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Rekarb

Low carbing but still spiking

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sumi

Hi Recarb,

Are you getting these spikes at 45 mins or an hour? I don't test until 2 hours, and I'm glad that I had not heard of testing earlier to find spikes until fairly recently. I had enough trouble handling my 2 hour pp numbers. Although I have looked, all I have ever found is the statement that prolonged levels over 140 can cause damage. No information on how long is prolonged. I suppose it depends on the person. Although a spike to 170 is not a non-diabetic number, and I can see you wanting to improve it, I wouldn't think an hour at such a level would be likely to hurt you. Joel makes a compelling case for insulin, especially since you are not dealing with weight issues.

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Rekarb
Hi Recarb,

Are you getting these spikes at 45 mins or an hour? I don't test until 2 hours, and I'm glad that I had not heard of testing earlier to find spikes until fairly recently. I had enough trouble handling my 2 hour pp numbers. Although I have looked, all I have ever found is the statement that prolonged levels over 140 can cause damage. No information on how long is prolonged. I suppose it depends on the person. Although a spike to 170 is not a non-diabetic number, and I can see you wanting to improve it, I wouldn't think an hour at such a level would be likely to hurt you. Joel makes a compelling case for insulin, especially since you are not dealing with weight issues.

 

Blood sugars go up pretty fast. 45 minutes is about where most spikes hit. Check this chart from "Blood Sugar 101"

What is a Normal Blood Sugar?

Most of the action takes place in 1.5 hours. The rest is a slow drifting down. If you look at the chart you'll notice that a spike of 170 is very diabetic. Normal doesn't go over 130. As to the damage, from my perspective, I itch like crazy and get a feeling like bug stings over different parts of my body. These little "ouches" stick around for 2 or 3 days. I call that damage being done. Even if this weren't the case, I believe we would all be best served by having our blood sugars as close to normal as possible. It's there for a reason.

 

Mike

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Rekarb
hi! i do basal and bolus. i started on very low doses. i have gradually worked myself up to what works for me.

 

i do a 30u basal at night now. i do 20-30u of bolus during the day.

 

but. today i was able to have a couple of french fries with dinner and some chocolate ice cream for dessert!

 

anyway. i think my highest reading today was about 104 (5.8).

 

keeping the bolus up, regular testing and generally low carb enables me to keep in a pretty good range.

 

i would advise taking it slow to start.

 

but, for me it was definitely a worthwhile decision!

 

:)

 

-- joel.

 

I've kind of decided that some sort of med before meals is my best shot at normal blood sugars. Now I'm weighing which one and why. It doesn't bother me if it's injectable or not except for the fact that there is far more control with injections as opposed to taking a pill.

 

Insulin sounds great but all it does it meet that particular spike at the moment. Symlin, I've heard will lessen the spike but also encourage a first phase response and help grow the beta cells.

 

Mike

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sumi

Recarb, I am familiar with Jenny's site, and agree with most of her interpretations, however, you might want to watch Dr. Christiansen's presentation to which she is referring (she has a link to it on her 'normal blood sugar' page. The test subjects, none of whom went over 140 on the OGT test, went as high as 160+ on their breakfast test, the average spike being over 130 at breakfast. Just like diabetics, it seems normal people also go higher in the morning. To me the most striking overall trait was their night BG levels which were without exception in the 80-90 range. Perhaps another reason to consider basal insulin.

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Rekarb
Recarb, I am familiar with Jenny's site, and agree with most of her interpretations, however, you might want to watch Dr. Christiansen's presentation to which she is referring (she has a link to it on her 'normal blood sugar' page. The test subjects, none of whom went over 140 on the OGT test, went as high as 160+ on their breakfast test, the average spike being over 130 at breakfast. Just like diabetics, it seems normal people also go higher in the morning. To me the most striking overall trait was their night BG levels which were without exception in the 80-90 range. Perhaps another reason to consider basal insulin.

 

I saw the presentation too. That 140 comes from some other places as well. I actually have basal insulin in the fridge but I come down pretty quick from the spikes and my bed time rate is about 100 now. Basal is too slow to stop the spikes. Maybe it will give a lower point to start from but going up to 170 might get reduced to 160 or maybe 150, not good enough.

 

I'm doing pretty good except for those spikes.

 

Thanks

Mike

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matingara
I've kind of decided that some sort of med before meals is my best shot at normal blood sugars. Now I'm weighing which one and why. It doesn't bother me if it's injectable or not except for the fact that there is far more control with injections as opposed to taking a pill.

 

Insulin sounds great but all it does it meet that particular spike at the moment. Symlin, I've heard will lessen the spike but also encourage a first phase response and help grow the beta cells.

 

Mike

 

not sure about whether Symlin will help grow beta cells but i am open to hearing some data on that.

 

one of the reasons i opted for insulin instead of diabetes medications (such as sulfonylurea) is that insulin allows my beta cells to rest. over-stimulation of the beta cells may lead to more quickly exhaust whatever function is left in my beta cells.

 

i know that taking sulfonylureas stimulated my pamcreas and kept my bgls down on a low carb diet.

 

i guess i am hoping that if i keep my beta cells intact i may be a more satisfactory patient to receive a beta cell "transplant" if/when that is available...

 

:)

 

-- joel.

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Rekarb
not sure about whether Symlin will help grow beta cells but i am open to hearing some data on that.

 

one of the reasons i opted for insulin instead of diabetes medications (such as sulfonylurea) is that insulin allows my beta cells to rest. over-stimulation of the beta cells may lead to more quickly exhaust whatever function is left in my beta cells.

 

i know that taking sulfonylureas stimulated my pamcreas and kept my bgls down on a low carb diet.

 

i guess i am hoping that if i keep my beta cells intact i may be a more satisfactory patient to receive a beta cell "transplant" if/when that is available...

 

:)

 

-- joel.

 

Most hypoglycemic agents work by either attempting

to increase insulin secretion from β cells (sulfonylureas,

meglitinides) or increasing peripheral insulin sensitivity

(biguanides, thiazolidinediones). None of them actually

targets the root cause of T2DM; deteriorating β-cell

function and mass. In addition to stimulating insulin secretion

and suppressing glucagon secretion, GLP-1 has other

pleiotropic effects in the pancreas. Animal studies have

suggested that chronic exogenous GLP-1 administration

has the ability to increase islet size, enhance β-cell

proliferation, inhibit β-cell apoptosis, and regulate islet

growth.36,37

 

This comes from here: Role and development of GLP-1 receptor agonists in the management of d

 

This effect on beta cells is why I find this class of drugs interesting.

 

Mike

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matingara
Most hypoglycemic agents work by either attempting

to increase insulin secretion from β cells (sulfonylureas,

meglitinides) or increasing peripheral insulin sensitivity

(biguanides, thiazolidinediones). None of them actually

targets the root cause of T2DM; deteriorating β-cell

function and mass. In addition to stimulating insulin secretion

and suppressing glucagon secretion, GLP-1 has other

pleiotropic effects in the pancreas. Animal studies have

suggested that chronic exogenous GLP-1 administration

has the ability to increase islet size, enhance β-cell

proliferation, inhibit β-cell apoptosis, and regulate islet

growth.36,37

 

This comes from here: Role and development of GLP-1 receptor agonists in the management of d

 

This effect on beta cells is why I find this class of drugs interesting.

 

Mike

 

thanks. now you have my attention. i will do more research on this. thanks.

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musique913
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I sometime think Ramon likes getting us riled up about his choices.:D

 

But yeah, alcohol and met..not a good idea.

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Rekarb
thanks. now you have my attention. i will do more research on this. thanks.

 

symlin is not GLP-1, Byetta is. They are both made by Amylin.

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lilmoe76

Rekarb-

I am very interested to see where you go with your choice. I am in kind of the same situation, still producing insulin-but my body is slow to respond when I eat. I am on a higher carb diet-100g per day though. I was concerned about spikes at 1.5 hrs pp (140-190) and spoke to my endo about insulin.

They evaluated my numbers, came back and told me to INCREASE my carbs to 150per day!!!! (I think they are worried about my weight loss) They said that the ADA states that if numbers are on their way down from 180 2hrs pp that is ok. They said that that is some people's goal!

I am not ok with this as I know from all the research you guys on here :) have done that is not the best, especially if you *can* get lower than that.

Long story short-I know my endo would support me if I chose to go on insulin but quite frankly I am terrified of the lows! I can go "lowish" (60's) just on my own!

Please let us know what you decide and how it goes! I am interested! I am also not as well read on everything either so the support here is great!

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xMenace

I experience spikes after meals too. I actually take a significant amount of insulin for my low carb meals. I often have rises later in the pp cycle too. Dr. Berstain describes this as the incretin effect or the “Chinese Restaurant Effect.”

 

Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars.

 

Once concern I have is with the guidelines focusing mainly on carbohydrates. Protein doesn’t raise sugar anywhere near as much as carbohydrate; however it can still raise blood sugar. Protein raises blood sugar by two mechanisms. The first mechanism is gluconeogenesis, which is the conversion of a small percentage of the protein to glucose. It converts to about 2 grams of glucose per ounce of protein, a very small percentage. An ounce is 28.5 grams. If you eat a 12-ounce steak, those grams can add up. The other mechanism by which protein raises blood sugar is the incretin effect, which in my books, I call the “Chinese Restaurant Effect.” Just distending your gut with anything will raise blood sugar, even a handful of pebbles, if you are a severe diabetic like me. So, just the presence of that steak in your gut will distend the gut, causing you to release hormones that will raise blood sugar. The first paper that I ever wrote that got published was published in the mid-1970s, somewhere around 1975, in a remote publication called Acta Paediatrica Belgique. It was entitled, “Protein as the Principal Source of Glucose in the Treatment of Diabetes.” If you eat protein as your major source of calories, you can derive glucose from the excess over what protein you need to build your muscles. Any excess protein gets slowly converted to glucose. You’re trickling in glucose slowly at a pace that can be covered with insulin.

 

My goal for 2010 is to quantify my needs. I want to expand the concept of a carb ratio. I believe I need separate ratios for the incretin effect, for carbs, and for protein. BlueSky has done some interesting experiements already [on another forum] which I want to use and maybe build on.

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Rekarb
Rekarb-

I am very interested to see where you go with your choice. I am in kind of the same situation, still producing insulin-but my body is slow to respond when I eat. I am on a higher carb diet-100g per day though. I was concerned about spikes at 1.5 hrs pp (140-190) and spoke to my endo about insulin.

They evaluated my numbers, came back and told me to INCREASE my carbs to 150per day!!!! (I think they are worried about my weight loss) They said that the ADA states that if numbers are on their way down from 180 2hrs pp that is ok. They said that that is some people's goal!

I am not ok with this as I know from all the research you guys on here :) have done that is not the best, especially if you *can* get lower than that.

Long story short-I know my endo would support me if I chose to go on insulin but quite frankly I am terrified of the lows! I can go "lowish" (60's) just on my own!

Please let us know what you decide and how it goes! I am interested! I am also not as well read on everything either so the support here is great!

 

Here you should check this out:

NEJM -- Weight Loss with a Low-Carbohydrate, Mediterranean, or Low-Fat Diet

 

Obviously, I can't just say your doc is nuts because I don't know your situation but on the face of it that sounds really awful. 150 is a lot of carbs for a diabetic especially for someone trying to find control.

 

The type of insulin I'm talking about is a bolus, this is a quick acting type that's there just to meet that spike. Since it's injected you also can control how much you want to challenge the spike. I typically won't eat more than 10 to 15 carbs per meal still I find myself up around 150 to 170. My thought is all I want to do is keep the thing below 140, (what I assume is the level of glucose toxicity).

 

All I would be injecting is for that 30 pts. Now if I only would have spiked to 150, knocking off 30 pts takes me to 120. I typically stay around 100 so even if I totally screwed up I would push myself down to 70. That's the theory I'm working on.

 

I plan to test like a demon as I do this and use foods that I've come to know really well and slowly but surely tweak this thing down to consistently be under 140.

 

I just thought about this though. If you were trying to match that carb load with insulin you would be pretty sure to put on weight.

 

I'll keep you posted.

 

Mike

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Rekarb
I experience spikes after meals too. I actually take a significant amount of insulin for my low carb meals. I often have rises later in the pp cycle too. Dr. Berstain describes this as the incretin effect or the “Chinese Restaurant Effect.”

 

Dr. Bernstein's Diabetes Solution. A Complete Guide to Achieving Normal Blood Sugars.

Once concern I have is with the guidelines focusing mainly on carbohydrates. Protein doesn’t raise sugar anywhere near as much as carbohydrate; however it can still raise blood sugar. Protein raises blood sugar by two mechanisms. The first mechanism is gluconeogenesis, which is the conversion of a small percentage of the protein to glucose. It converts to about 2 grams of glucose per ounce of protein, a very small percentage. An ounce is 28.5 grams. If you eat a 12-ounce steak, those grams can add up. The other mechanism by which protein raises blood sugar is the incretin effect, which in my books, I call the “Chinese Restaurant Effect.” Just distending your gut with anything will raise blood sugar, even a handful of pebbles, if you are a severe diabetic like me. So, just the presence of that steak in your gut will distend the gut, causing you to release hormones that will raise blood sugar. The first paper that I ever wrote that got published was published in the mid-1970s, somewhere around 1975, in a remote publication called Acta Paediatrica Belgique. It was entitled, “Protein as the Principal Source of Glucose in the Treatment of Diabetes.” If you eat protein as your major source of calories, you can derive glucose from the excess over what protein you need to build your muscles. Any excess protein gets slowly converted to glucose. You’re trickling in glucose slowly at a pace that can be covered with insulin.

 

My goal for 2010 is to quantify my needs. I want to expand the concept of a carb ratio. I believe I need separate ratios for the incretin effect, for carbs, and for protein. BlueSky has done some interesting experiements already [on another forum] which I want to use and maybe build on.

 

 

 

Hey, I love the articles you post they've been a great help.

 

You know I was thinking about quantifying this process but there just seems to be too many jokers in the deck. You're T1 but you've still got some pancreas going and I read many times in T1 posts about their insulin requirements changing - some times drastically. I think the system is too complex for that, just way too much interaction.

 

I'm just going to tweak one thing a little bit and see what occurs. I'll be looking at one output with one variable input. I'm at the level now, because of all of my testing, where I get a pretty predictable range, admittedly this is a wide range but I've got a real big margin of error this way

 

We shall see. Keep me posted

 

Mike

 

PS I've been interested in seeing the GLP - 1 trial results for T1s. The thought being that it can hopefully increase beta cell mass like it does in animals.

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Rekarb
I didn't say 170 was "good." I said it was no cause for alarm, when measured immediately after eating. I never found a situation where my glucose didn't elevate after a meal. Doctors consider a "spike" to be significantly higher. I believe (but I might be wrong) that they tell you not to be alarmed until a spike level reaches 240.

 

As to damage, I think you would be more concerned about A1C then instantaneous readings. Sugar needs to stay in your blood, unmetabolized, in order to cause organ and tissue damage. It seems, from your post, that you ARE metabolizing the sugar. That's a good thing.

 

All I'm trying to say, and again, I'm not a physician, is that from all I could gather from your post, you're in pretty good shape, and shouldn't stress out too much over a transient number.

 

If you just refuse to go through this however, which I totally get, ask your endo about Starlix. It comes in 60mg and 120mg doses. I was on the 120, but sometimes that actually caused me to go low. You only take it before a meal, and it will carry you through the spike period. It passes out of the body quickly, and causes no bathroom incidents or nausea.

 

I never brought up Starlix. My endo looked at all my numbers and said "Starlix".

 

Dude, you are too good!

 

Mike

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statdeac

Have you tried a 15 minute walk around the block immediately after the meal. I heard about this on a diabetes podcast and find it works pretty well.

 

Also, have you discussed this issue with your doctor/medical team?

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Subby

Just going back to the Symlin for a moment - something I like about it is that from my understanding it is basically a hormone replacement for amylin (the hormone, not the company...) which is also lacking alongside insulin, when beta cells mass goes missing. It is meant to help with slowing digestion of carbs and suppressing gluconeogenesis. I'd love to try it. Too bad it's not available in Aus.

 

Good luck with the starlix, I'm sure you'll let us know how it goes.

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Rekarb
Have you tried a 15 minute walk around the block immediately after the meal. I heard about this on a diabetes podcast and find it works pretty well.

 

Also, have you discussed this issue with your doctor/medical team?

 

This is the problem about not having a first phase insulin response. By the time I finish eating and head for the door the spike is well under way. Walking helps the second phase but I've got a good basal. For whatever reason, the initial response that blunts that spike is missing. I believe this process starts even before you take the first bite. I believe that anticipation sets up a dump of insulin to halt that rise in its tracks. What I have is a strong basal which brings it down quickly but the spike still happens.

 

Mike

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dbaratta
you could look at what type of carbs your eating to see if different foods react differently or you might want to try insulin a fast acting just a idea

 

Super true. Simple carbs race thru the system, they start digesting on the tongue if I am not mistaken? Stick with mother nature and see if that helps.:confused:

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Rekarb
Just going back to the Symlin for a moment - something I like about it is that from my understanding it is basically a hormone replacement for amylin (the hormone, not the company...) which is also lacking alongside insulin, when beta cells mass goes missing. It is meant to help with slowing digestion of carbs and suppressing gluconeogenesis. I'd love to try it. Too bad it's not available in Aus.

 

Good luck with the starlix, I'm sure you'll let us know how it goes.

 

I liked the idea of Symlin too. What I didn't like was the use of the pen. I could only get two dosages. We always say YMMV but you would never know that from Pharma. It can cause nausea but you can't adjust the dose to get it right. Byetta is just the same.

 

In my discussion with my endo I said I wanted the insulin because I felt that I could control dosage far better with a syringe. Actually, I've no better control with Starlix but it is a far weaker drug that targets a very specific system for a very short amount of time.

 

Mike

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foxl
Super true. Simple carbs race thru the system, they start digesting on the tongue if I am not mistaken? Stick with mother nature and see if that helps.:confused:

 

I have as much trouble with "complex" carbs as with simple -- I think it depends on your body chemistry! Always worth a try though!

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