing on reducing spikes may help to lower the average .</p><p>On the other hand, since you are fasting for longer periods, it's also a very good idea to get the basal insulin right so that you start eating at a reasonably low level and don't wake up to too high a level either.</p><p></p><p>If you want figures, then from a personal point of view, as someone on insulin ,my doctor wants my two hour level target of an increase of not more than 50mgdl which is 2,7mmol/l . I may well have a higher level in the period before that but bolus insulin keeps on working for another 2+ hours.</p><p></p><p>If you want to read some of the debate on what is called glucose variability. Here are two recent papers.</p><p>Glucose Variability, does it matter? <a href="http://press.endocrine.org/doi/full/10.1210/er.2009-0021" target="_blank">http://press.endocrine.org/doi/full/10.1210/er.2009-0021</a></p><p>Glycemic Variability, both sides of the story <a href="http://care.diabetesjournals.org/content/36/Supplement_2/S272.full" target="_blank">http://care.diabetesjournals.org/content/36/Supplement_2/S272.full</a></p><p>There is no answer from either paper.</p><p>Here is part of the conclusion from the second one.</p></blockquote><p></p>
[QUOTE="phoenix, post: 682576, member: 12578"] Going back to your original question, do spikes matter ? The answer is that no-one has the real answer, or at least no-one has any real evidence that they matter more than the average glucose levels in the long term. It is a matter of huge debate and too complicated to answer in a quick post. If your spikes lead to higher overall glycemia then they must be detrimental. If your average levels are higher than you 'want' then focusing on reducing spikes may help to lower the average . On the other hand, since you are fasting for longer periods, it's also a very good idea to get the basal insulin right so that you start eating at a reasonably low level and don't wake up to too high a level either. If you want figures, then from a personal point of view, as someone on insulin ,my doctor wants my two hour level target of an increase of not more than 50mgdl which is 2,7mmol/l . I may well have a higher level in the period before that but bolus insulin keeps on working for another 2+ hours. If you want to read some of the debate on what is called glucose variability. Here are two recent papers. Glucose Variability, does it matter? [url]http://press.endocrine.org/doi/full/10.1210/er.2009-0021[/url] Glycemic Variability, both sides of the story [url]http://care.diabetesjournals.org/content/36/Supplement_2/S272.full[/url] There is no answer from either paper. Here is part of the conclusion from the second one. [/QUOTE]
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