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Spiking and neuropathy/complications

LucySW

LucySW

Well-Known Member
Messages
1,974
Location
Denmark
Type of diabetes
LADA
Treatment type
Insulin
Who agrees with @donnellysdogs that even with a nice-sounding A1c, say in the 6s, it's spiking between high and low that seems to trigger complications? Does anyone else have knowledge or experience with this?

If it's true, then a) it's really important and we should all be working hard to fix this, and b) we should all be going for mean BG and standard deviation as our best tools to keep safe.

Anyone have stories to tell or nice articles to link? @dd, it sounds very plausible. But if so, we should be talking about it more ...

Lucy
 
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I've been told this since the get go (twenty years ago), that the variability is worse than the particular level of blood sugar.
Doesn't make it true though. I vaguely remember there may be something in the Gary Taubes book about it.

I too would be interested to know the evidence base (if any).
 
So some of the articles on that link are suggesting brief post meal spikes are a major culprit for many types of complications? Or is that just Jenny Ruhl saying that in her comments? I couldn't always tell. Though I do trust her analysis.
 
If there is a strong evidence of spikes being a major culprit of complications then the diabetes community needs some major changes because - as far as I am aware - the emphasis put on patients at the moment is solely on HbA1c results.

My consultant - who has been a T1 specialist for 20 years and is a "leader in the field" according to his bio on a Harley Street website - told me definitively that testing BG immediately before each meal is enough and that my desire to test more regularly was not necessary because "there is strong evidence that those with in-range BG before each meal go on to have excellent HbA1c results". However, testing only before each meal would completely miss the spikes and deviation of BG over the course of the day. Are there any clinical studies on the importance of minimising variability?
 
Whilst I have nothing to refute the analysis, the hypothesis this raises for me is that non-diabetics seeing post prandial spikes of >8 should also see nerve damage. Yet there seems little evidence of this, which suggests it is more complex than just spikes.

There is evidence that variability affects the eyes and the majority of opticians will confirm this.
 
A lot of those studies cited are saying that HBa1c alone would miss the complications. That people with in target HBa1c are getting complications due to high post meal spikes that don't really show up on their HBa1c and definitely don't show up on their pre meal or fasting BG.
 
tim2000s said:
Whilst I have nothing to refute the analysis, the hypothesis this raises for me is that non-diabetics seeing post prandial spikes of >8 should also see nerve damage. Yet there seems little evidence of this, which suggests it is more complex than just spikes.

There is evidence that variability affects the eyes and the majority of opticians will confirm this.
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But is it common for non-diabetics to spike >8? I thought 7.5-8.5 was the "high-end" of a non-diabetic person's post-meal glucose level?
 
Whereas some of you T2s get told to test 2 hours post meal, which would pick up some of this variability, as a T1 I was actively taught not to test until +4 hours which in effect means before the next meal. I don't know if this advice has changed for T1s?

I'm starting to think I need to check every 2 hours now.
 
Spiker said:
Whereas some of you T2s get told to test 2 hours post meal, which would pick up some of this variability, as a T1 I was actively taught not to test until +4 hours which in effect means before the next meal. I don't know if this advice has changed for T1s?

I'm starting to think I need to check every 2 hours now.
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Use the dexcom for it. That's where I've seen the post prandial variability, using the libre.
 
pinewood said:
But is it common for non-diabetics to spike >8? I thought 7.5-8.5 was the "high-end" of a non-diabetic person's post-meal glucose level?
Click to expand...
Looking at the readings of a non-diabetics using the libre on Facebook, more than I expected.
 
Spiker said:
Whereas some of you T2s get told to test 2 hours post meal, which would pick up some of this variability, as a T1 I was actively taught not to test until +4 hours which in effect means before the next meal. I don't know if this advice has changed for T1s?

I'm starting to think I need to check every 2 hours now.
Click to expand...
No, I was diagnosed in December and both my DSN and Consultant said I should test on waking, before breakfast, lunch and dinner and before bed. "No need to test after eating" is the message still being given from my experience ....
 
tim2000s said:
Use the dexcom for it. That's where I've seen the post prandial variability, using the libre.
Click to expand...
Yeah but I am really struggling to afford the Dexcom at the moment. If I can get similar results by testing every two hours for free I want to try that.
 
pinewood said:
No, I was diagnosed in December and both my DSN and Consultant said I should test on waking, before breakfast, lunch and dinner and before bed. "No need to test after eating" is the message still being given from my experience ....
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These guys need to catch up with the evidence. :-(
 
pinewood said:
But is it common for non-diabetics to spike >8? I thought 7.5-8.5 was the "high-end" of a non-diabetic person's post-meal glucose level?
Click to expand...
Some of those studies quoted by Jenny show damage kicking in, in real time, at levels above as little as 5.6 mmol/L (plasma). So even 6 mmol/L is immediately damaging.
 
I don't think we should get paranoid over what we can't control tho. Or we'll just be depressed. We decide what we're aiming for, right?
 
Spiker said:
Yeah but I am really struggling to afford the Dexcom at the moment. If I can get similar results by testing every two hours for free I want to try that.
Click to expand...
To see the spikes, dear heart, we could just test at one hour. Cos bolusing at the right time could then avoid the spike. Nicht wahr?

It's not like for poor old T2s - once they've screwed up there's nothing they can do to fix it.
 
LucySW said:
I don't think we should get paranoid over what we can't control tho. Or we'll just be depressed. We decide what we're aiming for, right?
Click to expand...
True point.
The "glass half full" way of looking at it is, every extra reduction we can achieve, makes an extra positive effect.
 
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