Multiple insignificant spikes after some meals.

Hey, prediabetic since this February, 22 y.o male, 5.1 HOMA-IR at that time with HA1C of 31 and fasting glucose of 5.9. Had covid in January.

Put on metformin, lost weight (100 kg -> 83 kg), HOMA-IR on metformin 1.2, HOMA-IR off metformin 1.4 measured twice, HA1C 33, 29 (tested in two different labs in June with 2 weeks between tests, I guess true number is somewhere in between). Still have 98 cm waist diameter, so obese by waist standard. Usually sub 5.0 mmol stable glucose on morning (once ate 2 burgers and a twister at kfc, kept me in 5.0 - 5.3 range for 2 days), no impact of dawn phenomenon noticed. Not on keto or very low carb diet, eat buckwheat, carrots and other veggies every day.

All test results below are given off metformin

My problem is, if I eat stuff like chocolate (40g carbs), I get spiked from 4.5-4.9 to around 7.0 mmol at 1 hour, drop to 5.8 - 5.6 at 2 hours mark, and go back to pre-meal sub 5.0 level during third hour. But sometimes if I eat some meals what contain a combination of proteins, fats and carbs, like pasta (I know, the same as sugar) with chicken and cheese, my maximum spike at 1 hour is around 6 mmol, but then I experience this kind of odd glucose behaviour: 6.0 -> 5.2 -> 5.8 -> 5.6 -> 5.9 -> 5.3 -> 5.4 -> <5.0, so, multiple small spikes happening during a few (3 - 5) hours. I must say that all measures are taken while being sedentary, so not wasting glucose liver storages on anything. Also, my glucose levels raise pretty slowly after consuming food, even with chocolate my glucose is below 5.5 until like 30 - 50 minutes mark.

So, spike from 4.9 to 6.0 mmol seems acceptable, but multiple small spikes happening for a good few hours bother me a little. Is that bad for my insulin resistance? Does that kind of stuff happen with healthy people. I am, like probably most of you, trying to mimic healthy people glucose spikes and charts and adjust my diet accordingly.

I even thought that it could be a sign of insulin deficiency, but GAD and IA-2 result is negative as I stated in my other post. Testing for the rest of antibodies seems hypochondrial considering my good numbers and will hit the wallet. My biggest ever measurement was in 40 minutes after eating 2 sugared buns with total weight of 100g, so probably like 60-70g fast carbs, the result was 8.9 mmol, 8.1 mmol at 1 hour mark, 6.2 mmol at 2 hours, 4.1 mmol at 3 hours, close to reactive hypo I guess. It happened during evening, I took 3 hours nap before that, my stomach was empty.

Goonergal said:

That to me looks like a completely usual range of fluctuations, especially if measured with a glucometer (opposed to a CGM), all of which have a 10-15% margin of error.

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I wasted some money and tested 2-3 times each time, posted value is average between those measurements, so a bit less unlikely to be wrong.

jaywak said:

All your readings seam totally normal in fact fantastically good , I think most of us would call a spike after a meal as going from a bg of 4 to a bg of 12 and higher !

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I guess with type 2 prediabetes situation is a bit different, a lot of guidelines I saw say you should avoid jumping more than 2-3 mmol higher than your baseline, as spikes like that can contribute to increasing insulin resistance. And you should avoid staying in 8 - 11 mmol and higher as you can start getting some damage to your blood vessels\kidneys.

EllieM said:

To be honest, everything apart from your waist measurement now sounds perfectly normal to me, but I freely admit this is far from my area of expertise (and I probably shouldn't comment ).

Will comment that you can't expect your glucometer to be perfectly accurate, they are allowed to be +-15%.
Maybe your weight loss has done the trick??? Or maybe your figures were just messed up by covid....

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I must say that my taiwanese glucometer is fairly consistent and accurate (compared with lab results) in 4-6 mmol range, and starts getting big differences in measurements higher than that. I always double or triple check if result is high or unexpected.

Ronancastled said:

Also remember that fats & protein can be converted to glucose over the longer term.
Hope this puts your mind at rest as your readings are super healthy

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I see that there is actually a kind of lack of evidence of glucose variance in healthy people. Most studies say that they don't spike to 11 + mmol, but I saw at least 2 people spiking higher than that after eating bananas or drinking cola. There also seem to be anecdotal evidence that some people don't go higher than around 6 mmol even if they eat lots of fast carbs, and some thin healthy people need 1/3 cups of rice to go to 7 mmol.

There is that study which is cited pretty often about non-diabetics being in >7.8 mmol range only for about 30 mins a day. But the thing is, afaik, their meals weren't accounted for, even some diabetics or prediabetics can eat carbs like buckwheat with fats and proteins and stay below that point. Averaging different generations with different eating habits doesn't sound like the best idea to me, young people may eat fast food and spike to 8-9 mmol and elderly people can eat some light food and stay in good range, or it could be totally vice versa. 30 minutes is still pretty significant, a person with normal metabolism needs significant amount of fast carbs to go that high. Maybe that's the effect of sugar drinks. Thank god I am fine with aspartame taste.

Also there is a concept that you should return to "baseline" in 2-3 hours after a meal, but what is baseline? Should you be close to your fasting level after a meal, or is it okay for it to be 0.5 mmol higher? Average healthy person's glucose is 5.4 mmol in that CGM study, which implies that either they spike pretty high a few times a day, or they stay in 5.x mmol glucose range for a good portion of day time instead of going back to fasting 4.x. There are also things like biphasical glucose curves like stated in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6300703/ and even triphasical, those things aren't studied at all.

And let's get pizza for an example, I think type 1 diabetics know that pizza can cause spikes delayed by multiple hours after consuming it. Pancreas is a reactive organ, not proactive, so should pizza cause delayed spike in healthy person? Probably, but I didn't find anything about that.

There is also not much information about normal glycemia -> insulin resistance -> prediabetes -> diabetes transformation, except for excessive fat tissue causing most of those problems. But not every fat person has prediabetes or diabetes. There seems to be a kind of fat mass threshold for each person, and that threshold if reached will get you into troubles with glucose. There are also different types of prediabetes, some people have normal fasting glucose and spike very high, some people have both high fasting and postprandials. If your glucose is high before eating it will also go somewhat higher after eating than compared to problems with postprandials only.

Obese people often get troubles like high blood pressure and heart problems, all things combined that can give you erectile dysfunction, and from the point of nature and evolution, with ED you are useless. Could diabetes be one of the triggers to make you stop poisoning your body with excessive energy and fat tissue, so you can serve your evolutionary purpose? Maybe, still not very well studied. For type 1 we know that it is an unfortunate coincidence with autoimmune reaction, different autoimmune reactions are not uncommon because our bodies are very difficult mechanisms in which errors happen sometimes.

I also see how I spike higher after eating chefburger from kfc than after eating chocolate. Chocolate is considered as one of the faster carbs to raise your sugar, tho they have some fats. And that chefburger is supposed to be a mix of fats, protein and carbs, carbs being a bit more prevalent, but still. And I guess that those fast food restaurants (if you can call them that) inject their meat and maybe buns with maltodextrin for it to taste better. Maltodextrin has an average glycemic index of 120 (!!!!!!!). I ate 12 sushi rolls with rice and my blood sugar was still lower (6.9) in 1 hour than it was after kfc food. That stuff is just simple posion and should be avoided at all costs, especially for your kids and young people like me.

With former fat-nutrient-phobia, which afaik was partly fueled with help of fast food and snacks companies, I guess you can see that they tried for a long time to make us think that their meals aren't so bad. But with current keto fashion we see that following low carb diets actually help you lose a lot of weight and stabilize some of your chronic condition, tho high fat diets can be hard for folks with pancreatitis and EPI problems.

Also medical institutions avoid testing your insulin and c-peptide if your fasting glucose is fine. HA1C is sometimes tested, insulin is the last test to do if you have some abnormalities in your results. A lot of people get their type 1.5 misdiagnosed because of that as well. And guess what, fasting glucose is actually the one which raises last before making you full-blown diabetic. Insulin resistance can preceed that for years or even decades. They also made a number "2.7" for HOMA-IR, while you should aim as close as possible to 1.0. I really think sometimes that most doctors aren't very interested in treating insulin resistance and prediabetes, and those conditions are MUCH easier to revert and control. Diabetics with advanced stages give a good monthly income for pharmaceutic companies and also pay some money for endocrinologist, podiatrist and opthalmologist visits.

Thanks for reading my Ted talk. I am really baffled how such serious condition is studied and acknowledged by many doctors.

Outlier said:

Re: waist measurement - different body types put weight on in different places. It's possible to be lean all over except for the midriff, or to carry weight on other areas (bum, tum, thighs, shoulders) but have a middle well within the so-called preferred range. BMI is a blunt instrument, and only a theory. You are the one who can judge whether you need to lose weight and if so from where. We are all individuals. Good luck.

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I still have XL size of clothes and belly fat. It seems that, like usually, the belly fat is the last to go. Measured today's morning it while fasting, it was 96 cm already. It probably can vary a bit, 98 cm measurement was actually taken 2 weeks ago. I think that my lean body weight is somewhere around 70 kg, I don't really have much muscles except in my legs (because for overweight/obese people leg day is every day, hehehe)

Goonergal said:

Still perfectly usual readings, but that doesn’t seem to be what you want to hear.

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Yes, I guess my glycemia looks like that of a healthy person now and I am not on tryhard diet, so everything looks good for now. But I had fasting hyperglycemia, epic high HOMA-IR and failed OGTT test in February, so I consider myself in prediabetes remission. If I gain weight again everything will become much worse, and also my age of 22 probably makes me one of the youngest users here. Even at 30 your metabolism becomes slower than it was at 21-25. And I wasn't severely obese, I was fat, but didn't notice any physical inconvenience.

Also, there is a factor of COVID, I saw some studies saying it can raise hormonal activity of fat tissue, make it more insulin resistant, but it totally could be bs.

Lamont D said:

I often refer to maintaining good blood glucose levels control as a way of treatment.
You do not have to be so vigilant. The reason is you have described yourself as prediabetic. If you continue to use a low carb approach, this will not be an issue and if you want, have the odd treat.

I would like to enlighten you to the fact that diabetes especially T2 has a broad spectrum, it is also a label to describe a period of time that your blood glucose levels are in average, not in normal levels.
This is because of many reasons, not just eating.
It is also sometimes not relevant in describing a non diabetic patient that there is nothing wrong in their endocrinology biology. There are many similar conditions to diabetes that have the same symptoms and complications that are not diabetic. They are synonymous with either hyperglycaemia or Hypoglycaemia.
Hormonal imbalance is also a similar symptomatic issue for dagnosis.

Until the proper diagnostic tests are done, and the correct tests, you just don't know!

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I am vigilant about food because I want to lose weight and become lean/thin. I am overweight since I was 10.

I believe there is something inbetween insulin blocking loss theory and calories deficiency theory, so the effect of food on my glucose is important.

About tests, all my diabetes-related test showed insulin resistance this february, I also have highish LDL cholesterol, uric acid and had problems with blood pressure. All those values are much better now than they were in February, but still not completely resolved. So, as my doctor said, somewhat classical metabolical syndrom wth the exception of normal triglycerades.