I’ve heard or read that these erratic swings of correcting highs then correcting lows and going up and down is bad for you. That is what happened last night for a big birthday dinner. Why is that so bad? Does anyone have any supporting documentation why going up and down so rapidly is bad? It doesn’t happen often to me at all but I miscalculated my dinner and then my birthday dessert (yes I know T1s shouldnt have dessert, lol) I don’t do it often at all.
I think the evidence would be those studies showing BG> 140 causes complicatins. I guess this is a pretty slow process but I don’t like taking chances with it? I think the “rollercoastering” is sort of frowned upon by MD’s as it sort of shows that you are “out of control”. I would not worry about it that much if it’s an occasional thing. This time of year is good b/c you have lots of opportunities to work on party strategies!
type 1’s can have dessert as well i know i don’t do it often but you can work them in. If you cover them properly.
They did a study where they exposed cells to a BG of 20 mmol/L (360 mg/dl) constantly, and where they exposed another to a BG that fluctuated between 5 mmol/L (90 mgdl) and 20 mmol/L (360 mg/dl) constantly. The cells exposed to the fluctuations actually had more damage done to them than those exposed to the constantly elevated BG.
I don’t have a reference for this, but I can look one up in the next day or two (I read it in a book which I just don’t have access to at the moment).
Still, I would say it happening occasionally isn’t a bad thing. And for T1s it’s hard to keep BG at a nice steady level continuously regardless, we just try our best.
Swings cause a repeated stress on the body and brain. With stress, there is the release of adrenal hormones. Finally, the symptoms abate and you have hypoglycemia unawareness. That leads to calling 911 by someone other than yourself.
Swings mean over-correction and they mean your A1c will be inaccurate, and physicians usually depend on that as an indicator. So then your physician becomes an unreliable guide (if he/she normally is a guide).
The idea is to have the smallest standard deviation you can have.
That being said, you are not alone. If birthday is the only time when you swing, be happy.
Wow really? I’d love to see that article.
i’ve also read about it causing early cell death on an individual cell level.
but mainly, i want to avoid it because it makes me feel like i’ve been hit by a truck.
and of course T1’s can have dessert. do the math, take the insulin appropriately. the keys for me are moderation [don’t eat the whole bag of cookies, etc] and timing the insulin right. that takes practice and measuring but now i know that nilla wafers digest almost immediately for me [they are one of my hypo emergency foods] and cheesecake takes a while. since i’m on a pump i can time my cheesecake bolus to be extended. there’s a movie theater near me that serves cheesecake and every few months i make a special treat out of it!
Researchers feel that a low standard deviation is important. Afraid I don’t have the studies available at the moment, but it certainly make sense that keeping BG as level as possible is a wise choice. Of course, we all know how hard this is! When on the high/low roller coaster, I feel horrible & it’s exhausting. Don’t know how people cope with this kind of thing frequently.
Happy birthday!
Me too - this is a real surprise based on other papers I’ve read. Please post this study or the book you read it in (or both!)
i think we should all eat blanced diets reguardless. but correct. sugar is not a bad thing, its just a very hard to control thing.
Mendosa.com has a pretty good overview of glycemic variability and the work of Irl Hirch. You can find a synopsis of the research here:
http://www.mendosa.com/blog/?p=192
Standard Deviation is just one measure of glycemic variability. This is the best part of the discussion:
“But what obviously excited Dr. Hirsch and his audience, myself included, was his announcement new software just became available that incorporates a much better tool for calculating glycemic variability than the standard deviation. It uses new low, high, and combined blood glucose indices developed by Dr. Boris Kovatchev, associate director of the University of Virginia Center for Biomathematical Technology.”
Thanks for the link. But that isn’t a synopsis of research - it is only his stated belief that variablility is important. I’ve seen that conjecture before - but never seen any evidence to back it up. There is a link to a paper that states “reducing variability [is important] to both reduce hypoglycemia and attenuate the risk for cardiovascular and behavioral complications due to hyperglycemia.” But this has nothing to do with the complication risk (i.e. neuropathy, etc). which is what was mentioned above.
There’s also a link to a debate between two doctors, one stating that variability is important, the other that the A1c is a sufficient measure. But again neither side seemed to have any hard evidence.
Yes, it’s not a synopsis of the research in general.I believe it’s mostly a summary of Irl Hirch’s research which, I believe, is some of the work that people refer to when they talk about the affect of BG variability on diabetes complications. I could be worng, but I do believe that Hirsh is either cited by many supporting papers, or has cited work. I honestly don’t recall.
My apologies to Gerri if I’m way off in using this link.
Personally, I think there is something to be said for controlling BG variability as well as average BG, but I don’t personally think that Standard Deviation is a particularly good measure of BG variability and I don’t think there is enough data on how big BG swings have to be before oxidative damage sets in in vivo.
Give me a few. I’ll see what I have saved on this computer.
I also read an article that studies show that frequent swings cause as much damage as staying high all the time. I lost all my links when my computer crashed a couple months ago but I will try to find that again. I think one of the ones that I read was on Science Daily.
Funny my doctor just told me after having a low and after eating to correct if I am high say at next meal or even two hours later to just give my food bolus and not my correction bolus or I will swing low again because of the natural hormones produced from the low. I experience the swings regardless and am trying to balance my meals with food I know will keep me in range but really I love birthday cake and snacks. Thanks for this discussion and everyone’s input.
Here is one article from a small study - this didn’t copy very well! I know the one I originally read was a cardiology article and more geared to damage to the heart by the swings.
http://www.jdrf.dk/UserFiles/file/Research%20E-Newsletter%2058.pdf
A new study in France shows that wide swings in glucose
levels may damage the body as much as sustained periods of
hyperglycemia (high blood glucose).
The finding suggests that diabetes patients should increase their
efforts to curb such fluctuations if they want to reduce the risk
of complications such as heart disease and damage to the eyes,
nerves, and kidneys. It also bolsters the view that continuous
glucose monitors and, eventually, an artificial pancreas, could
have a tremendous impact on reducing diabetic complications by
preventing repeated highs and lows.
The research, led by Louis Monnier, M.D., was conducted at
the University of Montpelier and published in the Journal of the
American Medical Association (Vol. 295, No. 14, p. 1681, 2006).
The study found that glucose fluctuations trigger “oxidative
stress,” changes in metabolism that lead to cell damage and
cell death and contribute to complications. It was known that
hyperglycemia had this effect, but now it appears that repeated
highs and lows can be equally damaging.
Previously, chronic hyperglycemia was viewed as the main cause
of blood vessel damage. As a result, diabetes care has focused on
reducing hemoglobin A1C (HbA1c) levels, which indicate average
blood glucose for a two-to-three-month period.
But the Montpelier study underscores that average levels can be
misleading. Two people with similar HbA1c levels might have a
dramatic difference in the number of glucose “excursions”—when
glucose levels depart from normal range and fall too low or
rise too high. In recent years, more researchers have concluded
that HbA1c readings are not the only measure of good glucose
control.
The development of accurate continuous glucose monitors now
allows researchers to design experiments that measure glucose
fluctuation. The devices can record glucose levels continuously
over several days and keep a record of the entire period, making
it possible to see how many glucose excursions occur and how
drastic they are.
The Montpelier researchers studied 21 patients with diabetes
over a three-day period, measuring how often glucose levels went
significantly high and low. They found that patients with more
glucose fluctuation also had higher levels of a biochemical marker
for oxidative stress. Although the study was conducted with type 2
diabetes patients, the findings should apply to type 1 patients as well.
In fact, the correlation between glucose fluctuation and
oxidative stress was more direct than the relationship between
sustained hyperglycemia and oxidative stress. In other words,
glucose fluctuation seems to have a more direct, predictable effect
on oxidative stress, and presumably, complications.
“These seminal findings provide a new perspective on the
development of diabetes complications,” said Antony Horton,
JDRF Program Director for Diabetes Complications.
“New technologies, such as continuous glucose sensors, and
ultimately a closed-loop system, will allow for significantly
better glucose control, including lower A1c’s and reduced glucose
variability,” said Aaron Kowalski, JDRF Strategic Project Director.
Yeah, there should be a direct link to a pdf of the Irl Hirsch paper that discusses microvascular damage due to oxidative damage caused by high glycemic variation on Mendosa’s site Jag. It’s more of a review paper and a discussion on how hypotheses could be tested, but the discussion specifically on how high glycemic variation could affect diabetes related complications is there.
I’ve seen papers on both sides of the debate. Like I said, I personally think there’s something to reducing BG variation but there are a lot of questions that need to be answered.
Interesting
I found one group of authors that seems to have published extensively on one particular experimental system. Are these the ones you were thinking of? It seems to support the thesis, though it is only one in vitro system that I could find.
Quagliaro, L., Piconi, L., Assalone, R., Martinelli, L., Motz, E., & Ceriello, A. (2003). Intermittent high glucose enhances apoptosis related to oxida- tive stress in human umbilical vein endothelial cells: The role of protein kinase C and NAD§H-Oxidase activation. Diabetes, 52, 2795 – 2804.
Risso, A., Mercuri, F., Quagliaro, L., Damante, G., & Ceriello, A. (2001). Intermitten high glucose enhances apoptosis in human umbilical vein endothelial cells in culture. American Journal of Physiology Endo- crinology and Metabolism, 281, E924–E930.
First off, since this isn’t routine for you, I wouldn’t worry. It happens to all of us. It’s likely that any damage occurs over the long term. Enjoy your occasional dessert:)
I’ve passed across a few papers that analyzed human data, and some appeared to show a link. I’ll try to find and post them later, but I’ll say that most of the larger ones are retrospective studies and none ‘sealed the deal’ on it. That is in large part because separating the damage done by hyperglyemia from the damage done by glycemic variability is a huge challenge, and will almost certainly have to be done prospectively. CGM will hopefully make it easier to ask the question but you’re still left with many obstacles, some scientific and some related to patient compliance.
That being said, I think the most compelling argument for low variability is the intuitive one. Your body probably does it for a reason. Since the non-D body carefully regulates bg, I think it is best to start with the hypothesis that variability does matter rather than the opposite. At least, until it’s proven otherwise.