Hi Fred

I'll just comment on this bit. Usually I only give a link to
my blog because this is one of the most common questions
that come up. I started writing the blog because I found
that I kept trying to find different ways to say the same
thing.

So here is my thinking on it.

When To Test. One-hour or Two-hour?
http://loraldiabetes.blogspot.com/2006/11/when-to-test-one-hour-or-two-hour.html

When we first received our brand new blood glucose meter the
majority of us were told by our doctor or qualified diabetes
educators to test twice daily - before breakfast, also known
as "fasting" and before the evening meal. Some, not many, of
us were also told to test occasionally two hours after
meals.

The "us" I speak of are the thousands of newly diagnosed
type 2's I've met in cyberspace over the past four years.
Over that time, in three diabetes usenet newsgroups, eight
Yahoo diabetes newsgroups and a couple of others via the
web, I have yet to meet a single newby who was told by their
doctor to test one hour after every meal or snack. In fact
I've only recently met a few who were advised to test one
hour after any meal at all.

[note: I've now met a couple]

So, why do I recommend that we should? Well, I must admit -
it wasn't my idea; I learnt it from Jennifer and her
Test,test,test advice. I also learnt from Derek Paice and
his e-book Diabetes and Diet
http://www.mendosa.com/DiabetesAndDiet.pdf

Any test is wasted if it neither informs nor confirms some
information. The tests prescribed by your medics are
designed to help them analyse your progress, to assist in
their decisions for your treatment - but they do very little
to help you personally manage your diabetes. The doctor
wants to see your "static" numbers, not the ones that might
be very high or low as a result of the carbs you ate, or
ignored, at your last meal.

And that's why I add those one-hour post-prandial
(after-eating) tests - they help me directly. They are the
"dynamic" numbers that showed the direct effect of the food
I ate and the exercise I did. I call them one-hour, but the
real term should be "peak" or maximum "spike"; mine is
one-hour but you'll have to find your own.

I don't think the timing of the spike is as important as
it's peak level and duration.

Think about it logically. Why would a spike of 10(180)
affect you any differently if it occurred at 30, 60, 90 or
120 minutes? It's duration would be a factor - but
post-prandial timing of the actual peak should be
irrelevant. It still got to that peak, no matter when it
occurred.

So, I learned to find my peak. That is slightly different,
but reasonably predictable, with different foods and meal
mixtures. Drinks, like OJ, spike me very quickly within 30
minutes and drop just as quickly. Which is why some people
use them as hypo treatment. Starchy carbs, without much fat,
will spike me in 30-45 minutes. But add fat - and it's about
60 minutes. A normal meal combining moderate fat, protein
and low GI carbs leads to a peak at 45-75 minutes for me,
and so on. That's why I settled on using the 1hr
post-prandial test as my guide, but I occasionally do a 30
minute one if the food was low-fat and high-GI.

As to whether a brief spike causes damage - not enough
research has been done. There appears to also be a
possibility that spikes have a damaging effect at lower
thresholds for type 2 than type 1, partly from anecdotal
discussions I've followed over the past four years and
partly from the slight differences in results in studies
like the DCCT and UKPDS. Let's face it - only type 2 have
beta cells to lose anyway. Therefore I am swayed by the
reports here, on Jenny's excellent web-page; there is enough
evidence to convince me that staying under 8(140) is worth
the effort - no matter when it occurs: Research Connecting
Organ Damage with Blood Sugar Level
http://www.phlaunt.com/diabetes/14045678.php

Of course, I tend to always aim a little tighter, so these
days I set the level at 7(126) for my one-hour post-prandial
maximum. What you do is up to you.

Cheers, Alan, T2, Australia.
d&e, metformin 1500mg, ezetrol 10mg
Everything in Moderation - Except Laughter.
--
http://loraldiabetes.blogspot.com
Latest: ACCORD, Foxes and Grapes

Ah. Right, two things happening here; the peak and the length of it.
Both cause damage in different ways.

The 2-hour figure comes because it takes that long for proteins in the
blood to be permanently changed by swimming in glucose - in other
words, for your A1c to be affected, and your risk of heart attack and
stroke to be increased. So being normal at 2 hours is a Good Thing,
but isn't the end of the story.

You get damage to sensitive bits like eyes, nerves and kidneys from a
spike. It amazed me when I was working on reversing my neuropathy that
the pain started as bg went UP through a reading - not if it hung
around there. Now, when the spike happens depends on a number of
factors - how good your first-phase insulin response is, how fatty the
meal is, etc - but an hour is usually a reasonable approximation.
Personally, now I've got good control, I try and stay in normal range
all the time - between 4.0 and 7.9 - because I reckon that's what we
evolved to cope with!

When I test, I don't bother with a pre-meal one any more - I know I'm
going to be 4.3-4.5 - and I only go beyond the 1-hour if it's too
high, or if I'm expecting a delayed effect from fat. Unless I'm
testing a new meal - then I might test every 15 mins beginning 30 mins
from starting to eat until the reading's returned to normal and stays
there for a couple of readings. I might test nothing for a week or two
- then use half a dozen strips on a single meal. I'm trying to figure
out what foods are safe for me to eat, which is information the A1c
doesn't give me - but I'm happy to use the A1c to check what my
baseline control's like. If it starts to drift up, I can investigate
outside mealtimes to find out why. I test fasting about once a week,
just to make sure there's no surprises there.

That's because the A1c measures the two-stage process of how glucose
is stuck to the blood protein they measure. The first stage is
reversible; the second isn't, and takes about 2 hours to get there. So
unless you're staying high after meals, or have dawn phenomenon,
there's long periods of time when you're not adding to the reading.

Heh, heh - nice problem :D

Nicky.
T2 dx 05/04 + underactive thyroid
D&E, 100ug thyroxine
Last A1c 5.6%  BMI 25

My name is Fred Fernackapan
I walk around the town
Sometimes with my trousers up
And sometimes with them down
And when they were up they were up
And when they were down they were down
And when they were only half way up
I was arrested

(Spike Milligan)

Good going otherwise