What's the deal with spikes?

[LinsT]

Hi all - I'm a little confused as to what I should worry about in terms of BG spikes. Generally the advice is to test 2 hours after meals to check BG has returned to normal. Now, when I do this, my BG is generally good - between 5 and 7. However, if I check after an hour, depending on whether I've eaten any carbs or not - I often see a higher result. But after 2 hours as I say, its normal.
A recent example - after a low carb lapse into cake territory, I had a spike of 13.5. But an hour later when i tested, I was back to 6.1.
I've read a lot about avoiding spikes, and I do understand that I should be trying to avoid them. But what's the important factor here - the spike itself or the fact that things return to normal reasonably quickly after?
I feel like I'm not explaining myself very well here!
How worried should I be about spikes if my levels return to normal within that 2 hour time frame?
I don't have the benefit of having had my first post diagnosis HbA1c yet, so trying to work out what I should and shouldn't worry about in terms of finger prick testing.
I really hope this makes sense to someone who can help me with this!

 

[urbanracer]

There seem to be different schools of thought on this @LinsT , many people on the forums like to maintain tight control and wouldn't let thier blood sugars rise that high.

My endocrinologist is only interested in my a1c and disregards any mention of highs and spikes. As a T1 I seem to drift up to 12 or 13 once a week when I misjudge carbs and insulin requirements, my endo' thinks that's normal.

Many people also watch the size of the actual spike, and think that you should try not to go higher than 2mmol from where you were at the start of the meal.

I am not sure if there's a clear answer to your question about the timing of the spike, and I am not in a position to cite any reference to research on this. Maybe somebody else can be more informative.

 

[copey399]

That's a good question that I was wondering about too. eg. if I eat something that spikes me and I get a reading of, say 11, I find that 2 or 3 hours later I drop quite low for me i.e. 4.2 (usually I'm in the 6s) and my monitor tells me that my average is still in the 6s because the low has evened out the high. So as the HBA1C takes an average reading, then only me and my monitor know that I spiked, presumably. I'm type 2 no meds just low carb diet. Are the spikes dangerous in themselves or is it only sustained high readings that are cause for concern?

 

[Squire Fulwood]

Here is a link to what this site has to say on the subject. It is based on the official advice.

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

Many people set themselves tighter targets because they either don't agree with the official ones or find that by doing so they are far more likely to achieve.

Usually, whatever targets a person sets themselves they feel they are right for them. You may end up doing the same.

For example, if you are unhappy with your one hour reading then set yourself a target and do whatever you need to do to achieve it. It is mostly up to you.

 

[Squire Fulwood]

if I eat something that spikes me and I get a reading of, say 11, I find that 2 or 3 hours later I drop quite low for me i.e. 4.2 (usually I'm in the 6s) and my monitor tells me that my average is still in the 6s because the low has evened out the high.

Whereas that sounds like a good get out clause people worry that actual damage is being done during the 11.1 period and they try to avoid it. I don't know of any official guidance on that but, on balance, I don't like the idea of getting high readings for any length of time.

 

[Bluetit1802]

As it says in Squire's link, the guidelines imply that NICE isn't interested in anything under 90 minutes. It is up to us, as individuals, to set our own targets using the NICE recommendations as a "do not exceed" guide.

The peak of the spike varies in timing depending on the combination of foods eaten - carbs/fat/protein. Major carbs will spike quickly, protein may spike much later (several hours later) but the more fat in the meal the lower the spike should be although it will be more prolonged.

 

[Pinkorchid]

We are all individuals so are our BG levels. It is said that testing 1 hour after food is to early as you will probably see a spike which may worry you. Even non diabetics BG can rise quite high after an hour not unknown for them to even have spikes into double figures after a carby meal. Testing can become obsessive if you are not seeing the levels you want to so try not to test under 2 hours after eating and then as you have done already you will find you are probably within range of the guidelines

 

[LinsT]

Here is a link to what this site has to say on the subject. It is based on the official advice

Thank you for this Squire. I had read this and knew the target levels and generally I am within the 'non diabetic' levels (only through serious monitoring of my carb intake) but reading further down the page it does state that problems occur when BG is high for sustained periods of time. Apologies for missing this first time round - hopefully that is a reflection on the amount of information our brains are bombarded with on diagnosis, and not due to my poor intellect!
My concerns came from the fact that its so easy to make innocent mistakes. The cake incident I mentioned in my initial post was obvious - i knew it was likely to affect BG (though not as much as it did!!). But there have been times when I've eaten things I honestly thought would be fine - a single teaspoon of a dried tropical fruit mixture on some natural yoghurt that spiked me to over 10 for example.

Are the spikes dangerous in themselves or is it only sustained high readings that are cause for concern?

I am coming to the conclusion that solitary spikes are not an issue, as long as you take notice of what caused it and avoid the trigger in future. However I'm happy to hear from people who may disagree with this.

I think I'm probably testing too much - maybe this is a common thing in the first 6 months
of diagnosis - I test around 7 times a day, sometimes more. It's just that I've read so many testimonials from people who have managed their BG's for ages and then things deteriorate without reason. So every time I see a spike I have a little panic!

 

[LinsT]

Even non diabetics BG can rise quite high after an hour not unknown for them to even have spikes into double figures after a carby meal.

Thats interesting Pinkorchid - I didnt know that. Hopefully it confirms that I don't need to worry too much about an occasional high reading as long as subsequent readings are normal and the high isn't sustained.

 

[Squire Fulwood]

But there have been times when I've eaten things I honestly thought would be fine - a single teaspoon of a dried tropical fruit mixture on some natural yoghurt that spiked me to over 10 for example.

Yes, dried tropical fruit mixture is where they take all the water away and just leave the sugar. I anticipate that you will have many surprises during you learning time. This is why you do a lot of testing in the beginning although I don't think I ever did seven in one day. I tended to concentrate on one meal and move on when I had cracked it.

One test that made my nurse throw her hands up in horror. I compared Mars bars to shop bought chicken kievs. They spike me equally. DN said it was the breadcrumbs but it wasn't. The so called chicken is made up of minced chicken, flour and goodness knows what else. The factory at Kiev was asked how many kievs they get from one breast and the answer was six.

If you compare that to original recipe KFC where the chicken is real, the carb content is minimal at 1 or 2. Ooda thunk.

Keep testing for now.

 

[copey399]

I've been doing strict lc/hf since July 2015 and I've tested and tested to see what spikes and I still can't get below the 6s even though I have lost over 2 stone in weight (which now seems to have stuck at 10st5) And things that I am OK with sometimes will spike at others. It's all a minefield really as pointed out by Bluetit when she says "The peak of the spike varies in timing depending on the combination of foods eaten - carbs/fat/protein." Brain overload. Despite all the reading and learning I've done I'm still not sure if I have it under control or not. I suppose my next HBA1c will be the deciding factor as to whether I need to go on the dreaded Metformin.

I had an interim one ordered by my GP when I said I wasn't taking any meds and doing the lc/hf diet instead which was about 3 months after starting lc/hf and I was down from 57 to 53 which was still not good and I don't think I've seen any vast improvements since then.

Apologies to @LinsT as I didn't mean to make this thread about me but I think it helps to compare notes (hopefully) xx

I know GPs are very dismissive of too much testing but as Squire Fulwood says how are we supposed to know if we're getting it right or living in a fool's paradise. It's a bit late by the time you get an HBA1c to find out that you've got it all wrong.

 

[LinsT]

protein may spike much later (several hours later)

I compared Mars bars to shop bought chicken kievs.

Lol sounds like a fun test
I had a run in with some breaded chicken myself . I ate some chicken goujons (shop bought) thinking the breadcrumbs couldn't possibly do much damage. They did - but maybe it was because of the extra ***** in them that you mentioned rather than the bread crumbs themselves.

 

[Bluetit1802]

Yes, keep testing. There will be many more surprises to come. They still happen to me after 2 years of testing. The most annoying thing is you can eat an identical in every respect meal and your spikes will be higher/lower/at a different time each time you test it.

 

[LinsT]

Apologies to @LinsT as I didn't mean to make this thread about me but I think it helps to compare notes (hopefully) xx

Hey no apologies needed!! The whole point of these forums is for everyone to get in there and discuss their problems xx

I still can't get below the 6s

That doesn't sound too bad to me - 6 to 7 is a reasonable number- are you seeing much higher readings after you've eaten or something?

 

[LinsT]

whether I need to go on the dreaded Metformin.

If its any consolation, I'm on metformin and don't have any problems with it xx

 

[Squire Fulwood]

Lol sounds like a fun test
I had a run in with some breaded chicken myself . I ate some chicken goujons (shop bought) thinking the breadcrumbs couldn't possibly do much damage. They did - but maybe it was because of the extra ***** in them that you mentioned rather than the bread crumbs themselves.

I actually included goujons in my tests. They are not very big are they but two of them took me to over 11. I did other tests and came to an all pervading conclusion. Unless it looks like part of an animal it probably isn't. So kievs, goujons, dippers, nuggets, fingers and cakes are off the list because they are origami of the flour and sugar kind.

Believe me, it's not the breadcrumbs.

 

[LinsT]

Have you ever tried making your own? We used to cook them a lot - the kids loved all the messy rolling around. But since my experience with the bought ones I haven't bothered trying. Wondering if they could be an occasional add to the menu with a sparse covering.

 

[copey399]

Hey no apologies needed!! The whole point of these forums is for everyone to get in there and discuss their problems xx

Thanks x Glad you see it that way.

That doesn't sound too bad to me - 6 to 7 is a reasonable number- are you seeing much higher readings after you've eaten or something?

No, not really, unless I've tried something to see if I can have it without spiking and I usually can't ..lol. But my fasting (early morning) ones are rarely below high 5/6s and today was 7.3 and others on the low carb diet seem to get 4-5s. I know I shouldn't compare myself with them as a lot are on meds too.

If its any consolation, I'm on metformin and don't have any problems with it xx

Yes, I tried it and the slow release but I felt quite nauseous on it but I know I didn't give it a fair chance as I was in denial that I even had diabetes at the time (blush).

 

[Squire Fulwood]

Have you ever tried making your own? We used to cook them a lot - the kids loved all the messy rolling around. But since my experience with the bought ones I haven't bothered trying. Wondering if they could be an occasional add to the menu with a sparse covering.

Not goujons but in the early days I had to put my money where my mouth was on the kiev front. A real chicken breast, garlic butter and breadcrumbs proved it was the shop bought "chicken" that was the problem. If I need a chicken snack nowadays you can get ready cooked chicken parts in boxes. They have bones in so I am confident they are real.

Tesco do a real breaded chicken product which is not a problem and is delicious. It's fresh so needs cooking and saves me going to KFC because you get about 8 pieces for about £4

 

[Bluetit1802]

No, not really, unless I've tried something to see if I can have it without spiking and I usually can't ..lol. But my fasting (early morning) ones are rarely below high 5/6s and today was 7.3 and others on the low carb diet seem to get 4-5s. I know I shouldn't compare myself with them as a lot are on meds too.

A higher than normal fasting could mean it is the protein from the previous evening meal kicking in (notwithstanding all the other reasons for high FBG numbers) I know from experience I always have a high fasting after eating liver & bacon the previous evening, for example. Also Metformin does help with morning fasting levels as it reduces the amount the liver can dump, so those on Metformin are more likely to see lower fastings. I'm med free but my FBGs are high 5's and low 6's.