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Type 2 Is no increase OK / healthy..?

L

LonelyFatGuy

Well-Known Member
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I think I can answer my own question here; that answer being no, but I just want to see what other people think.

Of course it's normal to have a spike in blood sugar 2 hours after a meal; that's what happens to normal people. I'm just wondering if it's dangerous / unhealthy in any way to see no increase after a meal, possibly due to Metformin in my case.

I did a pre-meal test last night and I was about 6 mmol. I ate 100 grams of bran flakes, with 15 grams of sultanas thrown in, 200ml semi-skimmed milk, and about 170 grams of cold chicken. I work that out to be about 34 grams of sugar. (Must be over 80g of total carbs). I also took my 2nd gram of Metformin for the day.

2 hours later I do my next test and I get 4.4 mmol. Test again to be sure, and get 4.7 mmol. So it was like that meal never even happened, and the blood sugar just kept decreasing from the 6 mmol I started at pre-meal.

So... healthy? Unhealthy? Of no consequence? Should I be eating more to ensure a normal spike..?
 
No I definitely don’t think there’s ANY reason to be concerned about that. And eating more, or eating more carbs, is absolutely not what you should take from this: you WANT your blood sugar lower! And remember you’re NOT supposed to have a spike 2 hours after eating, you’re supposed to be back to normal by then or close to it. It you were still spiked at two hours, that would mean the meal had too many carbs in it.

Various possibilities: you have an excellent insulin response and insulin sensitivity. Your pre-meal test was inaccurate. Your post meal test was inaccurate (less likely as you tested twice). You missed the spike (probably the most likely IMO. Something like cereal and sultanas would spike me pretty fast (within 30-45 minutes). But I would probably be back to baseline by two hours, as you were. You probably ended up a bit lower than you started because that high carb meal provoked a significant insulin response. I often end up lower than I started if I have a lot of carbs.

It wouldn’t be the metformin- metformin doesn’t work that way.
 
It's not the metformin!
The answer to your question about having no spike is normal, it is normal, nowt wrong with it!
The lower the spike, even keeping your blood glucose levels in normal levels is really healthy.

Being T2, continuous high spikes are dangerous over time!
 
finzi1966 said:
And remember you’re NOT supposed to have a spike 2 hours after eating, you’re supposed to be back to normal by then or close to it.
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Sorry, what..?

Everything I've read (including from the guide on this website) seems to suggest a spike 2 hours 'post prandial', even for non-diabetics, is the norm.

It says on this site that 4 to 5.9 mmol pre prandial is normal for non-diabetics, and it should be under 7.8 at least 90 minutes after a meal. How can anyone interpret this in any other way than that a spike is completely normal..? Where have you got this idea that it should be back to normal by then..?

finzi1966 said:
You probably ended up a bit lower than you started because that high carb meal provoked a significant insulin response. I often end up lower than I started if I have a lot of carbs.
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Why do you have diabetes then..?

If the cure for type 2 diabetes was just to eat a bunch of carbs, get an insulin spike, and end up lower than baseline, then wouldn't we all be cured?

finzi1966 said:
It wouldn’t be the metformin- metformin doesn’t work that way.
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It doesn't work what way..? Really short term, as in, having a direct affect on the meal just eaten..? Based on what I've seen over the last week, I think it might.

I'm only generally eating 2 meals a day. Usually the exact same meal twice. The first meal seemed to cause a normal spike 2 hours later, I'm assuming with the help of the Metformin. But the second meal that was exactly the same was causing me a larger spike at night.

So I reintroduced the second gram of Metformin with meal 2 (having previously ditched it because of the "brown rain"), and now I'm also getting a more normal spike with that second meal.

The half-life of Metformin is supposedly 6.5 hours, so wouldn't that make sense..? Unless I've misunderstood the half-life of drugs, a short half-life means it gets in and works fast and then it gets out. Seems logical that a pill taken with each meal is only really helping with that meal. The level of the drug will have diminished by half by the time of your next meal (if there is roughly 6.5 hours between your meals...) and thus wouldn't be as effective.
 
I work on the basis that these recommendations are essentially an acceptable target range for pre and post meal figures and are NOT absolute requirements to have or ever aim for higher post meal levels. So it does not necessarily follow that you will or even ought to see a 2 hour post meal rise. We should actually be aiming to be back (or as close as possible) to normal at 2 hours post meal as already stated, any spikes or bumps will (usually) be earlier and have at least started to come down at the 2 hour mark.

As T2s we can no longer handle carbohydrates very well, so the better we can manage by restricting their consumption the less likely we are to see any higher post meal figures. We may not ever be able to cure T2, but by carefully limiting carbs, we can at least control it and minimise any potentially harmful impact longer term higher glucose levels can have. Keeping pre and post meal levels as stable as possible is IMO one obvious solution.
 
LonelyFatGuy said:
Unless I've misunderstood the half-life of drugs,
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The half life is the amount of time it takes the active ingredient in your body to reduce by half.
Metformin is detectable for around 96hr's in blood and saliva and up to 4 days in urine
https://druggenius.com/half-life/metformin/
The reason you take metformin with meals is because the gastric side effects would be more likely on a empty stomach. Metformin works by reducing the amount of glucose your liver releases it does not reduce the amount of glucose in your blood from your meal. For that you would need stronger meds like jardiance or forxiga that make you pee out the excess sugar or gliclazide that forces your pancreas to produce extra insulin

LonelyFatGuy said:
spike 2 hours 'post prandial', even for non-diabetics, is the norm.
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There are always exceptions of course and a lot depends on the fat content of the meal because fat slows the digestion and can cause the carbs to hit the blood later. But generally speaking someone with a fully working pancreas and no insulin resistance will see their blood sugar return to pre meal levels within 2 hours. That's why we use the 2hr test as a benchmark.
 

My reply: It doesn’t work that way as in “lowering your blood sugar when you take a tablet”. There are drugs that do that: gliclazide springs to mind - it makes the pancreas produce insulin. Or insulin itself, of course. Metformin works on your longer term glucose metabolism, to reduce the production of glucose by the liver, and to improve insulin resistance in the cells. I don’t actually take metformin with meals at all, it’s more convenient for me to take it first thing in the morning and last thing at night before bed. Fortunately it causes me no gastric side effects.

Your user name suggests you may be carrying some excess weight? Have you lost some weight already maybe? That could explain improving figures. For me I am pretty sure it was the weight loss that made a big difference (which was achieved through a LCHF diet). I am assuming that it has improved my insulin resistance a lot, and also that my pancreas is probably more efficient as there is less visceral fat clogging it up. I still have weight to lose. My HbA1C is 35, but I don’t consider myself in remission because I am on medication. I do consider myself to be well-controlled, though. What I have to watch out for now is “carb-creep”.
 
Robbity2 said:
We should actually be aiming to be back (or as close as possible) to normal at 2 hours post meal as already stated
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Been stated by 3 people at this point I think, but as yet no source provided to back the claim up...

Robbity2 said:
any spikes or bumps will (usually) be earlier and have at least started to come down at the 2 hour mark.
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My own results show that will depend on what I eat. For example, I started at 6 mmol on Tuesday, and I had 150g of 'no added sugar' Alpen. Tested an hour later, was sitting at 13. Tested again at the two hour mark, was down to 8.4.

Had potato waffles for dinner on Thursday, tested an hour later and got 6.4, but went up to 8.2 at the two hour mark. So, clearly rising more slowly from the potato product.

So I'd have to call into question your use of the word "usually", since it seems to be diet dependent. Clearly the lower GI foods that we're supposed to be eating are going to cause a slower increase as is their nature.
 
catinahat said:
Metformin works by reducing the amount of glucose your liver releases it does not reduce the amount of glucose in your blood from your meal.
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Yes, but they say it decreases the amount of sugar absorbed by the intestines in the first place, so clearly it works on sugar from the meal before it ever gets to the blood. So as soon as you put the food in your body, Metformin is apparently working to ensure that you absorb less sugar.

catinahat said:
But generally speaking someone with a fully working pancreas and no insulin resistance will see their blood sugar return to pre meal levels within 2 hours. That's why we use the 2hr test as a benchmark.
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Again, people keep repeating that, but no one is posting a source to back it up..?
 
finzi1966 said:
Your user name suggests you may be carrying some excess weight? Have you lost some weight already maybe? That could explain improving figures. For me I am pretty sure it was the weight loss that made a big difference
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How much weight did you lose..?

I'm not really that fat... I lost 7lbs recently to take me down to just over 12 stone. I really can't say if that was enough to make any kind of difference to how my body is currently working. All I know is that I've been seeing encouraging numbers from the meter, and enjoying finding out what certain kinds of food and certain kinds of exercise do to me.

My last A1c was 66. In about 6 weeks time I get to find out if this meter has been lying to me. Doubtful, but I don't want to get my hopes up. Seems to good to be true.
 


OK so let me show the results from my OGTT just after I got into remission.

As you can see started at 5.2 and after 120 minutes was back at 5.7 (still slightly higher than start but nowhere near where I'd been). That's the kind of thing that many "normals" would see too.

Your 8.4 after 2 hours post Alpen shows that you are still a way of "normalising" your reaction and that Alpen is pretty bad for you with about 90g of carbs... plus whatever you had on it.


 
Thanks for posting your own personal experience, but I want to see a link to any respected source that says we should, that it's normal, to be back to baseline 2 hours after a meal.

If no one can substantiate it, it seems like just their opinion.
 
LonelyFatGuy said:
no one is posting a source
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Post-Meal Blood Sugar (Postprandial)
Independent of what they eat, the blood sugars of truly normal people are:

Under 120 mg/dl (6.6 mmol/L) one or two hours after a meal.

Most normal people are under 100 mg/dl (5.5 mmol/L) two hours after eating
Copied from here https://www.bloodsugar101.com/what-is-a-normal-blood-sugar

LonelyFatGuy said:
they say it decreases the amount of sugar absorbed by the intestines
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Who are "they" and can you show us a respected source ?

What Metformin Does
Metformin Inhibits the Liver's Production of Glucose
There is some scholarly debate about what exactly it is that Metformin does, but most researchers agree that in most people Metformin suppresses the production of glucose in the liver
Here's my source https://www.bloodsugar101.com/metformin
 

re read the words. Normal is up to 6mmol pre prandial. The post prandial is a maximum of just under 2mmol higher. Not a desirable or normal but a maximum. This is why we use the 2mmol in 2 hrs as a broad guideline to mimic a normal response

the described reaction is when a heavy load of carbs is responded to with a heavy return fire of insulin. So heavy it “overshoots” and goes lower than before the carb load. Whilst that might look desirable it is at the cost of super high insulin. And that high insulin is the fundamental problem of metabolic disease and type 2. Hyperinsulemia is bad for cardiovascular disease, blood pressure, insulin resistance and hinders fat burning. So it might for a period lower blood glucose or even mask the dysregulation for a while, even those super high levels can’t reliably control glucose levels.
 
Last edited:
And remember, @LonelyFatGuy that many other factors can also affect bg:
Sleep or lack of it,
Stress,
Exercise, intensity and duration,
Illnesses or infections
Other medications,
Temperature
Food eaten several hours before
To mention just a few
Yes food is a key factor, but it's not the only one
The number of variables does complicate things which is why the ranges given can only be guidelines, or averages or estimates. Its not an exact science. We just have to work with what we can
 
@LonelyFatGuy

bulkbiker said:
Define "respected source"

Personally I prefer people who have been there and done it.
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I totally agree - my respected /trusted sources since my diagnosis in November 2013 have always been the experiences of long term low carbing members of our forum - I have no wish to rely on scientific experiments done on rodents to manage my diabetes.

I eat a low carb normal/full fat diet, and as a T2 for the most part I'm able to keep my post meal glucose levels below the maximum recommended for normal people, & have done so or over 8 years, the last 5 of which have been without the need for any diabetic medication. I'm not alone in doing this and there are many more T2 forum members who manage far better than I.
 
LonelyFatGuy said:
How much weight did you lose..?

I'm not really that fat... I lost 7lbs recently to take me down to just over 12 stone. I really can't say if that was enough to make any kind of difference to how my body is currently working. All I know is that.
Click to expand...

I’ve lost about 25kg/50lb. I’d still like to lose another 10kg/20lb or so.

No at just over 12 stone you’re definitely not that fat! Unless you’re very tiny lol.
 
LonelyFatGuy said:
Thanks for posting your own personal experience, but I want to see a link to any respected source that says we should, that it's normal, to be back to baseline 2 hours after a meal.

If no one can substantiate it, it seems like just their opinion.
Click to expand...
I think you'll find that "respected sources" rarely use words like "should" and "normal". If you're looking to read more on what the medics think is going on then I'd recommend Bilous and Donnelly's "Handbook of Diabetes". It is written for the practitioner and is the current handbook for the NHS. You do have to struggle to see what you, as the subject, is supposed to be doing.

However there are as many references in Bilous and Donnelly as you could wish for. There is much less about the non-diabetic person for the reason I suppose that they are not being treated by the health service. I also think it clearly illustrates a lot of what's wrong with the way T2 (in particular) is treated by the health service. I have certainly learnt more from this forum than I ever have from "official sources" whose advice, boiled down, has generally been to eat lots more carbs.

My personal expectation is that most meals these days will not do a great deal to my BG at all. I don't eat carbs the way you do - I think what you describe for a daily intake would be the equivalent of a week's carb intake for me, so there may be no read-across. I don't consider all rises to be spikes - a spike to me is eg going from 4.7 to 13 in 20 minutes, which I could personally trigger by eating pastry. Going from eg 4.7 to 5.3 (which is more typical for me) is probably within the meter error range and I don't see it as a spike or significant. If I eat a meal and have a glass of wine with it, my BG is usually lower post-meal than when I started. My point is that we each react differently and the only "normal" that counts is what is "normal" for you. It doesn't really matter that other people might have different reactions - you're not eating for them.

Best of luck.
 
Drugbank online says:-

"Metformin decreases blood glucose levels by decreasing hepatic glucose production (also called gluconeogenesis), decreasing the intestinal absorption of glucose, and increasing insulin sensitivity by increasing peripheral glucose uptake and utilization" https://go.drugbank.com/drugs/DB00331
​
Yes, a glucose level below 7.8 mmol/l at 2 hours after a meal is considered normal (as long as it's not below a normal fasting level). https://emedicine.medscape.com/arti...hour postprandial glucose,older - < 160 mg/dL

A blood glucose level of 4.4 mmol/l is below 7.8 and is not hypoglycaemic (https://www.nhsinform.scot/illnesses-and-conditions/blood-and-lymph/hypoglycaemia-low-blood-sugar) so would still meet the definition of normal.

Note that there can be diurnal variation in response to the same food.
​
 
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