There’s a lot. I’ve put them into broad categories:
BG testing:
Is one or two hour post eating more important?
Does the rise at 2 hours matter so long as it stays below 8.5? (Does the 2-3 mmol rise max come from anywhere? Do I need to minimise the rise at 1-2 hrs or just keep it to 3mmol/8.5 max?) I ask because all meals are well below 8.5 in general at 2 hours, usually below 7.0, and my rise is usually about 1mmol, so can I eat a little more normally or should I minimise ups and downs? (I am tempted to find out what my carb tolerance for 3mmol rise max actually is…)
Is it specifically how *long* BG is raised rather than how high it is raised that we are trying to impact? (Eg: spike to whatever - but it needs to come down to normalish right-quick, thus a blunted peak?) or am I oversimplifying?
Hba1c:
How does avg glucose translate to a1c (not mathematically - eg, is a one off treat meal going to raise it? Once every three months? Monthly? Bimonthly?)? Once RBCs are glycated, they stay that way - so in theory a ‘treat’ close to an hba1c could actually raise it even though you’re otherwise in the green?
How long does it take for glucose to attach to red blood cells? (I think I’m trying to understand the 2 hour testing logic.)
General ‘other’ impacts on BG
Why does exercise raise BG in general that day but the next day is lower? (Might just be me.)
If stress plays a part (adrenaline -> glucose released for fight/flight), then surely mental health is paramount? Why is is left behind and food focussed on?
Other:
Why do people say (very?) low carb makes insulin resistance worse?
And, fine, this one is specific to me but it is curious:
My husband has kindly offered his own fingers for pricking and he’s always within .2 of me at the same time after the same meal. Not diabetic as far as we know, and even if he was I’d expect less similar measurements. What’s happening there?
Q: Is one or two hour post eating more important?
A: Each gives different information, but for a wet finger in the air interpretation, I would suggest the 2 hour gives a better idea.
Some feel the one hour point illustrates the top of the rise, but fat heavy meals this may simply not be the case. Fat slows the blood glucose rise, so any peak may come much later than an hour (or in some cases, even 2 hour) mark.
Q: Does the rise at 2 hours matter so long as it stays below 8.5? (Does the 2-3 mmol rise max come from anywhere? Do I need to minimise the rise at 1-2 hrs or just keep it to 3mmol/8.5 max?) I ask because all meals are well below 8.5 in general at 2 hours, usually below 7.0, and my rise is usually about 1mmol, so can I eat a little more normally or should I minimise ups and downs? (I am tempted to find out what my carb tolerance for 3mmol rise max actually is…)
Is it specifically how *long* BG is raised rather than how high it is raised that we are trying to impact? (Eg: spike to whatever - but it needs to come down to normalish right-quick, thus a blunted peak?) or am I oversimplifying?
A: As has already been said there's no definitive answer to this at the moment. Personally, I go for time in the Bell Curve as a measure of the impact of any given food. Again, personally, I was influenced by my reaction to pasts. Eating pasta, I found I experienced a very modest rise, but rise was very sustained - well in excess of 2 hours, or even 4 hours. So, for me, pasta wasn't doing me any favours. I just gave up pasta to be honest.
In the intervening period my Endo has recommended a strictly gluten free diet, due to another condition.
Q: Hba1c: How does avg glucose translate to a1c (not mathematically - eg, is a one off treat meal going to raise it? Once every three months? Monthly? Bimonthly?)? Once RBCs are glycated, they stay that way - so in theory a ‘treat’ close to an hba1c could actually raise it even though you’re otherwise in the green?
My understanding is the HbA1c test roughly reflects average blood glucose over a 3 month period, but in reality, so people turn over red blood cells more rapidly/slowly than others.
It is recognised that any HbA1c score will be influced more by the couple of week, immediately prior to the test, that the period further back. So, I would suggest if some form of treat is desired, then after the test will be less likely to influece the result than just before. Of course, that said, a single episode or even a couple of episodes is unlikely to materially change a result.
Again, my understanding is once glycated a red blood cell remains in that state until it expires and is replaced be a brabd spanking new cell.
Q: General ‘other’ impacts on BG
Why does exercise raise BG in general that day but the next day is lower? (Might just be me.)
A: In my own case, exercise can have a variable impact on my blood sugars. Gentle exercise, like a decent stroll will lower my numbers and sometimes quite dramatically (depending on the starting point), whereas vigorous exercise will raise my blood sugars for a period, then they will drop for a time. That is usually attributed to your liver releasing stored glucose to help fuel the exercise, then afterwards, replenishing it's stores again, explaining the lower post-exercise numbers and sometimes for a period.
Q: If stress plays a part (adrenaline -> glucose released for fight/flight), then surely mental health is paramount? Why is is left behind and food focussed on?
A: Stress does indeed play a part in blood glucose numbers, and for me, sustained stress is one thing I can be assured will notch me up. Fortunately, my life isn't generally too stressful.
Your question on focus; there is no doubt mental health is very important - overall, not just for blood glucose management, but in T2, there is little question that, certainly initially, if we are looking to manage our condition meds-free, or with minimal medications, then the stand-out tool in that is what enters our digestive system.
Q: Other:
Why do people say (very?) low carb makes insulin resistance worse?
A; Very low carb can induce a state called physiological insulin resistance which is a bit different to the more standard insuling resistance. For those who experience it, it is often (I'm tempted to go usually, but will be conservate here) possible to reset this by breaking the routine with a higher, or for some and even lower carb day or two. By higher carb, I don't mean full on chips, pizza and doughnuts, I just mean a nudge up in the carb numbers.
There is quite a bit written about physiological insulin resistance which is readily findable, via DrGoogle.Q: My husband has kindly offered his own fingers for pricking and he’s always within .2 of me at the same time after the same meal. Not diabetic as far as we know, and even if he was I’d expect less similar measurements. What’s happening there?
Q: My husband has kindly offered his own fingers for pricking and he’s always within .2 of me at the same time after the same meal. Not diabetic as far as we know, and even if he was I’d expect less similar measurements. What’s happening there?
A: That's impossible to answer, without knowing more about those numbers and what is consumed prior to them being taken.
It might also be useful for your husband to have an A1c test at some point, just to ensure he's in good shape.
0.2 is pretty close though, and I doubt any two T2s strictly shadow another's readings - especially in the early-ish period.
You clearly are curious about all of this, and I see that as being a good thing. For me, understanding and acceptance go hand-in-hand. If you haven't already, it might be worthwhile you taking up Abbott's offer of a trial Libre sensor.
Each sensor lasts 2 weeks and broadly track your blood glucose 24/7. I say broadly because it measures sugas in interstitial fluids, not blood. Broadly speaking, a Libre reading reflects a blood glucose reading of 10/15 minutes earlier, but it is a great tool to see what's actually going on. What peaks and troughs are and how long glucose actually remains elevated after any given eating or drinking episode.
I'm not advocating full-time use of the Libre, but I have learned a lot about how my body works by wearing a sensor from time to time.
I hope I've made a decent fist of responding to your questions.
Apologies for the gazillion typos, but shout if anything is unintelligible.
