[tanyatype1]

Hi everyone! I have a question that I've been wondering/worrying about since I was diagnosed. After you eat, your blood sugar spikes, then comes down from the insulin, but how dangerous are all of these spikes (over time)? Do we not really have to worry about them as long as our a1c's are low? I read on one of these posts that damage starts when blood sugar is above 7.5. That scares me. I haven't been worrying about eating things low on the glycemic index because I figured that the fast acting insulin would take care of it anyway. Any thoughts? Thanks!

[BlueSky]

Opinion is split on this one. The traditional view is that high BG is ok as long as it doesn't stay there too long. And it is the average BG that is really important. It is based on findings from big studies like the DCCT. But more recent research suggests that BG spikes are in fact harmful.

My experience has been that when BG spikes, getting it down again can be really difficult. And overcorrecting invariably results in hypos. Matching carbs with insulin action, to my mind, is more trouble than it is worth. I avoid spikes by limiting carbs and bolus insulin simply because removing BG volatility simplifies my life.

[tanyatype1]

Thanks for your input BlueSky - I have been noticing that my correction boluses don't seem to bring down my BG like it used to (in the evening anyway) I'm not sure if I should change my insulin to carb ratio at dinner, adjust my evening basal, or change the insulin sensitivity factor on the EZBG menu on my pump! So many variables! I'm going to try to limit my carbs a bit more too and see what happens.

[seacomp]

Note, Type 1 can also develop insulin resistance which would change the ratios.

[Harold]

Originally Posted by BlueSky

But more recent research suggests that BG spikes are in fact harmful.

Sure like to see a few of those researches.

The biggest problem with spikes I've seen is getting into a yoyo cycle. Those do increase the area under the curve.

[Stuboy]

I was told that even a non diabetic can go into double figures after a meal... so as far as im concerned, i've been taught it's absolutly normal. This is why we test 2 hours after a meal and not 1 hour.

[BlueSky]

Originally Posted by Stuboy

I was told that even a non diabetic can go into double figures after a meal... ..

It is also true that a lot of "normal" non-diabetics are suffering from the harmful effects of high blood glucose. The big DCCT and UKPDS trials showed that the risk of complications only starts increasing significantly when HBA1c goes over 6%. And everyone latched onto that figure as the the "normal" benchmark. But it has more recently been shown that heart disease and mortality risk increases when HBA1c goes over 4.8%. (You can read all about it in Regina Willshire's latest blog ). Here is a table relating CHD, CVD and mortality risk to HBA1c :

Percentage of men with CHD events at, with relative risk at:

Less than 5% = 3.8% (95% CI; RR = 1)
5% to 5.4% = 6.4% (RR 1.56 [1.09-2.24])
5.5% to 5.9% = 8.7% (RR 2.00 [1.39-2.88])
6% to 6.4% = 10.2% (RR 2.13 [1.35-3.35])
6.5% to 6.9% = 14% (RR 3.34 [1.78-6.63])
7% or higher = 28.4% (RR 7.07 [3.96-12.62])
Percentage of men with CVD events at, with relative risk at:

Less than 5% = 6.7% (95% CI; RR = 1)
5% to 5.4% = 9% (RR 1.23 [0.92-1.64])
5.5% to 5.9% = 12.1% (RR 1.56 [1.16-2.09])
6% to 6.4% = 15.2% (RR 1.79 [1.24-2.60])
6.5% to 6.9% = 25% (RR 3.03 [1.73-5.31])
7% or higher = 34.8% (RR 5.01 [2.95-8.51])

All-cause mortality (death within the six years of the study) in men at:

Less than 5% = 3.8% (95% CI; RR = 1)
5% to 5.4% = 5.5% (RR 1.25 [0.88-1.82])
5.5% to 5.9% = 7.5% (RR 1.57 [1.08-2.29])
6% to 6.4% = 9.9% (RR 1.80 [1.13-2.86])
6.5% to 6.9% = 19% (RR 3.49 [1.83-6.66])
7% or higher = 18.5% (RR 3.38 [1.74-6.53])

This emerged from a study on the effects of BG on cancer. It shows pretty hefty increases in risk and you need to get your HBA1c below 5% to get rid of it alltogether! So we are playing a risk-minimisation game here. And you have to decide how far you want to go with it. But don't delude yourself that BG spikes are normal and don't affect you.

To the extent that BG spikes increases HBA1c, CVD, CHD and mortality risk goes up. If these spikes last a couple of hours three times a day, the effects are likely to be substantial. And you don't have to be a diabetic for this to be an issue.

[tanyatype1]

oh my god - that is so depressing! thanks for the info - I wish it was wrong!