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spikes

Discussion in 'Ask A Question' started by Ali H, Jan 24, 2013.

  1. Ali H

    Ali H Type 2 · Well-Known Member

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    Please can anybody help with a link to articles that explain what sort of spikes cause problems such as neuropathy etc. What I mean is is it spikes above a certain level, prolonged spiking, regular spiking etc.

    Thanks in advance.

    Ali
     
  2. viviennem

    viviennem Type 2 · Well-Known Member

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    Complications are caused by running blood glucose levels too high. Many of us prefer never to be over 7.8, 2 hours after eating. This is one reason why testing is recommended, especially at first. By checking your BGs 2 hours after eating you can get some idea of which foods send you too high. With me, one to avoid is mince pies - even one will send me into double figures. :shock:

    7.8 is a figure that will lead to complications very slowly, if at all. For every point you go over that, complications are more likely. That's very simplistic, but a good rule of thumb.

    If your GP tells you not to test, and relies on a (say) 6-monthly HbA1c test, how can you know what your blood glucose is doing? You might follow the "NHS recommended" diet faithfully - but if I based my diet around starchy carbs, my BGs would be consistently too high - and if I didn't test, I wouldn't know. The damage would be creeping up on me. Because I do test, I know which foods to avoid, and am usually able to keep my blood glucose at non-diabetic levels by using a very low carbohydrate diet.

    We all have the odd treat, a food we normally avoid. With me it's fish and chips - I have fish, a small chips and mushy peas about once every 3 months. I do spike a bit, but it soon comes down. If I ate them once a week I'd certainly be doing damage.

    My advice to avoid spikes would be - learn which foods affect you badly, and avoid them; be very careful of your carbohydrate consumption, because all carbohydrates are turned to glucose in your system - sugar is only a form of carbohydrate; learn portion control; go for Low GI foods because they affect your BGs more slowly.

    Hope this helps a bit. Maybe someone else can find the links for you. :D

    Viv 8)
     
  3. Ali H

    Ali H Type 2 · Well-Known Member

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    Thanks Viv, I currently have everything under control but specifically want links.

    Ali
     
  4. Ali H

    Ali H Type 2 · Well-Known Member

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    Nobody? I am surprised because so many of us aim to keep below the 7.8 etc but whenever I talk to HCPs they are all quite blase about spikes and more concerned about HBA1Cs. Therefore I was looking for some links that back up the reasons to control spikes. I would thefore be grateful if anybody has any idea where the 7.8 figure comes from and the scientific evidence behind it.

    Thanks.

    Ali
     
  5. foreverdelayed

    foreverdelayed · Well-Known Member

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    I'd say, through experience that hba1c is more important than random spikes. Yeah you can have is so finely tuned that your spikes are minimal in regards eating but I've always found stress to be more of an enemy in that respect. I lowered my hba1c from 8.4 to 6.7 in just a few months cos I got told I had a macular oedema and it made things worse! Had to get laser in both eyes! Optometrist said not to worry about spiking, just concentrate on being consistent at particular times like bedtime etc. And touch wood I haven't been back to eye clinic in 4 years.

    All about the 420
     
  6. Ali H

    Ali H Type 2 · Well-Known Member

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    Thank you for your experience, sorry to hear you had eye problems though.

    Ali
     
  7. ewelina

    ewelina Type 1 · Well-Known Member

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    It would me good to know for sure. I was told that its better to have higher sugar levels (not too high of course) but consistent. Spikes cause the biggest damage and we sould avoid them as much as possible. Thats why low carb diets and GI index so important
     
  8. Ali H

    Ali H Type 2 · Well-Known Member

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    It would Ewelina, I am constantly told by HCPs that the HBA1C is the most important not what is happening on an hour by hour basis. But a lot of folk on here religously try to stick to low levels 2 hours post prandial and I am trying to find the evidence as to why that minimises complications to discuss with the HCPs.

    Ali
     
  9. viviennem

    viviennem Type 2 · Well-Known Member

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    I think the 7.8 figure comes from the much-missed Xyzzy's research into Scandinavian treatments of Type 2 diabetes. Sorry I can't give you the link - I'll ask him next time I post on his site.

    The NHS gives a top figure of less than 8 for non-diabetics, and less than 8.5 for Type 2s, both 2 hours after eating. The 7.8 just tweaks that down a bit.

    Viv 8)
     
  10. phoenix

    phoenix Type 1 · Expert

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    The figure of 7.8mmol/ml is the same as the 140mg/dl in the American College of Endocrinology 2002 guidelines.
    Interestingly the American Diabetes association don't have a post prandial figure on their website anymore (it used to be high at 10mmol/l) They now say
    " Postprandial glucose may be targeted if A1C goals are not met despite reaching preprandial glucose goal"
    http://www.diabetes.org/living-with-dia ... ucose.html
    So the emphasis is on HbA1c not post prandial spikes.

    Whether spikes cause damage over and above that associated with high average levels is a matter of huge debate and there is very little hard data
    .In vitro (ie cells in test tubes) studies do show damage caused by short term glucose exposure
    Results from long and medium term trials don't show much association between the day to day ups and downs and diabetic complications. To be honest there are few medium term trials and only two very long term ones DCCT ;T1 and the UKPDS ;T2 . The first one had seven point glucose profiles measured once every three months over 20+ years , the second one didn't look at daily glucose only HbA1c. So we don't really have much evidence . The limited evidence from the DCCT found that day to day variability didn't make a difference. It was overall glucose patterns that mattered.

    One complication which is definitely affected by glucose variability is hypoglycemia in insulin treated diabetics.

    http://edrv.endojournals.org/content/31/2/171.full

    What has been shown to matter is the HbA1c, the average glucose (subtly different) and whether that is high or varies considerably (ie high HbA1c followed by low followed by high over the years.
    There are several studies that show that this up and down over time seems affect outcomes.


    Here is a 2012 summary from a British researcher (the earlier paper was a 2009 one) I was trying to find a later paper that might have given some more recent evidence. It is a short communication in response to another paper so isn't in depth.

    ....The distinction between these definitions is of relevance because definitively showing an association between increasing short-term glycaemic variability and an additional risk of micro-or macrovascular complications has so far proved to be elusive. Retrospective data analyses of the Diabetes Control and Complications Trial (DCCT) have shown little signal that within-day variability is important in the development of microvascular complications [2–4]. However, this study was not originally designed to address this question.
    Although postprandial hyperglycaemia (a subset of glucose variability) is generally regarded as a risk marker for cardiovascular disease [5], the only prospective study to specifically assess whether reducing within-day glycaemia might influence cardiovascular events has been unable show any benefit [6].
    E. S. Kilpatrick (*)
    Department of Clinical Biochemistry, Hull Royal Infirmary,

    Diabetologia (2012) 55:2089–2091
    DOI 10.1007/s00125-012-2610-5

    Pragmatically, I doubt anyone can achieve lowish HbA1cs without relatively good control of post prandial spikes. However so far there isn't a lot of evidence to suggest that some interday variability is a risk factor (except perhaps in the case of pregnant women and critically ill patients in ICU which are very specific cases.)
    This may change as more studies use continuous monitoring but I can't see anyone funding a long term trial with large numbers of subjects using it .
     
  11. Ali H

    Ali H Type 2 · Well-Known Member

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    Thank you for the excellent reply Phoenix.

    Ali
     
  12. viviennem

    viviennem Type 2 · Well-Known Member

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    As always, Phoenix comes to the rescue with the information. Many thanks, Phoenix! :D :thumbup:

    Viv 8)
     
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