What exactly is a spike?

[Missmarple690]

I keep hearing about certain foods causing a spike in blood glucose levels. What constitutes a spike and if you have a spike does it make a difference to the severity of that spike if it takes longer than 2 hours to come down?
I was diagnosed with T2 in August with readings of 132, 3 months later I’d got my numbers down to 43 with a low carb diet. My BG levels are usually between 5.5 and 7.9 but creep up towards 9 when I have eaten ( even with low carb). Are my daily BG numbers ‘normal for type 2 and should I worry if they go up to 9 but come down in an hour or two?I have 2 Metformin daily totalling 1000mg

 

[mashedupmatt]

Hi @Missmarple690 those numbers are amazing - well done! 9 2hrs after eating is almost perfect (I think the target is 8.5 for type 2 if I remember correctly (I'm type 1 so may be wrong - feel free to correct me anyone!)?) - it sounds like you are doing brilliantly and the low carb diet has made a big difference - give yourself a pat on the back I'd say 🙂

 

[Leadinglights]

I keep hearing about certain foods causing a spike in blood glucose levels. What constitutes a spike and if you have a spike does it make a difference to the severity of that spike if it takes longer than 2 hours to come down?
I was diagnosed with T2 in August with readings of 132, 3 months later I’d got my numbers down to 43 with a low carb diet. My BG levels are usually between 5.5 and 7.9 but creep up towards 9 when I have eaten ( even with low carb). Are my daily BG numbers ‘normal for type 2 and should I worry if they go up to 9 but come down in an hour or two?I have 2 Metformin daily totalling 1000mg

The readings people should be aiming at are 4-7mmol/l fasting and before meals and no more than 8-8.5mmol/l 2 hours after eating, but nearer to 8 the better.

 

[Martin.A]

Are my daily BG numbers ‘normal for type 2 and should I worry if they go up to 9 but come down in an hour or two?I have 2 Metformin daily totalling 1000mg

Your numbers look fine, and 9 barely qualifies as a spike when you consider that between 8 & 8.5 is our post-meal target.

 

[SimonP]

In my world a change of 9 mmol/l would be a spike

 

[Missmarple690]

I am advised that all foods in moderation is ok. If I were to have a tiny roast potato, 30g of jumbo oats, rice or bread, my readings would go up to 11 ish but come back down to 6 ish within a couple of hours. So far I am doing without and it is very dull indeed but I fear spikes. Surely if my DN says have an occasional treat it can only do me harm? What are other peoples experiences?

 

[Leadinglights]

I am advised that all foods in moderation is ok. If I were to have a tiny roast potato, 30g of jumbo oats, rice or bread, my readings would go up to 11 ish but come back down to 6 ish within a couple of hours. So far I am doing without and it is very dull indeed but I fear spikes. Surely if my DN says have an occasional treat it can only do me harm? What are other peoples experiences?

What is important is to find a sustainable way of eating which is enjoyable so pick your 'treats' carefully and make it worth it for enjoyment.
People who only do a finger prick before and 2 hours after eating would be totally unaware of what happens in the interim and tend to use the no more than 8-8.5 mmol/l or no more than a 2-3mmol/l increase criteria to judge whether a meal is OK and they would usually then be in the 4-7 range before their next meal.
There is no need to do without completely but use a sensible testing regime to determine what meals and foods you are OK with, there are plenty of low carb options which are still fulfilling and tasty.

 

[silentsquirrel]

In my world a change of 9 mmol/l would be a spike

I think you misread that, agree a change/rise OF 9 mmol/l would be a spike, but the OP was talking about a rise TO 9, so only just above recommended levels.

 

[helli]

I think you misread that, agree a change/rise OF 9 mmol/l would be a spike, but the OP was talking about a rise TO 9, so only just above recommended levels.

I don't think it was a misread.
I think it was an attempt to answer the question posed on the title.
I think to "OF* was intended although not highlighted.

 

[silentsquirrel]

I don't think it was a misread.
I think it was an attempt to answer the question posed on the title.
I think to "OF* was intended although not highlighted.

I have re-read Post 1 and totally disagree!

"levels ...... creep up towards 9" and "BG numbers ..... go up to 9"

 

[Proud to be erratic]

I thought the "change of" was very intentional. In a gentle Ha-Ha sense.

 

[SimonP]

Sorry, was a somewhat tongue-in-cheek joke, I realise the definition of a spike depends on your point of view (and basically whether you're T1 or T2). I'll be quiet now 🙂

 

[Docb]

@Missmarple690. To return to your topic to which I do not think you have got an answer. In my opinion that is because there is no answer to the question, what exactly is a spike.

There is no exactness about what is a spike. In diabetes it is a fuzzy concept referring to the way in which carbohydrate affects blood glucose levels, misusing a term common in general science. The term spike is normally applied when a there is a sudden increase in something which disappears very quickly and equally suddenly and the increase is way outside what you might expect from the way the system is known to behave. The increase in blood sugar as a result of carbohydrate intake is not sudden and it does not disappear quickly and is explainable. In the diabetes world "spike" has become a portmanteau word to describe the way in which blood glucose goes up and down for one reason or another. It has no exact meaning and as a result means different things to different people.

It is not a word I use. Just causes confusion.

PS.. You can add it to the list of other labels I don't like. Bigger examples are Glycaemic Index and T2 diabetes.

 

[Leadinglights]

@Missmarple690. To return to your topic to which I do not think you have got an answer. In my opinion that is because there is no answer to the question, what exactly is a spike.

There is no exactness about what is a spike. In diabetes it is a fuzzy concept referring to the way in which carbohydrate affects blood glucose levels, misusing a term common in general science. The term spike is normally applied when a there is a sudden increase in something which disappears very quickly and equally suddenly and the increase is way outside what you might expect from the way the system is known to behave. The increase in blood sugar as a result of carbohydrate intake is not sudden and it does not disappear quickly and is explainable. In the diabetes world "spike" has become a portmanteau word to describe the way in which blood glucose goes up and down for one reason or another. It has no exact meaning and as a result means different things to different people.

It is not a word I use. Just causes confusion.

PS.. You can add it to the list of other labels I don't like. Bigger examples are Glycaemic Index and T2 diabetes.

Can I add my one of blood sugar.

 

[harbottle]

I don't like the use of spike.
Find it quite meaningless. My own levels go up and down all through the day, and the same meal can have different effects on different days. Just a daily ebb and flow.
I'd get concerned if I was seeing it go up over 10 too often, and stay there, which is pretty much what I've been told by a GP friend. It's the chronically elevated levels that cause the problems, IMHO, not the daily ups and downs.

 

[rebrascora]

I believe there is some suggestion that reducing glycaemic variability is helpful in reducing risk of long term complications although perhaps this is more relevant to people who are using insulin than those mostly dietary managed because we can experience more dramatic peaks and troughs, but I think if people can mostly (but not always) keep in single figures then the risks are reduced. Worrying about going up to 10 or 12 occasionally is probably going to do you more harm than actually briefly going up to those levels. Many of us who are using insulin have to accept that going up to 15 or more occasionally happens despite our best efforts and again, there is no point in worrying about it. We can only try to keep it to a minimum and get it back down in as timely and safe a manner as possible.

 

[harbottle]

Yep, in people with type 2 it tends to stay chronically high rather than zip up and down. I try to avoid going over 10 and generally like to keep it between 4 and 8 most of the time.

 

[everydayupsanddowns]

I believe there is some suggestion that reducing glycaemic variability is helpful in reducing risk of long term complications although perhaps this is more relevant to people who are using insulin than those mostly dietary managed because we can experience more dramatic peaks and troughs, but I think if people can mostly (but not always) keep in single figures then the risks are reduced. Worrying about going up to 10 or 12 occasionally is probably going to do you more harm than actually briefly going up to those levels. Many of us who are using insulin have to accept that going up to 15 or more occasionally happens despite our best efforts and again, there is no point in worrying about it. We can only try to keep it to a minimum and get it back down in as timely and safe a manner as possible.

Yes I’ve come across that too. There is research into the 3 different ways of observing blood glucose levels.

The overall ‘average glucose’ (which I guess could be either mean, median or mode, depending on your preference), alongside glucose variation (the gap between the highest high and the lowest low), and glucose instability (the frequency of fluctuations and how dramatic or gently they are).

It has been found that these 3 different things all affect risk differently over and above the simplistic measure of HbA1c (which is often used as a sort of proxy for average).

The very lowest risk seems to occur when all three average, variation, and instability are low. So ideally what you want are fairly gentle fluctuations around a good mid-point. If you have a higher mid-point, you can improve matters by reducing instability/variation. I’ve even read that steady BG in the 20s 😱 can give rise to lower risk of retinopathy than lower average, but unstable and widely varied BGs (John Walsh cites the research in Pumping Insulin)

You may also find the findings from this study into non-diabetes glucose variation helpful @Missmarple690 - you can see that healthy people can often see BGs in double figures, but they tend to not stay there too long, and overall their range/instability is low.

Thread 'BG Profiles in Healthy Non-Diabetics'

Apr 11, 2022

Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study

This study provides normative sensor glucose data in a healthy, nondiabetic population of children and adults.

academic.oup.com

A fairly large study from 2019 seeking to map out what "normal" BG profiles look like during the day and overnight, using CGM measures; often see it cited. Perhaps useful resource for people looking to benchmark themselves against "normal" etc.

Units are mainly in American for BG (mg/dl: divide by 18 for mmol/l) and for HbA1c (%; easy to find tools on-line for conversion to mmol/mol).

There is some circularity: the main thing for deciding whether somebody is "non-diabetic" is their HbA1c, so no surprise if BG profiles are...

• Eddy Edson
• Replies: 2
• Forum: Links

• 

I think most of us on the forum have developed a feel of what we consider to be a ‘spike’ (or rather, an unwanted glucose outcome) from a meal, and review our menu / meds / activity responses to that to try to reduce it next time - or accept it as an acceptable treat-related thing every so often. Like so much diabetes stuff, it’s all pretty individual really.

 

[silver minion]

Yes I’ve come across that too. There is research into the 3 different ways of observing blood glucose levels.

The overall ‘average glucose’ (which I guess could be either mean, median or mode, depending on your preference), alongside glucose variation (the gap between the highest high and the lowest low), and glucose instability (the frequency of fluctuations and how dramatic or gently they are).

It has been found that these 3 different things all affect risk differently over and above the simplistic measure of HbA1c (which is often used as a sort of proxy for average).

The very lowest risk seems to occur when all three average, variation, and instability are low. So ideally what you want are fairly gentle fluctuations around a good mid-point. If you have a higher mid-point, you can improve matters by reducing instability/variation. I’ve even read that steady BG in the 20s 😱 can give rise to lower risk of retinopathy than lower average, but unstable and widely varied BGs (John Walsh cites the research in Pumping Insulin)

You may also find the findings from this study into non-diabetes glucose variation helpful @Missmarple690 - you can see that healthy people can often see BGs in double figures, but they tend to not stay there too long, and overall their range/instability is low.

Thread 'BG Profiles in Healthy Non-Diabetics'

Apr 11, 2022

Continuous Glucose Monitoring Profiles in Healthy Nondiabetic Participants: A Multicenter Prospective Study

This study provides normative sensor glucose data in a healthy, nondiabetic population of children and adults.

academic.oup.com

A fairly large study from 2019 seeking to map out what "normal" BG profiles look like during the day and overnight, using CGM measures; often see it cited. Perhaps useful resource for people looking to benchmark themselves against "normal" etc.

Units are mainly in American for BG (mg/dl: divide by 18 for mmol/l) and for HbA1c (%; easy to find tools on-line for conversion to mmol/mol).

There is some circularity: the main thing for deciding whether somebody is "non-diabetic" is their HbA1c, so no surprise if BG profiles are...

• Eddy Edson
• Replies: 2
• Forum: Links

• 

I think most of us on the forum have developed a feel of what we consider to be a ‘spike’ (or rather, an unwanted glucose outcome) from a meal, and review our menu / meds / activity responses to that to try to reduce it next time - or accept it as an acceptable treat-related thing every so often. Like so much diabetes stuff, it’s all pretty individual really.

Very useful summary Mike and new information about BG risks that I find really helpful. Thank you!