Not a spike, but a plateau (T2)

[harbottle]

Morning all.

Do any other T2Ds out there see a 'plateau' around 7.5-8.5 mark when eating a high carb meal?

I've noticed this over the years when I do 'break the rules' and eat normally (Which isn't very often). No real 'hyperglycaemia', and not the huge rise into double figures that I'd expect. Not that I do it often. (50g+ of stir fry with egg noodles barely breaks the 7 barrier, but it hangs around there for a bit, as if it's reached a fix point where incoming/clearance rate is matched.)

 

[ew7k]

I asked a similar question a little while ago, but not as well, and linked it to a low/high GI query, but only got an answer about GI foods. I'm interested!

 

[harbottle]

Oh the type/mix of food makes a difference.
Lentils don’t cause it to rise for two hours!

Oats cause a quick rise and a sudden drop

In general, for a mixed with high carb content, it’s pretty much the same.

 

[JITR]

Google: 'time taken digest carbs and insulin to reduce blood glucose'?

AI Overview
The time it takes for insulin to reduce blood glucose after eating carbohydrates depends on the type of insulin and how long it takes to digest food:

• Digesting food
  After eating, blood sugar levels rise immediately. The rate at which glucose enters the bloodstream depends on the type of carbohydrate consumed. For example, a can of soda full of sugar causes glucose to enter the bloodstream at a rate of about 30 calories per minute, while a complex carbohydrate releases glucose at a rate of about 2 calories per minute.

... and what you eat with the carbs, such as pasta source, spreads the load over time.

 

[harbottle]

yes.
I know all that.
I was wondering if any others with T2D see the same,

(Given that hba1c was originally 83)

 

[Taighnamona]

yes.
I know all that.
I was wondering if any others with T2D see the same,

(Given that hba1c was originally 83)

I sometimes get a plateau instead of a rise and dip within the two hours.
I’ve found if I eat some carbs for dinner I can hang around 7.5-8 for three hours before sliding down. I suspect my half glass of wine plus fats in the meal are delaying digestion/ingestion. As long as it’s not going into double figures and staying high for hours and I don’t do it too often then I take it as a plus.

 

[harbottle]

I sometimes get a plateau instead of a rise and dip within the two hours.
I’ve found if I eat some carbs for dinner I can hang around 7.5-8 for three hours before sliding down. I suspect my half glass of wine plus fats in the meal are delaying digestion/ingestion. As long as it’s not going into double figures and staying high for hours and I don’t do it too often then I take it as a plus.

I don't get it for that long.

Wine, interestingly, sends my levels spiralling downwards, as does a pint of beer. In fact, if I drink a pint of beer I see an initial rise then a dramatic fall. I can go out to the pub, have beer and crisps to my heart's content and levels hardly move sometimes.

I'm wondering about the different aspects of T2D - insulin resistance in muscles, overproduction of glucose from the liver and a lack of insulin due to the beta cell loss (Plus the first phase insulin response being blunted.) and what is going on when I scoff 60g of carbs,

 

[AndBreathe]

The only time I would experience a plateau was any time I tried pizza - mainly toppings, but that almost certainly would end up with some base too.

That was very early after diagnosis, and giving up pizza totally was no hardship as it’d never been a favourite, but we used to eat out with friends at a near pizza/pasta only Italian place.

I’ve been GF for a long time now, so the draw to pizza is even less.

 

[BobbleHat]

I've been diagnosed since end of July - hba1c of 56 then 52 on repeat 3 weeks later. Never medicated. Waiting on my first follow up hba1c (and liver and cholesterol bloods) - there was a 4 week wait for an appointment so it's going to be another 2 weeks! I also have Non Alcoholic Fatty Liver (just in case these things factor in). I've had a CGM for most of the last 8 weeks and was finger pricking before/2hr after meals before that. I eat 16:8 - no breakfast and 2 x meals in my eating window. I'm 40-60g carbs. I have had 'spikes' about 3x - after a wheat wrap/tinned cream of chicken soup/ too large a portion of chickpeas casserole. Egg noodles cause only a slight plateau-ed rise for me too.

I have never, not once in the 4 months since diagnosis ever had a blood sugar higher than 9. My 'spikes' were from a low pre-prandial of below 5 to mid 8s. When I do spike >2mmols the line does come down as rapidly as it went up and I get a reactive low (but not hypo).

I was prediabetic 12 months before diagnosis (hba1c 42) so I have wondered if an early diagnosis and a lower hba1c means that maybe my beta cells aren't all totally broken and therefore I have a bit more capacity to manage carbs. I don't feel good on many more carbs than I eat irrespective of what my numbers say so I've not tested it much past the tin of soup (oh and the sourdough bread I had when eating out but the (too) many cocktails alongside definitely mopped up any spike!)

 

[PerSpinasAdAstra]

Yes I often see plateaus with some kinds of meals. A lot of very rapidly digested carbs produce a quick and very high spike for me - biggest was after eating a bag of fruit jelly sweets as a test. BG went very high very fast then crashed back down just as quickly. Other meals with a similar amount of carbs can produce a plateau. I think it's about the rate of digestion vs the rate of insulin release. Beta cells pump out insulin at a higher rate (in 2nd-phase 'mode') the higher BG levels go. Ever-increasing rates of insulin secretion from beta cells has been observed up to ridiculously high BG concentrations - Link

My guess is that as carb digestion rate rises so does insulin secretion. The level of the plateau is the balancing point between glucose entering the blood at a steady rate and a steady insulin secretion rate in response to that. I most often see plateaus with very fatty/meaty meals with a lot of carbs, like doner kebabs, and meals with lower-GI forms of carbs like noodles. Never with rapidly-digested carby foods like fruit or bread - those always looks like a 'spike' or a 'low hill' at best.

Alcohol does indeed have a magical and dangerously appealing effect. If you're wearing a CGM some time (and purely for scientific purposes) try stacking the 2nd-meal phenomenon with some lowering of muscle insulin resistance through exercise with the alcohol effect (low-carb alcohol is best) and the slower carb digestion rate from certain meals. This is what it looked like when I skipped breakfast, had a moderate amount of white rice with lunch, went for a walk afterwards, had a few dry white wines, ate a pizza from LIDL as my second meal of the day containing (supposedly) 134g of carbs in it, and continued drinking wine afterwards. (Needless to say this won't work for everyone - this is just what happened when I tried everything I knew possible to try to get away with eating a pizza).

 

[everydayupsanddowns]

Interesting observations @harbottle

I get a mixture of rapid rise/fall, rise-to-plateaus, and barely a wobble. Sometimes all for the same meal on different days!

Most of mine variations seem to be down to the constant ebb and flow of insulin sensitivity and whether doses are currently ’right’(ish).

Probably not all that helpful to your pondering!

 

[harbottle]

Yes I often see plateaus with some kinds of meals. A lot of very rapidly digested carbs produce a quick and very high spike for me - biggest was after eating a bag of fruit jelly sweets as a test. BG went very high very fast then crashed back down just as quickly. Other meals with a similar amount of carbs can produce a plateau. I think it's about the rate of digestion vs the rate of insulin release. Beta cells pump out insulin at a higher rate (in 2nd-phase 'mode') the higher BG levels go. Ever-increasing rates of insulin secretion from beta cells has been observed up to ridiculously high BG concentrations - Link

My guess is that as carb digestion rate rises so does insulin secretion. The level of the plateau is the balancing point between glucose entering the blood at a steady rate and a steady insulin secretion rate in response to that. I most often see plateaus with very fatty/meaty meals with a lot of carbs, like doner kebabs, and meals with lower-GI forms of carbs like noodles. Never with rapidly-digested carby foods like fruit or bread - those always looks like a 'spike' or a 'low hill' at best.

Alcohol does indeed have a magical and dangerously appealing effect. If you're wearing a CGM some time (and purely for scientific purposes) try stacking the 2nd-meal phenomenon with some lowering of muscle insulin resistance through exercise with the alcohol effect (low-carb alcohol is best) and the slower carb digestion rate from certain meals. This is what it looked like when I skipped breakfast, had a moderate amount of white rice with lunch, went for a walk afterwards, had a few dry white wines, ate a pizza from LIDL as my second meal of the day containing (supposedly) 134g of carbs in it, and continued drinking wine afterwards. (Needless to say this won't work for everyone - this is just what happened when I tried everything I knew possible to try to get away with eating a pizza).
View attachment 32528

That looks very similar to what I saw with sensors and high carb meals, although I did sometimes see two peaks - it'd go up, drop down, then go up again for a smaller peak.

I stopped drinking beer and high carb alcohol drinks at diagnosis, but tried it when I had a sensor and saw a small rise, then a quick drop. Subsequent drinks don't cause a rise at all. So I reintroduced it and it hasn't affected hba1c at all.

There'll be a point where clearance rate equals production rate.

 

[harbottle]

The only time I would experience a plateau was any time I tried pizza - mainly toppings, but that almost certainly would end up with some base too.

That was very early after diagnosis, and giving up pizza totally was no hardship as it’d never been a favourite, but we used to eat out with friends at a near pizza/pasta only Italian place.

I’ve been GF for a long time now, so the draw to pizza is even less.

I'm way too scared to try a pizza!
I've had lasagne and cannelloni without going hyper, and the odd slice of pizza, but that's about it!

 

[harbottle]

Interesting observations @harbottle

I get a mixture of rapid rise/fall, rise-to-plateaus, and barely a wobble. Sometimes all for the same meal on different days!

Most of mine variations seem to be down to the constant ebb and flow of insulin sensitivity and whether doses are currently ’right’(ish).

Probably not all that helpful to your pondering!

It's interesting, as I don't get the same results for the same meals on different days. If I have oats sometimes it'd peak at 8 and crash down, but other days it would rise up slowly and plateau.

It must be a nightmare trying to deal with this when you have to try to work out how a dose to deal with it!

 

[PerSpinasAdAstra]

The 'two peaks' thing is referred to as a 'biphasic glucose curve'. It's supposedly a sign of an extremely healthy first-phase insulin response when observed during the oral glucose tolerance test - Link. My understanding is that the amount of insulin secreted is greater than the rate that glucose is entering the bloodstream, levels drop back down, insulin secretion lowers as levels drop, then BG levels pop back up again as a result. The shifting balance between glucose and insulin. I've seen the two peaks thing too though only after eating 'slow release' type carbs, never after eating rapidly digested carbs.

 

[harbottle]

I've been diagnosed since end of July - hba1c of 56 then 52 on repeat 3 weeks later. Never medicated. Waiting on my first follow up hba1c (and liver and cholesterol bloods) - there was a 4 week wait for an appointment so it's going to be another 2 weeks! I also have Non Alcoholic Fatty Liver (just in case these things factor in). I've had a CGM for most of the last 8 weeks and was finger pricking before/2hr after meals before that. I eat 16:8 - no breakfast and 2 x meals in my eating window. I'm 40-60g carbs. I have had 'spikes' about 3x - after a wheat wrap/tinned cream of chicken soup/ too large a portion of chickpeas casserole. Egg noodles cause only a slight plateau-ed rise for me too.

I have never, not once in the 4 months since diagnosis ever had a blood sugar higher than 9. My 'spikes' were from a low pre-prandial of below 5 to mid 8s. When I do spike >2mmols the line does come down as rapidly as it went up and I get a reactive low (but not hypo).

I was prediabetic 12 months before diagnosis (hba1c 42) so I have wondered if an early diagnosis and a lower hba1c means that maybe my beta cells aren't all totally broken and therefore I have a bit more capacity to manage carbs. I don't feel good on many more carbs than I eat irrespective of what my numbers say so I've not tested it much past the tin of soup (oh and the sourdough bread I had when eating out but the (too) many cocktails alongside definitely mopped up any spike!)

There is a link between hba1c and beta cell dysfunction, I believe. A higher hba1c can mean more dysfunction. The number 87 (10%) seems to be used as some sort of medical threshold - you have to be below this to be allowed on the pathway to remission program and also I've seen research highlighting this level as the point where things outcomes might be getting worse!

 

[harbottle]

The 'two peaks' thing is referred to as a 'biphasic glucose curve'. It's supposedly a sign of an extremely healthy first-phase insulin response when observed during the oral glucose tolerance test - Link. My understanding is that the amount of insulin secreted is greater than the rate that glucose is entering the bloodstream, levels drop back down, insulin secretion lowers as levels drop, then BG levels pop back up again as a result. The shifting balance between glucose and insulin. I've seen the two peaks thing too though only after eating 'slow release' type carbs, never after eating rapidly digested carbs.

Yes, I saw it after eating some Chinese food with rice.
And I see it with oats as well if I get a fast drop.

 

[AndBreathe]

I'm way too scared to try a pizza!
I've had lasagne and cannelloni without going hyper, and the odd slice of pizza, but that's about it!

To be honest, neither pasta nor pizza would ever have been my choice, so the plateau scenario was the perfect reason to swerve it from then on.

Now, being GF and trying to avoid pretendy bakes etc, pizza, pasta, bread and cakes (and lots of other things) are a very distant memory. I'm content enough plodding along with my A1c bouncing 31<>33 with near metronomic regularity.

 

[harbottle]

I hardly ever ate pasta, but did like a pizza every now and then!