Peaks or AUC?

[Enrico C]

What should people check in order to prevent diabetes and be
sure they are in optimal health?

1. Fasting sugar blood in the morning should be as low
as possible?
2.b Would a 75 reading be better than an 85, for instance?

3. Postprandial blood sugar peaks should be as low as
possibile?
3.a: Ideally never over 140, even 30-45 minutes after lunch,
whatever you eat?

4. Postprandial blood sugar should be back to baseline as
quickly as possible?
5.b Ideally, no more than 2 hours, whatever you eat?

6. The incremental AUC (area under the curve) of the glycemic
curve should be as small as possible?
7.b Ideally zero?

8. The shape of the glycemic curve should be as "smooth" as
possible, no steep peaks nor deep "valleys"?
9.b "Valleys" shoud never go under baseline?

10. The glycemic curve is not the only thing that's
relevant, you should know what your insulin curve looks
like as well.
11.b Think of milk, for instance. I found out on myself (not a
diabetic) that if I drink a pint of milk, either full fat
or skimmed, blood sugar practically sticks at baseline. In
other words, milks seems not to raise my blood sugar, but I
guess it does so by raising insulin.

xpost misc.health.diabetes,sci.med.nutrition

[Enrico C]

On Sat, 20 Jan 2007 03:45:21 GMT, Julie Bove wrote:

> "Enrico C" <use_replyto_address@devils.com> wrote in message
> news:1vd5ikj7q0snm.dlg@news.lillathedog.net...
>>
>> What should people check in order to prevent diabetes and
>> be sure they are in optimal health?
>>
>> 1. Fasting sugar blood in the morning should be as low as
>> possible?
>> 1.b Would a 75 reading be better than an 85, for instance?
>
> BG should never be as low as possible. That would be a hypo.

What numbers would be a hypo (before breakfast) ?

>
>> 2. Postprandial blood sugar peaks should be as low as
>> possibile?
>> 2.b: Ideally never over 140, even 30-45 minutes after
>> lunch, whatever you eat?
>>
> Where did you see this?

Just asking :)

>> 3. Postprandial blood sugar should be back to baseline as
>> quickly as possible?
>> 3.b Ideally, no more than 2 hours, whatever you eat?
>
> Kind of hard to achieve. Don't you think?

Ok, but my question was about optimal glycemic control.

>> 4. The incremental AUC (area under the curve) of the
>> glycemic curve should be as small as possible?
>> 4.b Ideally zero?
>>
> If this were so, we wouldn't have diabetes.

Anyway I gather that the AUC is not usually monitored,
you look at peaks, right?, so maybe it's not really
relevant. Dunno.

>> 5. The shape of the glycemic curve should be as "smooth" as
>> possible, no steep peaks nor deep "valleys"?
>> 5.b "Valleys" shoud never go under baseline?
>
> Dunno. I've never mapped my BG nor have any of my Drs.

Ok.

>> 6. The glycemic curve is not the only thing that's
>> relevant, you should know what your insulin curve looks
>> like as well.
>
> And how would we know this?

By an insulin test, I guess :)

http://www.nlm.nih.gov/medlineplus/ency/article/003700.htm
[...]
| Why the test is performed
|
| Insulin is a hormone released from the beta cells of the
| pancreas. Insulin's most important function is to facilitate
| glucose (blood sugar) uptake by a variety of tissues,
| especially adipose (fat) and skeletal muscle. Insulin also
| stimulates the synthesis and storage of triglycerides and
| proteins. Insulin is the most important regulator of blood
| glucose. High blood glucose (such as exists shortly after a
| meal) stimulates the release of insulin, whereas low blood
| glucose levels inhibit insulin release.
|
| The most important reason for measuring the blood insulin
| level is the diagnosis or evaluation of hypoglycemia (low
| blood sugar).
|
| Also, insulin levels measured while fasting can give
| information about the body's sensitivity to insulin. High
| insulin, even with normal blood sugar, may indicate that the
| pancreas is working harder-than-normal to get the
| blood-sugar level down. This situation is usually caused by
| the body being resistant to insulin's effect -- a condition
| called "insulin resistance syndrome" or "metabolic
| syndrome." It is a very common feature of obesity and of
| hormonal problems such as polycystic ovary syndrome.
|
| The insulin test may also be combined with other tests, such
| as glucose, proinsulin, anti-insulin antibodies, and insulin
| c-peptide for the work-up of hypoglycemia.
[...]

>> 6.b Think of milk, for instance. I found out on myself (not
>> a diabetic) that if I drink a pint of milk, either full
>> fat or skimmed, blood sugar practically sticks at
>> baseline. In other words, milks seems not to raise my
>> blood sugar, but I guess it does so by raising insulin.
>
> Huh?

http://www.mendosa.com/insulin_index.htm [...]
| There are some instances, however, where a food has a low
| glycemic value but a high insulin index value. This applies
| to dairy foods and to some highly palatable energy-dense
| "indulgence foods." Some foods (such as meat, fish, and
| eggs) that contain no carbohydrate, just protein and fat
| (and essentially have a GI value of zero), still stimulate
| significant rises in blood insulin.
|
| At the present time, we don't know how to interpret this
| type of response (low glycemia, high insulinemia) for
| long-term health. It may be a good outcome because the rise
| in insulin has contributed to the low level of glycemia. On
| the other hand, it may be not-so-good, because the increased
| demand for insulin contributes to beta-cell "exhaustion" and
| the development of type 2 diabetes.
[...]

xpost misc.health.diabetes,sci.med.nutrition

[Chris Malc]

In misc.health.diabetes Enrico C
<use_replyto_address@devils.com> wrote:

> What should people check in order to prevent diabetes and be
> sure they are in optimal health?

> 1. Fasting sugar blood in the morning should be as low as
> possible?
> 1.b Would a 75 reading be better than an 85, for instance?

As low as possible is a hypoglycemic coma.

> 3. Postprandial blood sugar should be back to baseline as
> quickly as possible?
> 3.b Ideally, no more than 2 hours, whatever you eat?

What's baseline?

> 4. The incremental AUC (area under the curve) of the
> glycemic curve should be as small as possible?
> 4.b Ideally zero?

An area has be bounded on all sides. If the glycemic curve
bounds the top, what bounds the bottom and why?

> 5. The shape of the glycemic curve should be as "smooth" as
> possible, no steep peaks nor deep "valleys"?
> 5.b "Valleys" shoud never go under baseline?

What baseline?

> 6. The glycemic curve is not the only thing that's relevant,
> you should know what your insulin curve looks like as
> well.

Most of your items also assume an unspecified baseline.

--
Chris Malcolm cam@infirmatics.ed.ac.uk DoD #205 IPAB,
Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]

[Enrico C]

On Sun, 21 Jan 2007 14:51:42 +0100, Anja Länge wrote:

>> So, if you were non-diabetic but on the borderline for
>> prediabetes, for instance 95-100, wouldn't you "take
>> action" for prevention?

> You don't prevent diabetes by controlling these values, you
> prevent it by changing your lifestyle.

Righto, but most people would "take action" only when they see
an immediate danger, not before! Besides, there are many
different shades between Mr. Lazy and Mr. Active... Maybe you
did change your lifestyle at some extent, but is that enough?
So, my question is: what blood sugar levels should ring a
bell, even if apparently in the "normal" range?

[Nicky]

On Sun, 21 Jan 2007 15:31:06 +0100, Enrico C
<use_replyto_address@devils.com> wrote:

>So, my question is: what blood sugar levels should ring a
>bell, even if apparently in the "normal" range?

By the time your blood sugar levels are deteriorating, you've
already lost the first battle. Keeping an eye on insulin
levels (or, more practically, C-peptide) would be more useful.

Nicky. T2 DX 05/2004 A1c 5.5% BMI 25 D&E 100ug Thyroxine

[Anja LäNge]

Enrico C wrote:

> Righto, but most people would "take action" only when they
> see an immediate danger, not before!

Some not even then. But that's a different subject.

>Maybe you did change your lifestyle at some extent, but is
>that enough?

I am typ1, my change of lifestyle was the usage of insulin ;-)

> So, my question is: what blood sugar levels should ring a
> bell, even if apparently in the "normal" range?

I'd say you have to see the whole picture. You can have a good
fasting bg but higher postprandial readings... or vice versa.
You also can have other causes of elevated bg readings but not
caused by a beginning insulin resistance due to pre-diabetes.

Anja

[Anja LäNge]

Anja Länge wrote:

>> So, my question is: what blood sugar levels should ring a
>> bell, even if apparently in the "normal" range?
>
> I'd say you have to see the whole picture. You can have a
> good fasting bg but higher postprandial readings... or vice
> versa. You also can have other causes of elevated bg
> readings but not caused by a beginning insulin resistance
> due to pre-diabetes.

But again... if you see it, the point of effectivly preventing
diabetes was a while ago.

Anja

[Chris Malc]

In misc.health.diabetes Enrico C
<use_replyto_address@devils.com> wrote:
> On 21 Jan 2007 11:52:10 GMT, Chris Malcolm wrote:

>> In misc.health.diabetes Enrico C
>> <use_replyto_address@devils.com> wrote:

> [...]

>>> 3. Postprandial blood sugar should be back to baseline as
>>> quickly as possible?
>>> 3.b Ideally, no more than 2 hours, whatever you eat?
>>
>> What's baseline?

> I meant the preprandial level, just before the meal
> (time 0).

Which varies considerably depending on many factors.

>>> 4. The incremental AUC (area under the curve) of the
>>> glycemic curve should be as small as possible?
>>> 4.b Ideally zero?
>>
>> An area has be bounded on all sides. If the glycemic curve
>> bounds the top, what bounds the bottom

> The baseline :)

>> and why?

> Because that way you can measure the *incremental* area of
> the curve, id est how much the meal raised blood sugar.

Exactly. That would give you a good estimate of how much
that meal will raise blood sugar. But if you chose a fixed
baseline, such as the point at which glycation damage starts
rapidly increasing, rather than the variable preprandial
one, you'd be measuring something more closely related to
diabetic damage.

Depends for what purpose you're making these graphs.

--
Chris Malcolm cam@infirmatics.ed.ac.uk DoD #205 IPAB,
Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK
[http://www.dai.ed.ac.uk/homes/cam/]