Post-Prandial/Drinking Nonsense

That's the thing about peaks they go up then they come down except the ones that go up then down then up again and down again. What I believe we are interested in is how fast and how far that is how high is the peak how how long it takes to come down to normal or near normal levels. In most healthy non diabetic people the peak will normally drop back down within about two hours so you are comparing how your system is working with the average non diabetic system. Could be wrong if I am then some one here will soon let me know.

As to the drink I often have a glass of red or dry white wine they have less carbs and can as you say reduce spikes also liver can't hand booze and glucose at the same time.

Spirits have no carbs and I drink them when ever.

Cheers John

Billy_Pilgrim said:

Ok, first question: what is the significance of the 1.5/2hr post prandial reading? It seems a bit arbitrary, especially given that blood sugar peaks after just one hour following a meal. Is it because BG levels are sustained for longer at these times?

Click to expand...

If the aI, of blood sugar management is to get normal blood sugar that we need to look at what non diabetic blood sugar levels are like. They peak after eating and come back down within two hours.

Billy_Pilgrim said:

I was also wondering whether there was anything inherently wrong with having a glass of wine or vodka with an/every evening meal, given that it reduces the size of a spike, and seems to set me up at a decent level for the evening? It seems like cheating somehow, so I figured there must be a catch. I'm not talking about a balls-out ****-up, just a drink or two.

Click to expand...

Guidelines provide for less than 14 units of alcohol per week. That's about 6 small (175ml) glasses of wine. So 1 or 2 glasses of wine every day does take you over the limit set by the guidelines. There's also a lot of advice on having one or two days of alcohol per week on the basis it gives your liver a break. As a diabetic, I am mindful of my liver function because I know if I am hypo and pass out the only thing that is going to bring me round is my liver chucking out glucose. I also know if I've been drinking that liver response isn't going to happen as quick as not drinking. I don't want to give my liver too much to do, it can't multitask.

You test right before eating. Testing at 1 hour post meal tells you how high that food is spiking you. Testing at 2 hours tells you how well your body is dealing with the spike. At 2 hours you should be close to where you started before eating. This may take some time to achieve when you are first working on control. Many people only test at 2 hours but I have found that I can spike very high, in the double digits, at one hour and then be right back to normal at 2 hours. I do not find that high spike to be acceptable for me. I believe it causes damage and puts too much stress on my body. To each their own, this is just my opinion.

Yes, everyone has a rise in blood sugar after eating. 7.8 is my upper limit that I try to stick to but the real issue is the amount of the rise compared to where you started at. If you start at 5 and rise to 7.8 you are probably fine but the same rise of almost 3 points is not good if you started at 9. A case in point about testing at both 1 and 2 hours was when I had chinese takeout. I did not eat rice or noodles just meat and veggie dishes. I started at 5.8 and at 1 hour I was over 11. At 2 hours I was back at 5.8. If I had not tested at 1 hour I would have thought it was all fine and that there was no spike. It is great that my body handled the spike well but 11 is way to high for me. I am giving my own perspective as a type 2 not on insulin or insulin producing meds. I cannot balance higher bloods with meds so I have to do it with diet alone. I have some neuropathy and spikes to 11 make it worse.

These unnoticed spikes can be why often A1c is higher than expected

The timing of the peak is different for different combinations of foods. Quick acting carbs will spike you faster than slower acting ones. Protein in excess of your body's requirements may spike you many hours later, even the next day. Fat also plays a part as it binds with the carbs and keeps the spikes lower but longer. Catching your peak is never an exact science.

The 2 hour guidelines are just that, guidelines. They aren't intended to be your peaks.

Billy_Pilgrim said:

I've heard that said before - but surely even if these spikes occurred 3 times a day they wouldn't significantly skew an A1c - after all, we spend a good deal more time not eating than eating, and the spikes themselves are relatively short-lived.

Click to expand...

It is the spikes that cause the damage. Constant high spikes, even if only for an hour or two, will cause damage in the long term. It is thought that it is better to run at a slightly higher level all day but with very small variances is better than running at lower levels all day with big spikes after eating.

Billy_Pilgrim said:

Intuitively I agree with that, but it's a good question - is the size of the spike significant in itself, or should we disregard it and treat the 2hr reading as our main concern? After all I've heard that even 'normal' people can spike quite high (up to 7.8mmol/L) by their mere mortal standards.



That's a pretty good argument for restraint. I've been saying this a lot lately, but diabetes is a tyranny of moderation. Somehow I manage to shoehorn it into conversations.

Click to expand...

Normal can spike to 11.1. After two hours they should be below 7.8.

NICE guidelines are given here.

http://www.diabetes.co.uk/diabetes_care/blood-sugar-level-ranges.html

Many on here impose tighter tolerances on themselves though.

Billy_Pilgrim said:

I'd had that page bookmarked but missed that the upper-limit 'normal' level for a random glucose test was 11.1. If they can do that, (given that we need to emulate a non-diabetic BG), then why can't we?

I should point out that from everything I've read here and elsewhere, I'm now sold on keeping my BG between around 5 & 7, even post-prandial. But I'm still curious.

Click to expand...

I can't answer that, but I'm sure others can for you
(For information, my HbA1c has been around 5.7 for years, no diabetic complications at all, fasting in high 4's or low 5's, I don't overtest any more, and I'm fairly chilled about my diet. But I am very active, and lost my excess weight very early on with a low calorie diet. I think the information is important, as diet is only one part of my lifestyle)

I believe there is a school of thought that suggests that even non diabetic people can be harmed by repeated random high levels of blood sugar even though of generally short duration.

JohnEGreen said:

I believe there is a school of thought that suggests that even non diabetic people can be harmed by repeated random high levels of blood sugar even though of generally short duration.

Click to expand...

It would be interesting to see what developed that school of thought, and how non diabetics manifest symptoms related to high blood glucose, eg, neuropathy, retinopathy, CVD, etc, as my understanding was that these are specific to ourselves as diabetics?
Do you have any links?

My understanding is the post prandial measure is crucial to understanding the first - and second phase insulin response immediately after eating - first phase respone is insulin released from stored insulin in the pancreas - the second phase is insulin that is secreted and released - this takes much longer to bring a spike down ( several hours ?). In normal (non T2) people- there is sufficient first phase insulin response ( ie, stored insulin in the beta cells) to bring a spike down to normal levels very quickly - in T2 not always the case -hence spike stay higher for longer - ( and in turn can damage the beta cells further, a vicious circle)
useful link here
http://www.phlaunt.com/diabetes/14046621.php

Have a read of the www.bloodsugar101.com website (it is aimed at T2s but the info is valid for anyone wanting to preserve beta cells and prolong their 'honeymoon period')

Lots of information on what constitutes 'normal' blood glucose levels, and on what 'abnormal' blood glucose does to us over time. Beta cells die at certain blood glucose levels. 11mmol/l is way above that level. So every time we bathe our beta cells in raised blood glucose we advance our diabetes and reduce our capacity to produce insulin.

The problem is that the NHS expects diabetics to deteriorate over time, and to have blood glucose peaks that rise then drop.

My view is that diabetes is a growing problem across the world exactly because the world diet is shifting towards carb heavier eating and these big rises are becoming more and more 'normal'.

Except, of course, that the more peaks we have, and the higher we are with those peaks, the more cumulative damage we are doing.

So I take the view that those 'normal' rises of up to 11mmol/l are in people who are actually moving slowly towards diabetes and are damaging themselves every time.

My husband can eat 3pounds of jelly babies and not rise above 6.6 mmol/l
That is what I call a real 'normal'.

Billy_Pilgrim said:

I'd had that page bookmarked but missed that the upper-limit 'normal' level for a random glucose test was 11.1. If they can do that, (given that we need to emulate a non-diabetic BG), then why can't we?

Click to expand...

The major difference between T1/LADA/T2 and "T0" is that:

a) The majority of T0 do not spike to 11 at all frequently, indeed, even when eating high-GI carbs, spikes will often not exceed 9, as has been demonstrated by loads of T0 people using Libres, and a whole bottle of Lucozade is needed to get the 11 spike.

b) When they do spike to 11, they come back down really quickly. Those with impaired insulin response, whether no insulin or insulin resistance, tend to take a great deal longer to come down from the high level. That's what the two hour blood test is supposed to indicate.

What it comes down to is that in a non-diabetic, you rarely go as high as PWD do, and when you do go that high, you come down way more quickly (usually within 15 mins). So no, as a diabetic, T1 or T2, you should try to avoid those spikes, as your "area under the curve" (overall effect of elevated blood glucose) compared to a T0 is very different.

Billy_Pilgrim said:

is the size of the spike significant in itself, or should we disregard it and treat the 2hr reading as our main concern?

Click to expand...

I have never believed the size of a spike is of any consequence at all as long as levels are returning to normal after 2 hours, my reason for this belief is that non diabetics can and do spike to low double figures after a carb heavy meal but will always return to normal within 2 hours and this is what I have always aimed for.