I’ve learned since coming to TD that some of you (perhaps it is only T1s though?) test at both one hour and again at two hours after meal. (And I always wonder, too, do you time from when you begin to eat or when you finish??)
I wanted to get a better idea how I’m handling things; I want to know if I am spiking really high… so tonight an hour after supper at a local steakhouse, I tested. 209.
Now, I had a 6-oz filet, 6 grilled shrimp, cesear salad, and maybe a third-cup of baked sweet potato w/ only butter. It’s now two hours later, and it’s down to 107 – which is really good, yes, I know.
So… should I worry about the one-hour reading? I just have never taken one-hour readings before, so they may always be this way… and I was so pleased this morning when my pre-breakfast reading of 116 dropped to 96 an hour and a half after a large glass of milk beverage (approx. 35gr of carbs).
I’m curious to see what other people think about this. I test at one hour because by 2 hours, I am always back at a normal level. My numbers would be similar to yours, I think, I would be up at 170 or 180 because of the carbs in the sweet potato. I personally want to keep my numbers as close to normal as I can manage. While it is true that non-diabetics spike after eating carbs, they rarely go higher than 140 and the spike lasts only minutes, not an hour or more. In fact, non-diabetics spend 23 hours a day under 120. That’s what I am aiming for. If I only test at 2 hours I will miss the fact that I might be spending 6 hours a day in the higher range (3X2 hours for each meal) or even more hours if I go up with every snack as well. Since the only way to be sure of avoiding complications is to stay in the normal range I will continue to test at an hour when I eat new foods and take steps to ensure that I am back on target after an hour instead of after 2 hours. I do this by using a small amount of insulin, and/or restricting carbs and exercising. I am Type 1 (LADA) but am still in the early stages so might be more like a Type 2 in some ways except for the fact that I am insulin sensitive and can use it if I need to. I don’t inject with every meal, however. The other reason I test at one hour is that I don’t like how it feels to swing up and down in a short period of time. It makes me very tired and cranky. I also read somewhere that wildly fluctuating BG can actually damage your organs more than a high level which remains more stable.
The ADA which is ultra conservative says that several readings AT ANY TIME over 200 mg/dl are diagnostic for diabetes.
So yes, you have a problem. If you ignore it, eventually you’ll be seeing high numbers at 2, 3 and 4 hours. But for now you are in the early stages and still have living beta cells left, which is very good news.
My suggestion would be to lose the 35 grams carb intake. Do some 1 hour testing to determine how much carb you can eat and stay under 140 mg/dl which seems to be the number associated with developing neuropathy.
If you can eat at that level without problems, you’re all set. If not, you might want to talk to your doctor about starting Metformin which is the inexpensive drug that is currently recommended as a first drug. It does NOT cause weight gain, in fact it helps with weight loss, and it can prevent the progress to diabetes in people with impaired glucose tolerance.
The 35g of carbs at breakfast that day was very unusual for me. It is usually 20g or less. I didn’t intend to drink but half of what I put in the container, and save half for lunch time… but got distracted and suddenly it was empty. Usually I have water or coffee in the mornings. So, that is why I was rather surprised that the reading was not higher that morning.
The one-hour reading I took after supper is something I have not done in the past (generally due to the number of strips my current script/insurance which provides me only 3 test per day). I’ve been reading up on the PPG and thought I would start watching it, and when my doc writes the new script I’ll ask him to provide more per day.
But, I want to ask further about the numbers… you are saying 140 mg/dl after only one hour? I thought the goal was 140 after two hours… though I have also read that “normal” BG rarely goes over 140 after meals.
I think if you aim for 140 after 2 hours you are guaranteed that your BG went up much higher than that since most people peak at about 45 minutes and you could see this from your experience in testing after dinner. If your goal is normal blood sugars to avoid complications it stands to reason that shooting for 140 after 2 hours, (although considered low enough by most doctors and diabetic organizations) will not give you normal BG. I personally aim for under 120 after an hour and under 100 after 2 hours but I am more strict than most people. I think you’d be pretty safe with under 140 after an hour and under 120 after 2 hours. Not entirely normal, but close enough.
Actually, the research shows that most people spike at 75 minutes after eating. But that’s an AVERAGE and individuals differ from meal to meal and also with the degree of gastroparesis (slow stomach emptying.)
A person is at 140 at 2 hours they may have been extremely high at 1 hour, or that might be their peak if they have slow stomach emptying. Or they might peak a lot later if they ate four slices of Pizza.
That’s the problem with diabetes. Blood sugars are not tightly predictable.
I had a bizarre high yesterday 2 hours after eating half the crust of one slice of pizza correctly timed with 4.5 units of insulin (half R half N). I was at 221 at 2 hours so I retested with another meter after washing hands and got 225 so it was real. An hour later I was a 111. But I was high the previous morning and this morning, too. And I’m running high today, so something is going on, but what??? Who knows… My vial of R is only a few days old and it worked well when I opened it. And 2 units of good R should have been enough to knock the 1/2 slice of pizza down to a reasonable level.
I had taken a Prilosec the previous night for heart burn, and wonder if that could do something weird. Or if I’m getting sick. Or if some freak failure of new insulin could occur (though that seems unlikely.)
But this is why we have to test all the time rather than just for the first 2 weeks after diagnosis.
According to Professor Christianson’s study, the peak for the normal subjects is at 45 minutes. (The page is Mean Daily lLife TG and it’s the last page before the summary.) He actually comments on this because of the practice of measuring Post Prandial glucose at one or two hours and says that someone should test this in people with diabetes, who may have different peaks due to absorption issues and delayed stomach emptying. He also found that baseline recovery was 90 minutes after the start of the meal. I think my own situation is closer to that of regular folks than other people with diabetes. I have done enough testing at 15 minute intervals to be sure that my peak is between 30 and 45 minutes unless I am eating something high in fat, like pizza, in which case I have peaked at 2 or even 3 hours.
I’m pretty sure that the study I saw WAS in people with diabetes, but I don’t have the reference at hand.
The people on the diabetic newsgroup with Type 2 have generally reported that 1 hour works best for them but some measure from the beginning of the meal and some from the end. which would correspond to 75 minutes for many of us My own peaks were at 1 hour for many years and only started to change when I developed some stomach emptying issues from taking diabetes drugs which pushed them out further.
Normal people have a 1st phase insulin response, which is what returns them to baseline at 90 minutes.
By definition people considered diabetic in research studies either have a fasting bg over 125 or a 2 hr GTT over 200. That’s how they select them. So all studies of people with Type 2 diabetes are studies of people with NO first phase response.
That is why usually testing at 1 hour and 2 hours is the best timing for someone with recently diagnosed Type 2 diabetes. Type 2 is usually diagnosed around the time when first phase insulin response has disappeared though how much second phase is left will vary.
