Postprandial, is the first 2 hours significant?

[SurreyFifties]

Hi

Newly diagnosed here so perhaps an elementary question…

If I eat just one slice of rye bread then my mmol will rise from 7 to maybe 11 quite quickly, within an hour usually, two hours later I’ll probably be back under 9. I understand that under 9 mmol two hours after eating is ok but do I need to worry about the spike in the first two hours?

i have pretty much cut out all carbs for this reason to flatten my curve but keep losing weight which I can’t afford to keep doing. I might be getting impatient, I was only diagnosed in March.

thanks

March 2022 hba1c 98, 2000mg metformin daily.

 

[Vonny]

I'm not 100% sure, but I have been told that even non-diabetics spike, and that it is the 2 hour mark which is important. Happy to be contradicted by the more medically minded members on the forum!
If you don't want to lose more weight, bolster up your diet with more fat and protein to compensate for the reduced carbs. It will stop the hunger and keep your weight maintained.

 

[Leadinglights]

One of the criteria some people use is that the difference between your before meal reading and your after meal reading should be no more than 2-3 mmol/l and once you start to get your readings down to the recommended levels of 4-7mmol/l you should aim for a reading of no more than 8-8.5 mmol/l 2 hours after your meal.
If you are getting more than that, then it indicates your meal is too carb heavy and cutting out, reducing portion size or substituting something lower carb for any of the high carb components of the meal.
There is not too much mileage in testing sooner than 2 hours unless of course you are feeling unwell.

 

[SurreyFifties]

That’s helpful, i have a CGM so I see the spike anyway. I seem to be fine unless I eat anything! if I have zero carbs (apart from those in vegetables) then I’ll stay under 8, if I eat even 1 slice of brown bread or 1 tbsp of granola then I’m double figures.

hopefully one day I’ll get to the 4-7 range, though it feels like any carbs will be off the menu for a long time.

 

[Inka]

@SurreyFifties Is there a possibility you could be Type 1? Has this been ruled out?

 

[Leadinglights]

That’s helpful, i have a CGM so I see the spike anyway. I seem to be fine unless I eat anything! if I have zero carbs (apart from those in vegetables) then I’ll stay under 8, if I eat even 1 slice of brown bread or 1 tbsp of granola then I’m double figures.

hopefully one day I’ll get to the 4-7 range, though it feels like any carbs will be off the menu for a long time.

I wonder if you are actually Type 1 or LADA as only with virtually no carbs are your levels nearing normal. @Inka obviously has the same thought.
I think it may be that you may need insulin regardless of the type you are.

 

[SurreyFifties]

I wonder if you are actually Type 1 or LADA as only with virtually no carbs are your levels nearing normal. @Inka obviously has the same thought.
I think it may be that you may need insulin regardless of the type you are.

Could you elaborate on ‘levels nearing normal’? be good to understand that in case I need to raise it at review?

 

[SurreyFifties]

@SurreyFifties Is there a possibility you could be Type 1? Has this been ruled out?

No, I’ve only had a telephone consultation with GP so far, im Slightly worried that having gone so low carb that I might mask the true story at my next review.

 

[Leadinglights]

Could you elaborate on ‘levels nearing normal’? be good to understand that in case I need to raise it at review?

Normal would be 4-7mmol/l before meals and no more than 8 mmol/l 2 hours after meals.
It sounded as if it was only by eating no carbs were you able to be under 8mmol/l but it does depend on when that is.

 

[SurreyFifties]

Normal would be 4-7mmol/l before meals and no more than 8 mmol/l 2 hours after meals.
It sounded as if it was only by eating no carbs were you able to be under 8mmol/l but it does depend on when that is.

Ah probably me not explaining very well, thanks. If I eat carbs then for 2~3 hours after I am maybe 9, and by carbs I mean like one slice of bread. If I don’t eat those carbs then I’ll be back to 6.5.

 

[Inka]

No, I’ve only had a telephone consultation with GP so far, im Slightly worried that having gone so low carb that I might mask the true story at my next review.

Yes, that’s a valid concern. It might be worth eating the carb diet you were recommended for 2 or 3 days and recording your blood sugar. Type 1 is far less common than Type 2, but far too many adults are wrongly assumed to be Type 2 when, in fact, Type 1 can occur at any age.

Your mention of weight loss (a Type 1 symptom) and the fact you’ve practically cut all carbs out and are still seeing highish numbers is why I mentioned it.

 

[Leadinglights]

Ah probably me not explaining very well, thanks. If I eat carbs then for 2~3 hours after I am maybe 9, and by carbs I mean like one slice of bread. If I don’t eat those carbs then I’ll be back to 6.5.

Have you tried experimenting a bit and eating the same amount of carbs that would be in the slice of bread in another form as part of a meal with protein and healthy fats.
I imagine 1 slice of bread would be about 15g carb so instead have 80g peas =8g carb and 2 tomatoes = 8g carb with some fish or meat or eggs and see the effect of that.

 

[SurreyFifties]

Have you tried experimenting a bit and eating the same amount of carbs that would be in the slice of bread in another form as part of a meal with protein and healthy fats.
I imagine 1 slice of bread would be about 15g carb so instead have 80g peas =8g carb and 2 tomatoes = 8g carb with some fish or meat or eggs and see the effect of that.

Yes I did just that, and found that if I made up the carbs from yogurt, vegetables, eggs then I’m pretty flat, ie no spike.
eg here, first spike 09:00 was one tbsp of oats, nuts and seed granola , 15:00 spike was one slice of rye bread. At dinner 19:00 I had no brown carbs and was flat.

 

[Leadinglights]

Yes I did just that, and found that if I made up the carbs from yogurt, vegetables, eggs then I’m pretty flat, ie no spike. View attachment 21394
eg here, first spike 09:00 was one tbsp of oats, nuts and seed granola , 15:00 spike was one slice of rye bread. At dinner 19:00 I had no brown carbs and was flat.

I think that would be useful for your diabetic team to see but I have no experience of Libre graphs so I will let someone else comment.

 

[EmmaL76]

Hi. Can I just ask a personal question? Were you overweight on diagnosis? Is there a reason type 2 was assumed other than age? It’s just if you were quite slim in the beginning then this is unusual enough to warrant a little more investigation. I was assumed type 2 due to age and 2 years later with all of my results inconclusive I’m still no further forward, I just would like to warn you of the dangers of trying to achieve unachievable numbers. It sounds like you can tolerate very few carbs similar to me and as I also have the libre i know the spikes can be unsettling. I will just say that in my experience the spikes are rarely as dramatic if checked against finger prick. I’ve suffered with eating problems in the past and my diagnosis messed with me big time… please don’t feel guilty about food, if you can’t eat enough to stay healthy then don’t stop until adequate testing/treatment is provided. You want all you type 1 antibodies testing, c peptide etc. just in case. I only had a chicken breast for tea last night and I didn’t drop below 8 all night.

 

[EmmaL76]

No, I’ve only had a telephone consultation with GP so far, im Slightly worried that having gone so low carb that I might mask the true story at my next review.

And this is exactly what my consultant told me I am doing with my extreme low carb (less than 30g a day)

 

[SurreyFifties]

Thank you Emma that’s a great message and really appreciate how one can get obsessed by the numbers.
I was slightly overweight, by about 5kg, but initial h1 reading at 98 surprised everyone. I’m frustrated because I don’t understand and therefore can’t control it.
if I’m honest I’ve had severe ibs for 20 years that kept me largely housebound, now I’m a new person. However people are asking me not to lose any more weight.
Also, and to echo your point, I recently saw a consultant for another matter who happens to be a pancreatic surgeon, he was also a bit dubious about the diagnosis.
so I don’t know what I am, what I can eat, and how to get any GP attention… where’s that chocolate…

 

[EmmaL76]

No worries, anytime, and I totally understand the stomach issues. Been the same way for decades myself. Silent reflux, horrendous digestion. I’m currently having a Microbiome test done as I’m desperate. Some days I refuse to eat because it’s just easier. Unfortunately reducing my sugars hasn’t helped with mine . One thing I will say is I paid something like £150 to see a private endo who then did most of my testing through the nhs. He’s a brilliant guy who specialises in unusual cases. He likes me because I tick boxes for all types of diabetes so it’s a challenge. I produce enough insulin to be type 2 have the antibodies of a type 1. There is another type called MODY which I’ve also been tested for but no results as of yet. Double diabetes has been suggested… twice the fun !! 🙄

 

[SurreyFifties]

No worries, anytime, and I totally understand the stomach issues. Been the same way for decades myself. Silent reflux, horrendous digestion. I’m currently having a Microbiome test done as I’m desperate. Some days I refuse to eat because it’s just easier. Unfortunately reducing my sugars hasn’t helped with mine . One thing I will say is I paid something like £150 to see a private endo who then did most of my testing through the nhs. He’s a brilliant guy who specialises in unusual cases. He likes me because I tick boxes for all types of diabetes so it’s a challenge. I produce enough insulin to be type 2 have the antibodies of a type 1. There is another type called MODY which I’ve also been tested for but no results as of yet. Double diabetes has been suggested… twice the fun !! 🙄

Sounds like you have it very tough, hope it works out. Good call on private endo, if I can find one then that would be money very well spent, I’ll see what happens at my ‘review’.
Had one roast potato tonight, now hitting 12 mmol, and tonight I don’t care ‍!

 

[EmmaL76]

Sounds like you have it very tough, hope it works out. Good call on private endo, if I can find one then that would be money very well spent, I’ll see what happens at my ‘review’.
Had one roast potato tonight, now hitting 12 mmol, and tonight I don’t care ‍♂️

I have hope it will be ok. Well I did steak for tea, substituted the chips for a large gin and tonic and that worked out pretty well take care and stay in touch !