Peaks?

[Guest guest]

Hi Listmates,

I am a Type 2 diagnosed 8/94; I already had advanced retinopathy at that

time so I am very concerned about worsening this complication. I started

out on glyburide, but after losing just a little weight (10-15lbs.) I was

able to stop taking the medication and have not used anything but diet and

exercise to control for several years now. I have to brag a little here; I

have gone on to lose a total of 55lbs.

Anyway, I have a question for you all. My BG often peaks at 140 (or above)

one hour after a meal. Exercise will almost always bring this back down

into an acceptable range so that by two hours I will be below 120 and

usually right around 100 (or even lower). Even when I haven't been able to

exercise I find I usually get back into an acceptable range within two

hours. So, I am wondering how harmful these peaks are as far as

complications go. My A1C has been in the " normal " range (although at the

high end) most of the time and my doctor isn't concerned about these peaks

as long as it and my fasting BG are OK. BTW, my fasting BG is usually

around 90.

Do any of you have any thoughts on this?

Thanks in advance.

Sandy J.

Type 2, D & E

[Guest guest]

Sandy J. writes:

<< ... So, I am wondering how harmful these peaks are as far as

complications go. My A1C has been in the " normal " range (although at the

high end) ... >>

Sandy, we are going to experience higher bg's after eating ... even

non-diabetics have some bg swings. We can minimize the peaks and valleys by

lowering carbohydrate intake. You didn't indicate what your diet consists

of.

Susie

[Guest guest]

<posting this for Pete, who can't seem to post to the group ... >

Jim,

I saw your post on the diabetic onelist.com I tried to send this info

to the list, but apparently it didn't go through. This organization

should be just what you're looking for:

for Jim Darroch of Scotland (and everyone),

The International Diabetic Athletes Association would probably have all

the info you need about running, etc.

IDAA

1647-B W. Bethany Home Rd.

Phoenix, AZ 85015

USA

phone: or 800-898-IDAA [4322]

e-mail: idaa@...

http://www.diabetes-exercise.org

The IDAA was started by a Harper, a Type 1 who is a distance runner,

Registered Nurse, C.D.E., and the current president.

The IDAA is a non-profit organization which provides: quarterly

newsletters, workshops, conferences, publications, speakers, role models,

event support, volunteer services. (They sell some promotional items

which have the IDAA logo and slogan " I Run on Insulin " .)

Keep exercising, all !

Pete (type 1)

[Guest guest]

Sandy J. writes:

<< Thanks for the input on this; it's too bad that we can't judge the effect

of this until after the fact, as you said. >>

I have rejoined a former group to bone up on my technical stuff because I

got rusty. I should be better able to help more in the future. I did pick up

some info already today. The expected risk of complications increase by half

if your average glucose reading is 125 vs. 90. That is significant.

Sandy, you indicate you are eating starchy veggies, some bread, rice,

potatoes, fruit, and I would guess-timate that you are getting something

like 150-250 grams of carbs daily. If your carbohydrate intake is above 100

grams, your diet is probably not having a beneficial effect on your bg's. So

I would say you are one of the lucky ones who can eat a fair amount of carbs

with little adverse consequence. We are all different. Some people swear by

a high-carb/ultra-low-fat diet (even though the American Heart Association

had come out against this approach after doing a meta-analysis of all recent

studies).

Susie

[Guest guest]

Vicki wrote:

<< Boy, Sandy, I'd sure be happy if my fasting BG was 90...mine is usually

between 125 and 145. Susie, should I be increasing my bedtime NPH? (now

taking 2 units at 10 p.m.) I remember reading somewhere that BG should be at

about 140 two hours after eating...this is what I've been aiming for.

Sometimes reach it. Am I mistaken? >

I think reducing carbohydrate intake, exercising more (if possible), and

increasing insulin should all be looked at.

I'm a tad confused here, Vicki. Two hours after a meal is not considered

fasting. One and a half to two hours after a meal is usually your highest

reading. The food you eat can still be impacting your bg's twelve hours

after eating, especially if there is no exercise to crank it back down. So a

140 two hours after eating would be great. But your note said you were

having *fasting* readings of 125-145. Here is part of Rob Sebol's post from

another group, that says it much better than I can:

Dick wrote:

> She said " Let's give it a shot " and for 2 weeks I've been off the

> medicine with BG in the 85-125 range. The 100's+ are always in the

> mornings.

Dick: If you have only now found this list you probably missed some of

the trouble shooting info concerning those morning readings. First, you

might ask, why bother? The ratio of complications risk at about 125

average for sugar versus 90 is 1.5:1. You may not agree that reducing

risk of complications is a compelling reason to make further changes in

life style but I will assume you would at least like to see what is

needed so that you can make the decision objectively. In your case, it

is pretty simple. The portion weighted glycemic index of dinner and the

glucose contribution of any and all after dinner snacks combine in

determining how much glucogen is stored in the liver through the night.

In the morning the liver converts the store to glucose and releases it,

hence the morning rise also named dawn effect and technically named

gluconeogenesis. The store gets dribbled out at-a-rate in between times

and the rate peaks up in the morning. The overall retension is about 12

hours and the less there is left the smaller will be the morning rise.

This causality accounts for the action needed. Move more of the carb

budget to lunch from dinner, eat dinner earlier, quit after dinner

snacking. For most people with appreciable insulin production still

intact, the last alone is worth about a 30 mg/dl drop in the morning

reading. Don't worry about going too low by doing all of the things

named. There are internal feedback mechanisms that will produce

regulation at around 80 to 90. The other thing that also can drop

morning readings about 30 to 40 mg/dl is walking 1/2 hour at least 3

times a week. An evening walk helps to reduce the supply on hand in the

liver by making an immediate demand for some of it. A morning walk

consumes some of what is being released as it is released. The peak

release is usually about 10:30, approximately. Almost anything you can

say about diabetes mechanisms has individual variability both

quantitatively and qualitatively (the latter is less likely than the

former). Thus one has to enter into a to-do list with the attitude of an

experimenter. Change one thing at a time, take readings to see if the

desired result was attained (take readings for about three days to be

surer), and go through the entire list of candidate fixes. Then do a mix

and match from the ones that worked and worked best. It should be

possible, in your case, to get the morning readings into the normal

range if you have not tried the things mentioned.

Don't get me wrong. I am not ignoring the laudable fact that you have

already make a major improvement and that you did for yourself what you

probably feel your doctor should have told you how to do. That is great.

What I am saying is that since the doc didn't give you basic information

the doc almost certainly didn't tell you what I wrote above. That cause

and effect info. is buried in journal papers and is not seen in popular

diabetic books so my guess was that you probably had not heard the full

story yet. Oh yes, you probably should know that somewhere between 30

and 50 grams of medium to low glycemic index carbs per meal is a

sensable maximum for an early type 2.

[Guest guest]

Sorry to be so confusing Susie, I was talking about two different things

here. My fasting BGs are between 125 and 145 (and sometimes even higher). I

find they are going high when my last measurement the night before is below

120 and I do a little extra bedtime snack. When it's above 120 , all I have

is a half a graham cracker (a whole square) and this seems to regulate my

fasting BG the next morning okay. But if it's below 120 I'm a little worried

about going hypo during the night so I may add a few slices of turkey

pastrami and/or a slice or two of tangelo or orange. This is when I've noted

high fasting BGs the next morning. Is this what's causing the the a.m. highs?

Do I NOT have to be concerned about going hypo in the middle of the night

when I'm below 120 at 10 p.m.? Again, I take 2 units NPH at 10 p.m...

My reference to 140 two hours after eating was in reference to the rest of

the day, not fasting BG.

I do regular exercise -- gym three days a week, 45 minutes of walking

(including a hill) four days a week. But I can only do this in the morning as

I work nights. Vicki

In a message dated 99-05-24 18:41:47 EDT, you write:

<< < Boy, Sandy, I'd sure be happy if my fasting BG was 90...mine is usually

between 125 and 145. Susie, should I be increasing my bedtime NPH? (now

taking 2 units at 10 p.m.) I remember reading somewhere that BG should be at

about 140 two hours after eating...this is what I've been aiming for.

Sometimes reach it. Am I mistaken? >

I think reducing carbohydrate intake, exercising more (if possible), and

increasing insulin should all be looked at.

I'm a tad confused here, Vicki. Two hours after a meal is not considered

fasting. One and a half to two hours after a meal is usually your highest

reading. The food you eat can still be impacting your bg's twelve hours

after eating, especially if there is no exercise to crank it back down. So a

140 two hours after eating would be great. But your note said you were

having *fasting* readings of 125-145. Here is part of Rob Sebol's post from

another group, that says it much better than I can:

>>

[Guest guest]

Vicki writes:

<< From: WHIMSY2@...

Sorry to be so confusing Susie, I was talking about two different things

here. My fasting BGs are between 125 and 145 (and sometimes even higher). I

find they are going high when my last measurement the night before is below

120 and I do a little extra bedtime snack. When it's above 120 , all I have

is a half a graham cracker (a whole square) and this seems to regulate my

fasting BG the next morning okay. But if it's below 120 I'm a little

worried

about going hypo during the night so I may add a few slices of turkey

pastrami and/or a slice or two of tangelo or orange. This is when I've noted

high fasting BGs the next morning. Is this what's causing the the a.m.

highs?

Do I NOT have to be concerned about going hypo in the middle of the night

when I'm below 120 at 10 p.m.? Again, I take 2 units NPH at 10 p.m...

My reference to 140 two hours after eating was in reference to the rest of

the day, not fasting BG.

I do regular exercise -- gym three days a week, 45 minutes of walking

(including a hill) four days a week. But I can only do this in the morning

as

I work nights. >>

(I'm so clueless about insulin, I have to look everything up before I can

even respond.) What is your complete insulin timing, types and amounts? A

graham cracker or fruit would probably be out of your system before the NPH

peaked. Protein and fat before bed make more sense - but only if you are

actually dropping too low during the night. What are some of your lowest

readings? Are they frequent? At what reading do you feel hypo-y?

What I am having trouble digesting is I think of hypos like something

beneath 50. Are you saying you drop from 120-150 all the way down to 50 or

below overnight, on just *two* units of insulin? Or are you saying that you

are not actually hypoing? I would say skip the before-bed snack and set the

clock for six hours after your NPH and take a reading. You may not be low at

all.

As Ron Sebol's post indicates, those bedtime feedings can do a number on

your the next day. Your exercise sounds find. You are checking often. It all

sounds good, but I think you really want to get your numbers down more. It

would be better to adjust insulin types and amounts and timing then to " feed

hypos " and cause yourself unnecessarily high readings - especially if you

are not actually hypoing during the night but are just worried it could

happen. I think (if you can stand it) a few nighttime readings could

reassure you here, Vicki.

Susie

[Guest guest]

Hi Susie

Thank you that was very informative. I find when I get up in the mornings my bg

levels are between 6-8mmol/l. I would like to have them lower.

Gail

OtterCritter wrote:

>

>

> Vicki wrote:

>

> << Boy, Sandy, I'd sure be happy if my fasting BG was 90...mine is usually

> between 125 and 145. Susie, should I be increasing my bedtime NPH? (now

> taking 2 units at 10 p.m.) I remember reading somewhere that BG should be at

> about 140 two hours after eating...this is what I've been aiming for.

> Sometimes reach it. Am I mistaken? >

>

> I think reducing carbohydrate intake, exercising more (if possible), and

> increasing insulin should all be looked at.

>

> I'm a tad confused here, Vicki. Two hours after a meal is not considered

> fasting. One and a half to two hours after a meal is usually your highest

> reading. The food you eat can still be impacting your bg's twelve hours

> after eating, especially if there is no exercise to crank it back down. So a

> 140 two hours after eating would be great. But your note said you were

> having *fasting* readings of 125-145. Here is part of Rob Sebol's post from

> another group, that says it much better than I can:

>

> Dick wrote:

> > She said " Let's give it a shot " and for 2 weeks I've been off the

> > medicine with BG in the 85-125 range. The 100's+ are always in the

> > mornings.

>

> Dick: If you have only now found this list you probably missed some of

> the trouble shooting info concerning those morning readings. First, you

> might ask, why bother? The ratio of complications risk at about 125

> average for sugar versus 90 is 1.5:1. You may not agree that reducing

> risk of complications is a compelling reason to make further changes in

> life style but I will assume you would at least like to see what is

> needed so that you can make the decision objectively. In your case, it

> is pretty simple. The portion weighted glycemic index of dinner and the

> glucose contribution of any and all after dinner snacks combine in

> determining how much glucogen is stored in the liver through the night.

> In the morning the liver converts the store to glucose and releases it,

> hence the morning rise also named dawn effect and technically named

> gluconeogenesis. The store gets dribbled out at-a-rate in between times

> and the rate peaks up in the morning. The overall retension is about 12

> hours and the less there is left the smaller will be the morning rise.

> This causality accounts for the action needed. Move more of the carb

> budget to lunch from dinner, eat dinner earlier, quit after dinner

> snacking. For most people with appreciable insulin production still

> intact, the last alone is worth about a 30 mg/dl drop in the morning

> reading. Don't worry about going too low by doing all of the things

> named. There are internal feedback mechanisms that will produce

> regulation at around 80 to 90. The other thing that also can drop

> morning readings about 30 to 40 mg/dl is walking 1/2 hour at least 3

> times a week. An evening walk helps to reduce the supply on hand in the

> liver by making an immediate demand for some of it. A morning walk

> consumes some of what is being released as it is released. The peak

> release is usually about 10:30, approximately. Almost anything you can

> say about diabetes mechanisms has individual variability both

> quantitatively and qualitatively (the latter is less likely than the

> former). Thus one has to enter into a to-do list with the attitude of an

> experimenter. Change one thing at a time, take readings to see if the

> desired result was attained (take readings for about three days to be

> surer), and go through the entire list of candidate fixes. Then do a mix

> and match from the ones that worked and worked best. It should be

> possible, in your case, to get the morning readings into the normal

> range if you have not tried the things mentioned.

>

> Don't get me wrong. I am not ignoring the laudable fact that you have

> already make a major improvement and that you did for yourself what you

> probably feel your doctor should have told you how to do. That is great.

> What I am saying is that since the doc didn't give you basic information

> the doc almost certainly didn't tell you what I wrote above. That cause

> and effect info. is buried in journal papers and is not seen in popular

> diabetic books so my guess was that you probably had not heard the full

> story yet. Oh yes, you probably should know that somewhere between 30

> and 50 grams of medium to low glycemic index carbs per meal is a

> sensable maximum for an early type 2.

>

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