T2 - How to lower sugar AFTER a bad meal

[Joepubli]

I am a T2 non insulin. Occasionally I end up going to a party or event and eat stuff I know I shouldn't - this I did last night. Then I saw the massive spike on my Freestyle Libre device that I am trialling for last 3 weeks - last night I hit 260 with an xmas meal despite my normal medication (sitagliptin+metformin). For the last 3 weeks I have been staying largely in the range - peaks below 180 and good Time in Range.

Accepting that my self control at such events is poor, is there anything I can do to bring the spike back down quickly or avoiding it to start with? Or take an extra pill before or after knowing that I am going to be bad?

Secondly - is a bad day hitting 260 really a big deal if not happening too often? Say once a week?

 

[JoKalsbeek]

I am a T2 non insulin. Occasionally I end up going to a party or event and eat stuff I know I shouldn't - this I did last night. Then I saw the massive spike on my Freestyle Libre device that I am trialling for last 3 weeks - last night I hit 260 with an xmas meal despite my normal medication (sitagliptin+metformin). For the last 3 weeks I have been staying largely in the range - peaks below 180 and good Time in Range.

Accepting that my self control at such events is poor, is there anything I can do to bring the spike back down quickly or avoiding it to start with? Or take an extra pill before or after knowing that I am going to be bad?

Secondly - does is a bad day hitting 260 really a big deal if not happening too often? Say once a week?

Hi Joe, good morning,

If you're up, and you want to get down, there's little else to do but go for a brisk walk. Half an hour or so should help, a bit longer if you're really seriously spiking. Don't start messing with your medication. Metformin isn't going to lower your blood glucose (it's just tells your liver not to dump too much glucose, it doesn't do anything whatsoever about what you eat.), and upping the sitagliptin might end with you going hypo while you sleep. So don't do any of that on your own, without medical advice from your nurse or team, if there's a block or street around which you can walk for a bit. The only thing it'll cost you is a little time out of your day.

I have to say, peaks below 180 still sounds not exactly good, nor in an acceptable range. Anything over 153 will do damage to organs, arteries etc, so you'll want to stay below that if you can. Low carbing should help with that, so if you can tweak your diet further, that'd be good. (https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/) And no, I wouldn't recommend hitting 260's once a week or so. Your body won't thank you for it in the long run. If you're usually relatively low, a peak like that might make you feel ill as it is. Look at it this way: How do you think you'd do, having a small dose of arsenic per week? Once might not kill you, but it does add up after a while, making you seem flu-ish and anaemic. And then, after a few months or even years have passed, it will make you kick the bucket, after a long sickbed. Think of spikes as drip-fed small doses of arsenic. They will hurt you eventually, even if they don't seem to at the get-go. (Sorry if this sounds overly dramatic, but the "once won't hurt" theory is a bit off... It's rarely the once, and it will, in all likelihood, hurt. That's why the bulk of us here fall off the wagon only at certain times of year: Christmas, or their birthday. It only comes along once, not every week, and they can get back on the wagon right after.)

Be safe, don't do anything rash with medication, and invest in some walking shoes.
Good luck!
Jo

 

[Joepubli]

Hi Joe, good morning,

If you're up, and you want to get down, there's little else to do but go for a brisk walk. Half an hour or so should help, a bit longer if you're really seriously spiking. Don't start messing with your medication. Metformin isn't going to lower your blood glucose (it's just tells your liver not to dump too much glucose, it doesn't do anything whatsoever about what you eat.), and upping the sitagliptin might end with you going hypo while you sleep. So don't do any of that on your own, without medical advice from your nurse or team, if there's a block or street around which you can walk for a bit. The only thing it'll cost you is a little time out of your day.

I have to say, peaks below 180 still sounds not exactly good, nor in an acceptable range. Anything over 153 will do damage to organs, arteries etc, so you'll want to stay below that if you can. Low carbing should help with that, so if you can tweak your diet further, that'd be good. (https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/) And no, I wouldn't recommend hitting 260's once a week or so. Your body won't thank you for it in the long run. If you're usually relatively low, a peak like that might make you feel ill as it is. Look at it this way: How do you think you'd do, having a small dose of arsenic per week? Once might not kill you, but it does add up after a while, making you seem flu-ish and anaemic. And then, after a few months or even years have passed, it will make you kick the bucket, after a long sickbed. Think of spikes as drip-fed small doses of arsenic. They will hurt you eventually, even if they don't seem to at the get-go. (Sorry if this sounds overly dramatic, but the "once won't hurt" theory is a bit off... It's rarely the once, and it will, in all likelihood, hurt. That's why the bulk of us here fall off the wagon only at certain times of year: Christmas, or their birthday. It only comes along once, not every week, and they can get back on the wagon right after.)

Be safe, don't do anything rash with medication, and invest in some walking shoes.
Good luck!
Jo

Good morning. Thanks Jo for your great answer. Currently pretty difficult to keep spike as low as 153 - I am a vegi and its difficult to get to very low carb - although it does go down pretty quickly. The analogy with arsenic is pretty effective in explaining. Is there a source for that 153 figure?

 

[Daibell]

Hi. adding Diamicron/Gliclazide to your script may help a bit as it stimulates the beta cells. A lot depends on whether you a 'true' T2 i.e. with excess insulin due to insulin resistance or a possible T1/LADA with a lack of insulin. Are you slim or overweight?

 

[Lamont D]

Hi @Joepubli

The reason your doctor has prescribed sitagliptin is because it helps you produce more useful insulin to counter the weak insulin response you have been having, that is one of the reasons why you are still spiking high. You derive too much glucose from carbs, the initial insulin response isn't enough, you have too much glucose and not enough insulin to use that glucose for your energy levels.
Finding out which carbs and sugar gives you that spike, is important in going forward.
Do not over medicate, I am on sitagliptin, it will help but it will take time, I would imagine you do have some insulin resistance, which is not helping and through dietary advice, not having the carbs, the control you need to have, will happen.

If you're not sure, ask more questions and have a word with your GP.

 

[Joepubli]

Hi. adding Diamicron/Gliclazide to your script may help a bit as it stimulates the beta cells. A lot depends on whether you a 'true' T2 i.e. with excess insulin due to insulin resistance or a possible T1/LADA with a lack of insulin. Are you slim or overweight?

Definitely overweight!

 

[Joepubli]

Hi. adding Diamicron/Gliclazide to your script may help a bit as it stimulates the beta cells. A lot depends on whether you a 'true' T2 i.e. with excess insulin due to insulin resistance or a possible T1/LADA with a lack of insulin. Are you slim or overweight?

Thanks Daibell - is there a test that can be done to check whether its excess insulin or lack of insulin?

 

[Joepubli]

Thanks Daibell - is there a test that can be done to check whether its excess insulin or lack of insulin?

answering my pown questions - seems its a C-Peptide Test

 

[nutribolt]

I am a vegi and its difficult to get to very low carb - although it does go down pretty quickly.

Hi... apart from all the wonderful advice on this thread I just wanted to say I am a veggie too so I can understand the constraints that come with it. Having said that, I am a vegetarian by choice and I don't mind eating eggs and I hope that when you say veggie you don't mean vegan because vegans can't have eggs either and that limits the options even further.

Anyway I have found some really good vegetarian recipes both with and without eggs that have helped me limit my carb intake to a max of 30g a day and that in turn has not only had me off medication but also allowed me to keep my BG between 4 to 7.5 (72 to 135) and as an added side benefit helped me reduce my weight as I have managed to stay in ketosis all the while I am low carbing.

One recipe I use everyday is this low carb eggless almond flour bread:

And one channel with Eggless yet very tasty recipes is this:

https://youtube.com/c/MagicinmyFood

Hope this helps.

 

[Joepubli]

Hi... apart from all the wonderful advice on this thread I just wanted to say I am a veggie too so I can understand the constraints that come with it. Having said that, I am a vegetarian by choice and I don't mind eating eggs and I hope that when you say veggie you don't mean vegan because vegans can't have eggs either and that limits the options even further.

Anyway I have found some really good vegetarian recipes both with and without eggs that have helped me limit my carb intake to a max of 30g a day and that in turn has not only had me off medication but also allowed me to keep my BG between 4 to 7.5 (72 to 135) and as an added side benefit helped me reduce my weight as I have managed to stay in ketosis all the while I am low carbing.

One recipe I use everyday is this low carb eggless almond flour bread:

And one channel with Eggless yet very tasty recipes is this:

https://youtube.com/c/MagicinmyFood

Hope this helps.

Thanks Nutribolt - that's really kind and helpful. A common issue everyone faces is that it is not always practically possible to largely control what you eat if you are out a lot. If I am visiting someone its kind of difficult.

That's why I asked the question - what to do if you know you had a high carb meal resulting in a big spike.

 

[ziggy_w]

Hello @Joepubli,

Welcome to the forum.

I agree with what has been said before. Large swings in blood sugars can lead to complications. Personally, I always try to keep my blood sugars always below 140 mg/dl, even half an hour or one hour after a meal.

You were asking for some sources for this. Jenny Ruhl (bloodsugar101) has a great website looking among other things at scientific research connecting blood sugar levels and organ damage as well as cardiovascular complications.

Here are the links:
https://www.bloodsugar101.com/organ-damage-and-blood-sugar-level
https://www.bloodsugar101.com/a1c-and-heart-disease

I agree being a veggie makes things a bit more difficult, but not impossible. For example, chia and lupin beans hardly have any carbs. Edamame is also good. I make rolls which would also probably work for you, using lupin bean flour, oat fiber, almond flour, potato fiber, psyllium husk, baking powder, different seeds (such as linseed, sesame, pumpkin, chia) and spices. They are about 3g of carbs per roll and hardly move my blood sugars.

Dietdoctor.com also has different meal plans, accommodating many different food preferences, including vegan and vegetarian.

With respect to insulin production -- my guess would be that your making plenty of insulin given your weight (especially if you have not been losing significant amounts of weight lately) -- because we need the help of insulin to store fat.

Good luck on your journey.

 

[nutribolt]

Thanks Nutribolt - that's really kind and helpful. A common issue everyone faces is that it is not always practically possible to largely control what you eat if you are out a lot. If I am visiting someone its kind of difficult.

That's why I asked the question - what to do if you know you had a high carb meal resulting in a big spike.

Yeah I understand that and answer to that is like Jo said brisk walk... but i was just trying to help with the veggie part that you mentioned is stopping you from achieving low crabs when you are at home...

When I am out and about because I follow intermittent fasting, I can and do try to avoid eating if I can as you are right in outside world anywhere I see its all carbs, carbs and more carbs... I also carry with me some almonds and nuts as well as a keto chocolate bar so that I can munch on it if the need arises but other than that perhaps you can have yogurt or a high cream coffee... Point is prevention to high carbs than to be in a situation that requires action on bringing the reading down as that part is quite difficult to control.

I hope I make sense...

 

[ziggy_w]

Thanks Nutribolt - that's really kind and helpful. A common issue everyone faces is that it is not always practically possible to largely control what you eat if you are out a lot. If I am visiting someone its kind of difficult.

That's why I asked the question - what to do if you know you had a high carb meal resulting in a big spike.

When I am going out and don't know what will be available, I either eat something before or take something with me (for example, nuts, olives, high cocoa content chocolate). However, on most occasions, there will be something available, which will also work for me (though I sometimes have to limit portion size).

 

[JoKalsbeek]

Good morning. Thanks Jo for your great answer. Currently pretty difficult to keep spike as low as 153 - I am a vegi and its difficult to get to very low carb - although it does go down pretty quickly. The analogy with arsenic is pretty effective in explaining. Is there a source for that 153 figure?

I don't remember where I got 153 from... Could be Dr. jason Fung, could be elsewhere. It is just a number that stuck with me. https://www.diabetes.co.uk/Diabetes-and-Hyperglycaemia.html quotes an even lower number. Basically, if it's classed as hyperglycemia, it'll be damaging. Here's another analogy, which has stuck with me since I read it a few years ago, I think actually on this site: having high blood glucose is like having ground glass in your veins. You don't want to going around your arteries, organs... Damaging eyes, kidneys, what have you. It just sands away at everything until something sooner or later, breaks. Or multiple somethings.

Being a vegetarian does complicate things, it but's not impossible. https://www.diabetes.co.uk/forum/category/vegetarian-diet-forum.71/ is a whole subsection on this forum you might find helpful. And if it comes down to eating out or over at friends, if they can cater to vegetarian, which is still more exception than the norm, they can cater to a low carb vegetarian. I hated asking for something special from the kitchen due to both diabetes and food sensitivities/inflammatory or migraine triggers, but they'd rather make you something special than make something they have to toss out for the most part. (And my usual spots know I tip nicely for their efforts). So if you're out and about, you can actually ask a kitchen to keep your special dietary needs in mind. Also, if it's friends you're eating at, just talk to them. I'm sure your hosts would rather give you something you can eat without too many problems, than give you something that'll adversely impact your health.

It's not easy to ask for what you need, this introvert knows that all too well... But it does help you in the long run. It is worth it.
Good luck!
Jo

 

[Joepubli]

I don't remember where I got 153 from... Could be Dr. jason Fung, could be elsewhere. It is just a number that stuck with me. https://www.diabetes.co.uk/Diabetes-and-Hyperglycaemia.html quotes an even lower number. Basically, if it's classed as hyperglycemia, it'll be damaging. Here's another analogy, which has stuck with me since I read it a few years ago, I think actually on this site: having high blood glucose is like having ground glass in your veins. You don't want to going around your arteries, organs... Damaging eyes, kidneys, what have you. It just sands away at everything until something sooner or later, breaks. Or multiple somethings.

Being a vegetarian does complicate things, it but's not impossible. https://www.diabetes.co.uk/forum/category/vegetarian-diet-forum.71/ is a whole subsection on this forum you might find helpful. And if it comes down to eating out or over at friends, if they can cater to vegetarian, which is still more exception than the norm, they can cater to a low carb vegetarian. I hated asking for something special from the kitchen due to both diabetes and food sensitivities/inflammatory or migraine triggers, but they'd rather make you something special than make something they have to toss out for the most part. (And my usual spots know I tip nicely for their efforts). So if you're out and about, you can actually ask a kitchen to keep your special dietary needs in mind. Also, if it's friends you're eating at, just talk to them. I'm sure your hosts would rather give you something you can eat without too many problems, than give you something that'll adversely impact your health.

It's not easy to ask for what you need, this introvert knows that all too well... But it does help you in the long run. It is worth it.
Good luck!
Jo

Followed the link. It says:
What is hyperglycemia?
Hyperglycemia, the term for expressing high blood sugar, has been defined by the World Health Organisation as:

• Blood glucose levels greater than 7.0 mmol/L (126 mg/dl) when fasting
• Blood glucose levels greater than 11.0 mmol/L (200 mg/dl) 2 hours after meals

Although blood sugar levels exceeding 7 mmol/L for extended periods of time can start to cause damage to internal organs, symptoms may not develop until blood glucose levels exceed 11 mmol/L


So this suggestes that for short post prandial spikes upto 200 is OK?
this is where my confusion is and it makes a huge difference to the quality of life.

 

[Joepubli]

so far - if I ALREADY had a bad meal and it will/has spike my sugar the solutions to bring it back down quickly are:
1. Drink more water - but this only works if you are over 180mg/10mmol - thats when it gets into urine? - "When there is too much glucose in the blood, the kidneys may not be able to reabsorb it all. When this occurs, the body excretes the glucose from the body through the urine. For this to happen, the blood sugar concentration usually has to exceed 180 mg/dl (10 mmol/L)"

2. Walk

3. If you are on insulin take fast acting insulin to bring it down.

Is there anything else?
I get the point that highs should be avoided and even once a week is too much.

 

[Oldvatr]

There seems to be only one class of medication that I have seen used post-meal to reduce spikes but I have no personal experience of using them. They are an older therapy and not used much nowadays

Meglitinides. These medications — such as repaglinide (Prandin) and nateglinide (Starlix) — work like sulfonylureas by stimulating the pancreas to secrete more insulin, but they're faster acting, and the duration of their effect in the body is shorter. They also have a risk of causing low blood sugar and weight gain.

I think a brisk walk is a lower risk option. Portion control is a more effective solution. I am also on orals, and I try to avoid stressing my system in advance. As others have said, playing with medication is not advisable, after all it is not a headache. Any other quick fix being offered is IMHO a dose of snake oil. There is no safe OTC remedy

 

[Mbaker]

I don't remember where I got 153 from... Could be Dr. jason Fung, could be elsewhere. It is just a number that stuck with me. https://www.diabetes.co.uk/Diabetes-and-Hyperglycaemia.html quotes an even lower number. Basically, if it's classed as hyperglycemia, it'll be damaging. Here's another analogy, which has stuck with me since I read it a few years ago, I think actually on this site: having high blood glucose is like having ground glass in your veins. You don't want to going around your arteries, organs... Damaging eyes, kidneys, what have you. It just sands away at everything until something sooner or later, breaks. Or multiple somethings.

Being a vegetarian does complicate things, it but's not impossible. https://www.diabetes.co.uk/forum/category/vegetarian-diet-forum.71/ is a whole subsection on this forum you might find helpful. And if it comes down to eating out or over at friends, if they can cater to vegetarian, which is still more exception than the norm, they can cater to a low carb vegetarian. I hated asking for something special from the kitchen due to both diabetes and food sensitivities/inflammatory or migraine triggers, but they'd rather make you something special than make something they have to toss out for the most part. (And my usual spots know I tip nicely for their efforts). So if you're out and about, you can actually ask a kitchen to keep your special dietary needs in mind. Also, if it's friends you're eating at, just talk to them. I'm sure your hosts would rather give you something you can eat without too many problems, than give you something that'll adversely impact your health.

It's not easy to ask for what you need, this introvert knows that all too well... But it does help you in the long run. It is worth it.
Good luck!
Jo

The 153 mg /dl or 8.5 mmol/l is a suggested maximum high for Type 2's, I believe due to an assumption of an inevitable likelihood of non optimal control . Whereas 140 or 7.8 for the general public.

This makes little sense as the T2 would want as low as possible due to damage after 7.8.

https://www.bloodsugar101.com/organ-damage-and-blood-sugar-level.

 

[Oldvatr]

The magic figure of 153 appears to be used when diagnosing Gestational Diabetes using the One Step Method. It is the response to an OGTT, and is the 2hr PP minimum for PWD diagnosis as specified for the USA and some parts of Europe.

It is also the upper threshold for diabetes diagnosis where the HbA1c is expressed in the old system of % as it equates to 7% apparently.

 

[Brunneria]

Followed the link. It says:
What is hyperglycemia?
Hyperglycemia, the term for expressing high blood sugar, has been defined by the World Health Organisation as:

• Blood glucose levels greater than 7.0 mmol/L (126 mg/dl) when fasting
• Blood glucose levels greater than 11.0 mmol/L (200 mg/dl) 2 hours after meals

Although blood sugar levels exceeding 7 mmol/L for extended periods of time can start to cause damage to internal organs, symptoms may not develop until blood glucose levels exceed 11 mmol/L


So this suggestes that for short post prandial spikes upto 200 is OK?
this is where my confusion is and it makes a huge difference to the quality of life.

that quote can be interpreted in different ways.

you seem to be interpreting it as ‘so long as I don’t go too high for too long, everything is fine (and I get to eat treats regularly).’

I and others on this board interpret that quote as ‘the organ and nerve damage from blood glucose levels above 7mmol/l is longterm and cumulative, and may not become noticeable until a great deal of damage has already occurred, making future management increasingly difficult, and diabetic complications becoming more and more likely as time goes by.’

it is, of course, everyone’s personal choice as to how they evaluate their personal risk and how they manage their health and lifestyle.

my personal view is that I am 53 and would like to live another 30+ years in good health, with eyes, feet, hands and internal organs all functioning well. So I don’t want my blood glucose rising to damaging levels at any point during the day which will, over the years to come, cause cumulative damage. I also like to keep my blood glucose well below damaging levels at all times, to give me a nice safe buffer zone.
Because I am human, I don’t always achieve this, but I achieve it consistently, and when I err, I keep my blood glucose well below 11mmol/l

Your mileage may vary, but you mentioned ‘quality of life’.
I make decisions that will improve my health a great deal in future decades, which will in turn improve my quality of life.