View Full Version : Perhaps the A1c is unimportant, and only peaks count ???
What do you think of this hypothesis? The body can tolerate
relatively high 'average' bg levels, so it's postprandial
peaks that cause renal (nephropathy) and retinal cell
(retinopathy) damage, small vessel and neural cell
(neuropathy) damage, and secondary impact on various
organs. The idea is that if high bg is "bad", then peaks
are worse...
If that's true, then the A1c is relatively unimportant.
Adoption of that view means that testing patterns should
change (forget about fasting numbers), diet selection
becomes critical, and peak-management medications become
paramount. For Type IIs -- 95% of all diabetics, here's what
works for me:
1. Test 45-60-75-90-115 minutes after eating to study your
own postprandial response to various foods; keep records.
2. Use the Glycemic Index (mendosa.com) to pick low GI
food, and therefore food with relatively low
postprandial peaks.
3. If you must eat the wrong carbs, eat with some fat
content to slow down processing and therefore
postprandial peaks.
4. Use acarbose (Precose) to reduce the amplitude of
postprandial peaks resulting from carb intake.
5. Use nateglinide (Starlix) to stimulate insulin production
and reduce glucose peaks.
6. Use isometrics to knock the tops off peaks when nothing
else is available.
I'm no physician, but have adopted this protocol and it
works very well. I'm just a population of one, but my
numbers support the idea that glycation of hemoglobin is
accelerated during peaks, and by controlling peaks the A1c
drops. I've been following a diet that would make the
average diabetic's average numbers go through the roof, but
have been aggressively controlling postprandial peaks - and
my A1c has fallen like a rock.
Please don't undertake this or any other diabetes management
philosophy from any source, professional or quack, without
first getting clearance from your diabetologist.
Henry
"HLE" <OOH!RAH!@USMC.net> wrote in misc.health.diabetes:
> What do you think of this hypothesis? The body can
> tolerate relatively high 'average' bg levels,
My body can tolerate open fire for some time, yet the burns
are considerable and the damage is high.
> so it's postprandial peaks that cause renal (nephropathy)
> and retinal cell (retinopathy) damage, small vessel and
> neural cell (neuropathy) damage, and secondary impact on
> various organs.
Why does your "tolerating high average BG's" deliver proof
that complications are caused by spikes?
> The idea is that if high bg is "bad", then peaks are
> worse...
So you conclude both spikes and a high average BG are bad
and will probably support the development of complications.
Keep your BG's in range all the time, and so your HbA1c.
Better safe than sorry.
--
CeeBee
EMH Mark I: "Stop breathing down my neck." EMH Mark II: "My
breath is merely a simulation." EMH Mark I: "So is my neck.
Stop it anyway."
"HLE" <OOH!RAH!@USMC.net> wrote in message
news:10e3s8i3l4huf7e@news.supernews.com...
> What do you think of this hypothesis? The body can
> tolerate relatively
high
> 'average' bg levels, so it's postprandial peaks that cause
> renal (nephropathy) and retinal cell (retinopathy) damage,
> small vessel and
neural
> cell (neuropathy) damage, and secondary impact on various
> organs. The idea is that if high bg is "bad", then peaks
> are worse...
Not exactly sure what you mean by "the body can tolerate
relatively high averge bg levels".
>
> If that's true, then the A1c is relatively unimportant.
> Adoption of that view means that testing patterns should
> change (forget about fasting numbers), diet selection
> becomes critical, and peak-management medications become
> paramount. For Type IIs -- 95% of all diabetics, here's
> what works for me:
The A1Cc can be useless for some people. That includes
people with spherocytosis or brittle diabetics, among
others.
> 1. Test 45-60-75-90-115 minutes after eating to study
> your own
postprandial
> response to various foods; keep records.
Why not test tat two hours after eating? This is the most
important time to test. Seems like a waste to test at those
other times, except perhaps at the one hour mark.
> 2. Use the Glycemic Index (mendosa.com) to pick low GI
> food, and therefore food with relatively low
> postprandial peaks.
This doesn't always work for everyone. I find that my best
foods are some of the worst, according to that list.
> 3. If you must eat the wrong carbs, eat with some fat
> content to slow down processing and therefore
> postprandial peaks.
Fat only delays the absorption of carbs. Eat too much fat in
the meal and you'll just spike later on.
> 4. Use acarbose (Precose) to reduce the amplitude of
> postprandial peaks resulting from carb intake.
I don't think this is a med that everyone can tolerate. I
don't like having gas. And from what I've read, that's what
it does for you.
> 5. Use nateglinide (Starlix) to stimulate insulin
> production and reduce glucose peaks.
Starlix is VERY expensive and I don't think it is something
everyone would need. I also don't think it is usually used
in conjunction with Precose, but I'm not Dr. or pharmacist.
> 6. Use isometrics to knock the tops off peaks when nothing
> else is available.
I do that.
>
> I'm no physician, but have adopted this protocol and it
> works very well.
I'm
> just a population of one, but my numbers support the idea
> that glycation
of
> hemoglobin is accelerated during peaks, and by controlling
> peaks the A1c drops. I've been following a diet that would
> make the average diabetic's average numbers go through the
> roof, but have been aggressively
controlling
> postprandial peaks - and my A1c has fallen like a rock.
>
> Please don't undertake this or any other diabetes
> management philosophy from any source, professional or
> quack, without first getting clearance from your
> diabetologist.
As I'm sure you know, each case of diabetes is different.
What works for you might not work for me.
--
Type 2 http://users.bestweb.net/~jbove/
"HLE" <OOH!RAH!@USMC.net> wrote in message news:<10e3s8i3l4huf7e@news.supernews.com>...
> What do you think of this hypothesis? The body can
> tolerate relatively high 'average' bg levels, so it's
> postprandial peaks that cause renal (nephropathy) and
> retinal cell (retinopathy) damage, small vessel and neural
> cell (neuropathy) damage, and secondary impact on various
> organs. The idea is that if high bg is "bad", then peaks
> are worse...
>
> If that's true, then the A1c is relatively unimportant.
> Adoption of that view means that testing patterns should
> change (forget about fasting numbers), diet selection
> becomes critical, and peak-management medications become
> paramount. For Type IIs -- 95% of all diabetics, here's
> what works for me:
>
> 1. Test 45-60-75-90-115 minutes after eating to study your
> own postprandial response to various foods; keep
> records.
> 2. Use the Glycemic Index (mendosa.com) to pick low GI
> food, and therefore food with relatively low
> postprandial peaks.
> 3. If you must eat the wrong carbs, eat with some fat
> content to slow down processing and therefore
> postprandial peaks.
> 4. Use acarbose (Precose) to reduce the amplitude of
> postprandial peaks resulting from carb intake.
> 5. Use nateglinide (Starlix) to stimulate insulin
> production and reduce glucose peaks.
> 6. Use isometrics to knock the tops off peaks when nothing
> else is available.
>
> I'm no physician, but have adopted this protocol and it
> works very well. I'm just a population of one, but my
> numbers support the idea that glycation of hemoglobin is
> accelerated during peaks, and by controlling peaks the A1c
> drops. I've been following a diet that would make the
> average diabetic's average numbers go through the roof,
> but have been aggressively controlling postprandial peaks
> - and my A1c has fallen like a rock.
>
> Please don't undertake this or any other diabetes
> management philosophy from any source, professional or
> quack, without first getting clearance from your
> diabetologist.
>
> Henry
I'm curious about your fbg and postprandial numbers at 1 and
2 hours, though!
--pinecone
HLE wrote:
> What do you think of this hypothesis? The body can
> tolerate relatively high 'average' bg levels, so it's
> postprandial peaks that cause renal (nephropathy) and
> retinal cell (retinopathy) damage, small vessel and neural
> cell (neuropathy) damage, and secondary impact on various
> organs. The idea is that if high bg is "bad", then peaks
> are worse...
I think there's clear evidence that high average BGs
are harmful. See the DCCT and UKPDS. The higher the
average BG, the greater the risk of complications.
>
..... and by controlling peaks the A1c drops.
>
This undercuts your experiment. Everyone agrees that
low A1c's results in fewer complications. That's not
your theory. You're postulating that they're not
harmful. To test your own hypothesis, you set up
your experiment such that you run constant high bgs,
say around 400, with no peaks. Then wait to see if
you go blind or suffer kidney failure. Please report
back to us. We'll be interested.
E
On Tue, 29 Jun 2004 15:45:19 -0700, "HLE" <OOH!RAH!@USMC.net> wrote:
>What do you think of this hypothesis? The body can tolerate
>relatively high 'average' bg levels, so it's postprandial
>peaks that cause renal (nephropathy) and retinal cell
>(retinopathy) damage, small vessel and neural cell
>(neuropathy) damage, and secondary impact on various
>organs. The idea is that if high bg is "bad", then peaks
>are worse...
>
>If that's true, then the A1c is relatively unimportant.
>Adoption of that view means that testing patterns should
>change (forget about fasting numbers), diet selection
>becomes critical, and peak-management medications become
>paramount. For Type IIs -- 95% of all diabetics, here's
>what works for me:
>
>1. Test 45-60-75-90-115 minutes after eating to study your
> own postprandial response to various foods; keep
> records.
>2. Use the Glycemic Index (mendosa.com) to pick low GI
> food, and therefore food with relatively low
> postprandial peaks.
>3. If you must eat the wrong carbs, eat with some fat
> content to slow down processing and therefore
> postprandial peaks.
>4. Use acarbose (Precose) to reduce the amplitude of
> postprandial peaks resulting from carb intake.
>5. Use nateglinide (Starlix) to stimulate insulin
> production and reduce glucose peaks.
>6. Use isometrics to knock the tops off peaks when nothing
> else is available.
>
>I'm no physician, but have adopted this protocol and it
>works very well. I'm just a population of one, but my
>numbers support the idea that glycation of hemoglobin is
>accelerated during peaks, and by controlling peaks the A1c
>drops. I've been following a diet that would make the
>average diabetic's average numbers go through the roof, but
>have been aggressively controlling postprandial peaks - and
>my A1c has fallen like a rock.
>
>Please don't undertake this or any other diabetes
>management philosophy from any source, professional or
>quack, without first getting clearance from your
>diabetologist.
>
>Henry
>
>
Hi Henry
I don't disagree with your logic in minimising BG spikes,
but I do disagree with your subject heading. Both BG
spikes AND HbA1c are important in my opinion. However, it
is possible that by minimising spikes you will also
minimise A1c. At least, that has been the case in my own
attempts at control.
The problem I have with the traditional view is the opposite
opinion, that A1c is important but spikes are not.
Cheers, Alan, T2 d&e, Australia. Remove weight and
carbs to email.
--
Everything in Moderation - Except Laughter.
I really appreciate the views and critique. Here's my
perception of the problem: I (and my diabetology friends)
have found no study that evaluates the relative impact of
'average' vs 'postprandial peak' bg. It's very likely that
by controlling pp glucose, the A1c falls (because glycation
is reduced).
And as an answer to one good question: The reason I stop
measuring after two hours is that by then I know what sort
of curve that combination of food and meds is producing.
Another: my fasting bg is 120, A1c is now 5.5.
Before I began attacking pp peaks, those numbers were much,
much worse. Unfortunately, since I'm a population of one
it's all anecdotal and there's not enough data to be
meaningful - except to me.
On Wed, 30 Jun 2004 08:01:57 -0700, "HLE" <OORAH!@USMC.ret> wrote:
>I really appreciate the views and critique. Here's my
>perception of the problem: I (and my diabetology friends)
>have found no study that evaluates the relative impact of
>'average' vs 'postprandial peak' bg. It's very likely that
>by controlling pp glucose, the A1c falls (because glycation
>is reduced).
>
>And as an answer to one good question: The reason I stop
>measuring after two hours is that by then I know what sort
>of curve that combination of food and meds is producing.
>Another: my fasting bg is 120, A1c is now 5.5.
>
>Before I began attacking pp peaks, those numbers were much,
>much worse. Unfortunately, since I'm a population of one
>it's all anecdotal and there's not enough data to be
>meaningful - except to me.
>
Hi Henry
You may find the following articles interesting. I've
snipped only representative pieces; I'd recommend reading
them all in full, particularly number 3.
1. [alpha]-Dicarbonyls Increase in the Postprandial Period
and Reflect the Degree of Hyperglycemia
"In particular, it is well known that in type 1 diabetes, in
which glycemic fluctuations are greater than those in type 2
diabetes, there is a significantly higher prevalence of
diabetic complications, suggesting that transient glucose
excursions may be an important independent variable"
http://articles.findarticles.com/p/articles/mi_m0CUH/is_4_2-
4/ai_73086930
2. Monitoring Glycemic Control by HbA1c or Postprandial
Glucose Levels
"Thus, although HbA1c is currently the principal tool for
assessing glycemic status, one must continue to measure
fasting and, particularly, postprandial glucose levels, in
the determination of individual glycemic risk."
http://www.medscape.com/viewarticle/413353
3. Getting to Goal in Type 2 Diabetes: Role of Postprandial
Glycemic Control
"When your HbA1C is very high, when you have a fasting
glucose level over 200 mg/dL, most of the HbA1C will be due
to fasting hyperglycemia. However, earlier in the stage of
diabetes, when HbA1C levels are lower, it's going to be the
postprandial values that contribute most to HbA1C."
http://www.medscape.com/viewprogram/3036_pnt
My take on the subject, from reading articles like this and
personal experience, is that post-prandial testing is a
critical tool for personal control while A1c and fasting
tests are more reliable indicators for medical advisors.
I posted on this in a different thread as micro-management
(by us) and macro management (by the doctors). I'll repeat
what I said below, ignore it if you read it earlier,
because the comment I made about two-hour tests applies
also to HbA1c.
The doctor and I use the test results in different ways. The
HbA1c, FBG and two-hour test results are indicators for the
doctor of the success (or failure) of my control and whether
I need changes in treatment - what I'd call macro-
management. The one-hour tests, again in my opinion, are a
direct indication of the effects of a specific meal or food
and allow me to make specific dietary changes, or micro-
management.
Macro-management: The doctor, once we are diagnosed, can't
rely on the one-hour tests because they are too dependant on
what we ate, something the doctor can't control. The two-
hour test is more valid for them because our Type 2 system
has settled back from the peak by then. HbA1c is their best
indication of long-term control. To the doctor, a poor A1c
or consistently high numbers at two hours indicates that we
aren't improving and need to change treatment if we won't
change lifestyle, or are deteriorating with progression.
That is also why "the 2-hour test has been well correlated
with death by heart attack"; when I read those studies I
can't remember one which tested at one hour to discuss a
possible correlation there.
Micro-management: For me the one hour test is a much more
accurate indicator of whether I need to change something in
my diet or exercise regimen, for precisely the same reasons
that the doctor can't rely on
it: it is reflecting what I ate in the most recent meal and
the exercise I am doing.
Consequently, now that I have gained a degree of control, I
still regularly test at one hour, but I only bother with a
two hour test if the one hour was unusual.
However, I still get my A1c results every three months to
reassure both myself and my doctor that I am still in
control. And, as a "belt and braces" man I also got
fructosamine last time.
Cheers, Alan, T2 d&e, Australia. Remove weight and
carbs to email.
--
Everything in Moderation - Except Laughter.
Alan, that post is a gold mine for me - thanks! It'll take
me a while to track the data and the references, and to get
my team of cooperative endos to take a look. We had already
agreed that the A1c is a useful tool to the physician in the
ordinary relationship, and that I'm a nut who generates three-
dimensional relational charts showing the dependencies of pp
bg upon various factors, and when I visit they cringe hoping
and praying that I won't make them look at the entire
notebook. Worse, I demand meaningful responses!
I don't even care what my A1c is - but they're required to
keep track because it's the scorecard, the barometer. To me,
however, the scorecard has two factors: the average pp bg,
and the absence of problems. As to the former, I can
precisely manage pp bg now and never exceed 200 (rarely go
over 150 if I'm focusing on it, even if the meal ended with
a big wedge of cheesecake!). As to the latter, I'm 66, weigh
exactly what I weighed at retirement from the Marines in
1978, and am in excellent shape. So their view is that
whatever I'm doing now is working (remember, population =
1), so it's interesting.
At the risk of getting shredded, or (worse) injuring
someone, I posted here. However, a few friends have
adopted the protocol I described, and they're doing really
well, so maybe...
Again, thank you!
Henry
> You may find the following articles interesting. I've
> snipped only representative pieces; I'd recommend reading
> them all in full, particularly number 3.
>
> 1. [alpha]-Dicarbonyls Increase in the Postprandial Period
> and Reflect the Degree of Hyperglycemia
>
> "In particular, it is well known that in type 1 diabetes,
> in which glycemic fluctuations are greater than those in
> type 2 diabetes, there is a significantly higher
> prevalence of diabetic complications, suggesting that
> transient glucose excursions may be an important
> independent variable"
>
> http://articles.findarticles.com/p/articles/mi_m0CUH/is_4-
> _24/ai_73086930
>
> 2. Monitoring Glycemic Control by HbA1c or Postprandial
> Glucose Levels
>
> "Thus, although HbA1c is currently the principal tool for
> assessing glycemic status, one must continue to measure
> fasting and, particularly, postprandial glucose levels, in
> the determination of individual glycemic risk."
>
> http://www.medscape.com/viewarticle/413353
>
> 3. Getting to Goal in Type 2 Diabetes: Role of
> Postprandial Glycemic Control
>
> "When your HbA1C is very high, when you have a fasting
> glucose level over 200 mg/dL, most of the HbA1C will be
> due to fasting hyperglycemia. However, earlier in the
> stage of diabetes, when HbA1C levels are lower, it's
> going to be the postprandial values that contribute most
> to HbA1C."
>
> http://www.medscape.com/viewprogram/3036_pnt
>
> My take on the subject, from reading articles like this
> and personal experience, is that post-prandial testing is
> a critical tool for personal control while A1c and fasting
> tests are more reliable indicators for medical advisors.
>
> I posted on this in a different thread as micro-management
> (by us) and macro management (by the doctors). I'll repeat
> what I said below, ignore it if you read it earlier,
> because the comment I made about two-hour tests applies
> also to HbA1c.
>
> The doctor and I use the test results in different ways.
> The HbA1c, FBG and two-hour test results are indicators
> for the doctor of the success (or failure) of my control
> and whether I need changes in treatment - what I'd call
> macro-management. The one-hour tests, again in my opinion,
> are a direct indication of the effects of a specific meal
> or food and allow me to make specific dietary changes, or
> micro-management.
>
> Macro-management: The doctor, once we are diagnosed,
> can't rely on the one-hour tests because they are too
> dependant on what we ate, something the doctor can't
> control. The two-hour test is more valid for them because
> our Type 2 system has settled back from the peak by then.
> HbA1c is their best indication of long-term control. To
> the doctor, a poor A1c or consistently high numbers at
> two hours indicates that we aren't improving and need to
> change treatment if we won't change lifestyle, or are
> deteriorating with progression. That is also why "the 2-
> hour test has been well correlated with death by heart
> attack"; when I read those studies I can't remember one
> which tested at one hour to discuss a possible
> correlation there.
>
> Micro-management: For me the one hour test is a much more
> accurate indicator of whether I need to change something
> in my diet or exercise regimen, for precisely the same
> reasons that the doctor can't rely on
> it: it is reflecting what I ate in the most recent meal
> and the exercise I am doing.
>
> Consequently, now that I have gained a degree of control,
> I still regularly test at one hour, but I only bother with
> a two hour test if the one hour was unusual.
>
> However, I still get my A1c results every three months to
> reassure both myself and my doctor that I am still in
> control. And, as a "belt and braces" man I also got
> fructosamine last time.
>
>
> Cheers, Alan, T2 d&e, Australia. Remove weight and carbs
> to email.
> --
> Everything in Moderation - Except Laughter.
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