Low hba1c but glucose spikes. Does it matter?

[Gloaming]

Hi all,

I'm still trying to further my understanding around the mechanics of insulin production and glucose levels. Rather more specifically, how it relates to me!

I am not diagnosed with diabetes or even pre-diabetes. My hba1c was 33 in February. What I've learnt though, is that I don't handles carbs well.

I attached yesterday's libre graph. Lunch was a palm sized jacket potato with butter and cheese (30g carbs). Dinner was pizza (80g carbs).

At present it doesn't appear to be causing a problem, although I do have mild symptoms when my BG goes to either extreme.

Clearly I don't have prediabetes so my concern isn't about that. I guess I'm trying to establish whether this is actually a really common issue and so long as I manage my diet all will be fine?

I don't understand the mechanics enough to be able to make sense of the data I have!

I'd be grateful for your thoughts and/or explainations of what's happening here.

(My GP is useless, even if I could get an appointment, I very much doubt she'd be of any use so I figure I'd ask the patient experts. )

 

[Lobsang Tsultim]

Our blood sugars naturally go up after we eat, more so if we eat a meal with a lot of carbs. The problem for typical type 2s is that we don't handle those raised levels well due to insulin resistance. For a non-diabetic without insulin resistance, it's not a particular problem (unless their diet is always very high in carbs because that will likely lead to insulin resistance in the future). Your graph looks like a normal non-diabetic response to high-carb meals, but I'm no expert, so take that opinion with a pinch of salt.

I've heard it's quite common for the response to pizza to be longer than the typical 2 hours due to the fat from the cheese delaying the digestion of the carbs. Your HbA1c result shows that, on average, your blood sugars are not raised to dangerous levels and that your body is okay dealing with carbs.

If I were in your shoes, I wouldn't be worried, but I might think about cutting down the carbs a bit - at least not having high-carb food for every meal.

 

[catinahat]

You eat carbs, the glucose from the carbs gets into your blood, your blood sugar rises.
Your pancreas releases insulin in repone to the rise in blood sugar, your insulin deals with the glucose and your levels fall.
Without the rise in sugar levels there is no reason for your pancreas to release insulin to deal with it. In other words the sugar has to get into your blood before the insulin can enable it to be used for energy.
The reason we are diabetic is because for whatever reason (T1, T2, T3, LADA,) we have trouble using that glucose.
With a HbA1c of 33 you clearly don't have diabetes or a danger of developing it any time soon, and no problem processing carbs.
If I were you I would put away that meter and enjoy an occasional pizza

 

[In Response]

@Gloaming that high spike looks like a LIbre-ism. If you had diabetes, I would suggest you checked it with a finger prick but I am guessing you don't have a meter.
Libre is not that accurate, especially on the first day and especially on spikes.
Those of us with diabetes, use it to track trends as we are aware of the imitations of CGMs and the trends determine our treatment rather than one off (dubious) spikes.

 

[KennyA]

Well - there's nothing in what you've said or shown that indicates you have diabetes or a problem with carbohydrates. That looks like a perfectly natural and normal response to me . Carbs go in, carbs are digested to glucose, blood glucose levels rise, insulin produced, insulin clears blood of glucose. It is a perfectly normal thing for people's blood glucose to rise and fall over the course of a day, in response to many factors not limited to food.

It follows I don't think you have any evidence whatsoever to say that you don't handle carbs well. The evidence points the other way. Your A1c clearly shows you do handle carbs - exceptionally well, actually. I'll attach a graph that shows A1c distributions in a non-diabetic population - ignore the percentage values, the mmol/mol is the relevant one. See where your 33 comes?

My experience of CGMs is that they are OK to track trends over extended periods and to show diabetics what happens in the periods when you're not testing (eg when asleep), but they're not a record of blood glucose except by proxy as they measure glucose in interstitial fluid. They are also (again in my experience) more than a little inaccurate for any given point.

 

[IncogKeto]

In addition to the carbohydrate content, there are numerous other factors that can have a bearing on an individual's glucose response to a particular meal - such as activity level before/after and any possible residual effect from food intake earlier in the day. Fat and fibre content will modify the rate of absorption and protein will itself induce a release of insulin in addition to that caused by the carbohydrates.

Taking the example from your CGM graph of the pizza that you had for dinner, your glucose response would be different depending on your choice of topping. Your peak glucose level on that occasion occurred after about two and a quarter hours but in theory you could have delayed it even further by adding more cheese to the pizza - even with the carbs remaining at 80g.

If you're trying to establish how your body responds solely to carbohydrates then an Oral Glucose Tolerance Test may be of value to you since it attempts to minimise the influence of those other factors. The test is generally done in the morning with the patient in a fasted state (to ensure the maximum time since their previous meal) and they're instructed to remain seated throughout (to remove activity level from the equation). The drink contains only carbohydrate (ie no protein, fat or fibre) and because it is a standardised quantity it allows the patient's results to be compared against that of other research subjects.

Rather than wasting your energy trying to talk an NHS worker into giving you the test, I'd suggest that you take advantage of your CGM and finger-prick meter and do the test yourself.

If you do a google search for 'Rapilose 300ml 75g' then you'll find the solution that a number of people on this forum have used - it's about £10.
Also, a search on this forum for terms such as 'GTT', 'OGTT', 'Rapilose' will bring up some info.

 

[HSSS]

This is a paper showing a variety of “normal” responses to glucose using a cgm. You might find it interesting. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296129/

 

[Kate_Emily3]

This is a paper showing a variety of “normal” responses to glucose using a cgm. You might find it interesting. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296129/

Really interesting, thanks. So if I’m understanding that right, most people without diabetes are “in range” 96% of time so that’s a useful metric to track alongside HBA1C?

 

[sgm14]

Really interesting, thanks. So if I’m understanding that right, most people without diabetes are “in range” 96% of time so that’s a useful metric to track alongside HBA1C?

I think that depends on the definition of "in range". If I am reading the report correctly the 96% is between 3.9 to 7.8 mmol/L whereas the AGP standard is in between 3.9 - 10.0 ‬mmol/L - which would probably mean non-diabetics are in the AGP range 98.9% of the time.

 

[Kate_Emily3]

I think that depends on the definition of "in range". If I am reading the report correctly the 96% is between 3.9 to 7.8 mmol/L whereas the AGP standard is in between 3.9 - 10.0 ‬mmol/L - which would probably mean non-diabetics are in the AGP range 98.9% of the time.

I took in range as 3.7 - 7.8 (which I’d read before was the range for non diabetics). The report was really reassuring. I’ve been wearing a libre again (been prediabetic before and had gestational diabetes but currently non diabetic). My libre range (based on 7.8 and under) is 90% which seems pretty good actually, for a non diabetic with a history of rubbish bloods My estimated HBA1C over 20 days (with a gap) is 5.5. So I’ll be taking the advice from previous posters in response to my post to not worry, but keep an eye on carbs and monitor very occasionally

 

[aaq]

Thanks for this thread. I am in a similar situation. I had HbA1C of 42 in a blood test mid-Feb. Previous reading were in the range of 39-41 over the last 3 years.

Since Feb I have been trying to take some corrective actions. To help with that I have been using Libre 2 over the last 10 days. Current snapshot shows:

Using 3.7-7.8 range - in the range is 95% and above range 5%
Using AGP standard - in the range is 100%
Average Glucose: 5.3 mmol/L
Glucose Management Indicator (GMI): 5.6% or 38 mmol/mol
Glucose Variability: 14.2%

Things I am trying
- lose weight - my BMI was always below 25. But trying to reduce weight further, especially abdominal fat - have lost 4 kg in last 5 weeks. So now the BMI is 23. Will aim to lose 3 more kgs to bring my BMI to 22.
- reducing carbs - I notice spikes after consuming fruits/fruit juice - so reducing the quantity and also being selective on which fruits I eat
- intermittent fasting - limited window for eating, avoid snacking, trying alternate day 18-24 hrs fasts
- regular exercise - an hour in the gym 3 times per week and walking every day for 40-50 min

Is there anything else I should be trying? When should do the next blood test to see if these changes are working in reducing HbA1C level?

 

[HSSS]

Thanks for this thread. I am in a similar situation. I had HbA1C of 42 in a blood test mid-Feb. Previous reading were in the range of 39-41 over the last 3 years.

Since Feb I have been trying to take some corrective actions. To help with that I have been using Libre 2 over the last 10 days. Current snapshot shows:

Using 3.7-7.8 range - in the range is 95% and above range 5%
Using AGP standard - in the range is 100%
Average Glucose: 5.3 mmol/L
Glucose Management Indicator (GMI): 5.6% or 38 mmol/mol
Glucose Variability: 14.2%

Things I am trying
- lose weight - my BMI was always below 25. But trying to reduce weight further, especially abdominal fat - have lost 4 kg in last 5 weeks. So now the BMI is 23. Will aim to lose 3 more kgs to bring my BMI to 22.
- reducing carbs - I notice spikes after consuming fruits/fruit juice - so reducing the quantity and also being selective on which fruits I eat
- intermittent fasting - limited window for eating, avoid snacking, trying alternate day 18-24 hrs fasts
- regular exercise - an hour in the gym 3 times per week and walking every day for 40-50 min

Is there anything else I should be trying? When should do the next blood test to see if these changes are working in reducing HbA1C level?

That sounds an excellent plan to me. Just be mindful of all carbs not just the fruits. RBC take about 3 months to replenish on average so a test 3 months or more after you began this should be checking rbc’s that have only ever been exposed to this new lifestyle and give you the answers you want.

 

[aaq]

That sounds an excellent plan to me. Just be mindful of all carbs not just the fruits. RBC take about 3 months to replenish on average so a test 3 months or more after you began this should be checking rbc’s that have only ever been exposed to this new lifestyle and give you the answers you want.

Thanks and also thanks for reminding me to be mindful of all carbs.

Yesterday, BGL had a big spike at 7 pm after the consumption of the below (after 10 days of low carb, I decided to test impact of moderate level of carbs)
Tomato and Mozzarella Baguette
Juice/smooth (Mango, coconut yoghurt, apple juice, spinach and fresh ginger) 250ml - https://www.pure.co.uk/menu-item/get-vit-250ml/

7.00-7.15 pm - food consumption - BGL 5.0 - 5.7
7.30 pm - BGL - 7.8
8.00 pm - BGL - 7 - walk for 30 min
1000-1030 pm - BGL - 8.3 (is this delayed spike because of the earlier walk?)
1130 - BGL 5 - after walking for an hour
1200 - BGL 6.3 - went up slightly again
1215 - BGL 5.2 - got down no activity
1230 - 1000 - BGL 4.7 - stayed constant - no activity

How concerned should I be
- to get such a big spike - an eye opener that till now I would happily eat this as 'healthy' food and not be aware of the impact on blood sugars and metabolism.
- that it so much time for it to come down. Would it have settled down if I had not done the 2nd walk or the walk perhaps delayed the process?

 

[HSSS]

Not such a moderate test. Theres a lot of carbs there

when testing food it’s better to avoid the walks otherwise it’s so hard to work out what did what when As you are seeing now. You went above the 2mmol at 2hrs (3hrs and more than 3mmol in this case and yes it’s very likely it would have been higher still without the walk) so it’s not something your body dealt with well. Personally it’s not something I’d repeat in a hurry.

The walks helped but the bounces back up show the issue was still happening. Fruit juice is such a fast hitting carb insulin users have it as a hypo rescue. So that is shown in the fast high rise in less than 30 mins. The bread rise isn’t confined to a short period in us all. Some things will rise us slower or longer or both. Fats and fibres often slow things down for instance but it still has to be digested at some point. Individually we might have particular items that has a less than typical response too.

 

[aaq]

Not such a moderate test. Theres a lot of carbs there

when testing food it’s better to avoid the walks otherwise it’s so hard to work out what did what when As you are seeing now. You went above the 2mmol at 2hrs (3hrs and more than 3mmol in this case and yes it’s very likely it would have been higher still without the walk) so it’s not something your body dealt with well. Personally it’s not something I’d repeat in a hurry.

The walks helped but the bounces back up show the issue was still happening. Fruit juice is such a fast hitting carb insulin users have it as a hypo rescue. So that is shown in the fast high rise in less than 30 mins. The bread rise isn’t confined to a short period in us all. Some things will rise us slower or longer or both. Fats and fibres often slow things down for instance but it still has to be digested at some point. Individually we might have particular items that has a less than typical response too.

Thanks again. This is very useful.

Overall this is highly concerning and I would have not known the havoc my food has been causing regularly without a CGM. HbA1C would have taken much longer to unearth this - it already has given a false sense of security over several years.

I'll now focus on my plan
- reduce carbs - this has to be number 1 - as a vegetarian, this is slightly more difficult
- lose weight - lose 3 more kgs to bring my BMI to 22
- intermittent fasting - limited window for eating, avoid snacking, trying alternate day 18-24 hrs fasts
- regular exercise - an hour in the gym 3 times per week and walking every day for 40-50 min

 

[Mrs HJG]

@Gloaming Get yourself onto instagram @glucosegoddess (Jessie Inchauspé) and she has all the graphs, hacks and science behind glucose spikes, their causes and ill-effects not specific to those with diabetes - she also has a book 'Glucose Revolution' and a new once coming soon.

 

[aaq]

It worked out better today -

Dinner -
Avocado, Feta & Grain Salad - https://www.ocado.com/products/m-s-avocado-feta-grain-salad-518542011
Nuts mix
Olives

5.30 pm dinner 5.6 mmol/L
7.11 pm BGL 7.5 mmol/L
7.30 pm BGL 5.9 mmol/L
11.00 pm walking BGL 6.3 mmol/L (it seems when I begin an activity after some inactive period BGL goes up without eating anything)
11.55 pm end of walk BGL 5 mmol/L

 

[finzi1966]

Wow that one looks MUCH better!

Baguette to me is absolute kryptonite. There is not a single other foodstuff (well, maybe pure sugar but I don’t eat that!) that has such a dire and dramatic effect on my blood sugar. Not cake, not croissants, not sliced bread, not chocolate: nothing. Baguette has not passed my lips for nearly ten years.

 

[aaq]

After 2.5 months my HbA1C has reduced from 42 to 39 - so not a massive reduction but it is in a better place. However, it seems to have caused a spike in triglycerides from 1.8 to 2.5.

 

[ajbod]

That spike is because whilst burning body fat, the triglyceride levels go up because they are in your blood stream on the way out of your system.