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Quick Question On Glucose Spikes, Flattened Spike (PPG)

R

rachelsmith10111

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Type of diabetes
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Hi I had few questions regarding this, while I don't have type 2 diabetes (i have fatty liver so it's beneficial to have lower insulin release). I wanted to know your opinion and experiences for this.

I know that if you eat fats, proteins, fiber the spike won't be as BIG. The spike will flatten. However, it will still be elevated more than normal.
Let's say if you were to eat starch/sugar ALONE, you would get a higher peak but a shorter elevation vs if you ate the same thing with fat, the duration of the flattened spike will be longer.

So I just wanted to know what would cause more insulin release? The flatten spike/curve, or just 1 big quick spike? I was told by someone that PPG (Postprandial glucose) is what contributes to H1AC more and they used this study to justify it.

Importance of Postprandial Glucose in Relation to A1C and Cardiovascular Disease - PMC

IN BRIEF This article reviews the evidence regarding the impact of postprandial glucose (PPG) on overall A1C and its relation to cardiovascular disease (CVD). To date, four randomized, controlled trials have evaluated the impact of PPG reduction on ...
pmc.ncbi.nlm.nih.gov
 
It's likely that HbA1C is linked to cumulative total area of the curve above some threshold value (i.e. BG above threshold * time above threshold to give a value in e.g. mmol*minutes/l), though there is no particular evidence I've seen either way and there is a quite significant possibility that glycation of haemoglobin is not linear with glucose concentration. Journal paper diving required)

My assumption would be that by reducing the rate at which carbs are absorbed you'll give your pancreas a better chance to produce sufficient insulin to keep yourself below the nominal high BG threshold and so will end up with a lower (or zero) area above the curve, i.e. the areas won't be the same.

This assumes that the pancreas doesn't have non-linear insulin production rates depending on BG level, which may or may not be true, though for a person without disease one assumes the production rate should be fairly linear with carb absorption rate/BG excursion rate.

I'm also assuming that dealing with carb spikes by needing to generate large quantities of insulin is less "good" for both the long term health of the pancreas and e.g. rate of fat absorption, than is dealing with a longer and lower rate of carb absorption.

I'd therefore stick with mixed macros if I were you.
 
I don't know of any scientific studies of the comparison of blood glucose levels and insulin, though I agree that @SimonP78 comments sound reasonable.

However, I do know of several studies, plus lots of individuals experiences of dealing with fatty liver. These tend to show the benefits of reducing dietary carbohydrates and increasing both protein and fats rather than reducing calories. The evidence is that those eat low fat and high carbohydrate (as we have been advised for the last 3 decades) have it completely the wrong way around as any livestock farmer can verify. They feed grains (carbs) to fatten their animals, indeed, feeding humans with natural fats tends to make them slimer (including internal fat such as liver fat) as many forum members can attest.

I was always slim and was still normal weight when I was diagnosed with Type 2 diabetes. I gained remission (for 5 years now) by using a LCHF way of eating without conscious calorie reduction and no hunger. My Blood Glucose reduced first, but this was followed by my weight decreasing until I decided I was more than slim enough at which time I increased the calories and added a few more carbohydrates (in the form of nuts).
 
Good question.

Rises in blood glucose following carb consumption are normal. This study was set up to show what "normal" looked like for the newer CGM machines, but gives a good picture of BG changes in non-diabetic people.

https://pmc.ncbi.nlm.nih.gov/articles/PMC7296129/

The way to find out would be to measure insulin levels following various food combinations, but I'm not aware of any work having been done on establishing the resulting insulin levels. The other thing is that insulin isn't released "steadily" - there's a first and second phase pattern.

Obviously, the post-prandial level is due mainly to carb in food, while the fasted level is due mainly to what the liver is doing. Bilous and Donnelly (Handbook of Diabetes) have this to say about insulin secretion (nb - the levels given for insulin in the graphic are in "arbitrary units", which leads me to think they weren't actually measured) -

Insulin secretion
Glucose is the main stimulator of insulin release from the β cells, and insulin secretion occurs in a characteristic biphasic pattern – an immediate ‘first phase’ response that lasts only a few minutes, followed by a more gradual sustained ‘second phase’ (Figure 5.11). The first phase of insulin release involves a small, readily releasable pool of granules fusing with the plasma membrane. Of particular importance is the observation that first‐phase insulin secretion is lost in patients with type 2 diabetes. Various types of fuels, hormones, and neurotransmitters regulate insulin secretion. Glucose is the most important regulator and glucose stimulates insulin secretion by mechanisms that depend upon the metabolism of glucose and other nutrients in the β cells.




[Edit: I don't know exactly what B&D mean when they say "first phase insulin secretion is lost in patients with Type 2 diabetes". They may mean "...patients with high blood glucose levels..." or possibly anyone who's ever had a diagnosis of T2. I'd guess it's the first, but what do I know?]
 
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There's studies showing when overfed on saturated fat vs fructose, the fructose developed less of a fatty liver than when compared with saturated fats.

Although I have issues with fats. And I am lacto vegetarian, so it's just better for me to just use apple cider vinegar, lemon with pysilium husk (fiber) and also protein before eating carbs rather than use fats to flatten the curve. Of course, I want to keep carbs lower, but there have been many people who reversed t2 diabetes using whole plantfoods based diet just like how people reversed it using low carb high fat. One guy I saw on youtube (type 1 diabetic) he used to take around 27 units of insulin doing the standard low carb high fat protocol, then he did the whole plant based LOW fat diet and only had to take 22 insulin per day. (KEEP in mind this guy ate a ton of fruits, I won't eat as much as this guy. But I do plan to take more protein)


This was from his video. And while this guy doesn't reduce his fructose intake, I do prefer to keep my fruit intake minimal. LMK if I am allowed to post his video here or not.
 
rachelsmith10111 said:
So I just wanted to know what would cause more insulin release? The flatten spike/curve, or just 1 big quick spike?
Click to expand...
I think the same amount of carbs would cause the same amount of insulin to be released, although not with the same speed.
This is exctly what T1 treatment is based on: You count the carbs, calculate how much insulin you need for those carbs, and adjust the timing of your insulin dose to the type of meal and the speed at which you expect those carbs to hit the bloodstream as glucose.
(And then you adjust everything again based on two dozen other factors like exercise, sleep, time of day, illness, etc, but that's a different story.)
 
Well if that was the case what about FIber? Don't T1 diabetics subtract the amount of Carbs - Fiber?

Fiber is also supposed to delay the spike. How come they subtract fiber from the carbs BUT they don't subtract fat or protein.
 
rachelsmith10111 said:
Well if that was the case what about FIber? Don't T1 diabetics subtract the amount of Carbs - Fiber?

Fiber is also supposed to delay the spike. How come they subtract fiber from the carbs BUT they don't subtract fat or protein.
Click to expand...
That might be something slightly different. In the USA, carbs are normally quoted on food packaging as "total carb" which is digestible carb plus indigestible fibre (there's often a clue in the fibre/fiber spelling). In the UK, fibre is deducted already so the carb value on a food item is only the digestible. So I (as a T2) would normally subtract fibre from total carb, if in the USA, to get the actual digestible carb amount. I'm only concerned about what digests to glucose.

I'll let someone with T1 answer the specifics on T1 practice.
 
rachelsmith10111 said:
Well if that was the case what about FIber? Don't T1 diabetics subtract the amount of Carbs - Fiber?

Fiber is also supposed to delay the spike. How come they subtract fiber from the carbs BUT they don't subtract fat or protein.
Click to expand...
As far as I know (but I may be mistaken) the US is the only country to include the fibre in the carbs. In Europe, we only have to be wary of polyols, which are included in the carb count but shouldn't be digestible.

We don't subtract the fibre from the carbs because it delays the spike, but because it isn't digestable so it won't turn into glucose. A high fibre food, like a high fat food, needs a different timing of insulin because it raises BG slower than the same amount of carbs without the fat or fibre.

I don't understand your question about subtracting fat or protein. Those are not carbs and they are not listed with the carbs, can't subtract those.
 
The question about protein and fat might be related to the fact that when little or no carbs are eaten, the body will break down protein and fat to produce glucose (gluconeogenesis), but this isn't something to worry about too much unless you're not eating many carbs - it's also a slow process which helps to flatten the response.

I think the fundamental point made above is that for a given quantity of things that can turn into glucose in the blood stream (mainly carbs) you need to take a given amount of insulin (which depends on you, the time of day, exercise, etc.) but which isn't affected by eating additional protein/fat, which just (though usually a good thing) slow absorption and flatten the shape of the response to give a still working pancreas an easier time of dealing with controlling the rise in BG.
 
rachelsmith10111 said:
Well if that was the case what about FIber? Don't T1 diabetics subtract the amount of Carbs - Fiber?

Fiber is also supposed to delay the spike. How come they subtract fiber from the carbs BUT they don't subtract fat or protein.
Click to expand...
As @KennyA said, subtracting fiber is done in the US because the fiber carbs are included in the nutrition figures, whereas in UK, Australia and New Zealand (countries where I've lived as a T1) fibre is not included in carb values so there is no need to subtract it.

But insulin calculation as a T1 is not just a question of counting carbs - if you are on a very low carb diet you have to count protein and fat as well

Dosing for Protein and Fat in Type 1 Diabetes: The OzDAFNE experience | ADE

Research has shown that high protein and high fat meals cause delayed hyperglycaemia in some people with type1 diabetes. This delayed rise in blood glucose...
ade.adea.com.au

As to the best diet? Yes, I have read posts from some people who do well on a plant based system, whereas many (most?) of the folk in T2 remission here appear to be doing it via a low carb approach. My personal opinion (remember I'm T1 not T2) is that different things work for different people and you just have to find a diet that works for you and your body and your food preferences. And using a glucometer or cgm can help determine how well a diet works for you.
 
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