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Posted 12/30/2005 8:30 AM (GMT 0)
Hi everybody!Iam a new member and i seek your co-operation and help.My main worry throughout my diabetic career as a fellow-traveller has been "post-lunch sugar control"what i mean is the afternoon glucose control.I found that in the first place i tend to concentrate more on the morning and evening(night)glucose values and the afternoon values get ignored.Secondly i found it irksome to interrupt my afternoon work to take the afternoon tests.Please share your thoughts and experiences.

                                                                                                  sharer 

Posted 12/30/2005 2:50 PM (GMT 0)

Hi sharer,

Im a Byetta user.  The way we use Byetta is once in the morning and once in the evening, both before meals.  I have the same concerns as you as I want to make sure that the meds can hold me through any kind of lunch meal.  To date the only way that I've delt with it is 2 fold. If I know I'll be eating lunch I eat a very light breakfast and cut back on my oral meds.  This lets the Byetta still push my blood sugar down but I don't have to worry about Hypoglycemia by eating just a little breakfast.  THEN I take the rest of the oral meds I omitted at breakfast before lunch and Voila, my numbers stay where they should be. The other way I control my afternoon numbers is I eat very little or nothing for lunch.  In those cases, the Byetta carries me through with numbers hovering around 100.

As far as testing....well, its if I remember or its convenient in the 90 min window after lunch.  For me its not critical, but I like to see where the spike is if Im in a position where the testing is not a pain in the butt.  I would say as a type 2, your testing is not critical like with a type 1, and really is for informational purposes only, so if you are lax about afternoon testing, thats ok.  After all you really only need to do it ocassionaly to get a picture of what is going on with you in the afternoon.

scool Warren

Post Edited (Warren) : 12/30/2005 8:04:18 AM (GMT-7)

Posted 12/30/2005 4:52 PM (GMT 0)
Hi Warren,
Thanks for your thoughts,but boy o boy have you touched my raw nerve,if i may use the phrase;i:ethe 90 minute post-prandial versus the 120 minute pp testing.My point is that if you concentrate only and put emphasis only on the 90 minute spikes ,you may miss the 2 hour lows!Furthermore studies on post-prandial glucose say that the spike can occur anytime between 60 to 90 minutes after a meal.So if you eat foods that are rapidly absorbed,the spike may actually be at 60 minutes.This is where Glycosylated Haemoglobin comes into the picture.
SHARER
Posted 12/30/2005 5:11 PM (GMT 0)
sharer-

The differences between the 60, 90 and 120 minute tests are more what you are looking for. The 120 will give you the level you need to see if you are coming down to an acceptable level. There is nothing you can do about it if you are not - not in the short term anyway. I prefer the 60 minute myself. If you look at the phase 1 curve you will see that you bg's go up quickly and hold the high level for a while - hopefully trending down to an acceptable range in 120 minutes. If you are looking for the highs then the 60 and the 90 minute test will give the most accurate results. If the highs are within what you are trying to hold to then the 120 minute will most likely follow where you want it. This is if you are controlling your bg's well. Depending on what you have eaten will depend on when you spike - it is doubtful we can really get a handle on this. It is best to pick a time to test and live with that.

The A1c actually does not show quick spikes. It is an average of long term levels. It does not show quick spikes because the process of red blood cells getting glycoslated(spelling) happens when they are made. Short term spikes effect fewer blood cells than when it is for a longer period. Because red cells live for something like 90 to 120 days on a curve with many dieing sooner than later the last 30 days have more alive red cells than the older ones. They use a scale to account for this, but you can change your A1c by "doing very good' for 30 days. The test is not the absolute test we would hope it to be. Your daily testing is more indicator than the A1c.
Posted 12/30/2005 6:02 PM (GMT 0)

Very well put Desertdiabtic.  I do "90" in hopes of catching most of my spike.  Im not worried about a low as I know with my current meds I always come back to an acceptable level.  I AM concerned about how high the spikes are going.  If I go from 94 to 200 and have to rely on my Byetta to mitigate this spike, thats not as good as if I went from 94 to 140 as a spike.  Anyway, its all informational for me as I dont' do insulin from those numbers and adjustments in my lifestyle or meds are only really based on trends over say a month, not on an occasional outlying number.

scool Warren
Posted 12/31/2005 10:29 AM (GMT 0)
Desert diabetic,
1)You prefer 60 minute pp testing,Warren prefers 90 minute pp testing and i prefer the 120 minute pp testing!So,don't you see the subjectivity involved?THERE IS NOT A SINGLE ARTICLE IN ANY REPUTED DIABETES JOURNAL,OR ANY DIABETES TEXTBOOK,OR ANY EXPERT OPINION VOICED IN ANY INTERNATIONAL DIABETES FORA THAT ADVOCATE 60 MINUTE POST-PRANDIAL TESTING WHICH YOU PREFER!Iam writing this in bold print because the readers in this forum should not be misled by a single person's opinion.

2)Now coming to Warren's 90 minute test for assessing pp control,there are very few advocates of this timing andTHE MAJORITY OF PHYSICIANS AND DIABETOLOGISTS ADHERE TO 120 MINUTE PP TESTING FOR CONTROL.Check it out!
3) Any sincere diabetic will not cheat himself in the last 2 to 4 weeks leading to the HbA1c test.Since a "normal" as well as a"diabetic" spend the major part of a day in the prandial state,all the spikes are evened out finally in the HbA1c test.FOR YOUR INFO'GLUCOSE GETS ATTACHED TO THE HAEMOGLOBIN IN ALMOST ALL RED BLOD CELLS THROUGHOUT THEIR LIFETIME,AND NOT AT THE BEGINNING AS YOU MENTIONED.We all know the pitfalls of HbA1c testing and needs no special mention.
4)As for the part Warren mentioning "well put Desert Diabetic",i leave it to his better judgement after He reads this reply.
sharer
Posted 12/31/2005 4:10 PM (GMT 0)
"Desert diabetic,
1)You prefer 60 minute pp testing,Warren prefers 90 minute pp testing and i prefer the 120 minute pp testing!So,don't you see the subjectivity involved?THERE IS NOT A SINGLE ARTICLE IN ANY REPUTED DIABETES JOURNAL,OR ANY DIABETES TEXTBOOK,OR ANY EXPERT OPINION VOICED IN ANY INTERNATIONAL DIABETES FORA THAT ADVOCATE 60 MINUTE POST-PRANDIAL TESTING WHICH YOU PREFER!Iam writing this in bold print because the readers in this forum should not be misled by a single person's opinion."

Boy, you must be the most well read and have done more research than any else around here. All the journals, any textbooks, any expert opinion voiced in any international diabetes forum. That must be thousands of journals, who know how many text books, and the experts are in the many thousands. Thanks for doing that research for all of us. Yes, this is sarcastic, but your statement is totaly without merit and a direct personal attack on me. I could care less about that. you ask for an opinion and you got it. If you are offended in opinions different than yours then you should ask your question differently. State that in there and we woud be guided to your needs I am not offended, believe me, I take opinions of those who profess to have read everything and know everything just like those who don't feel that way. We all have opinions, you have yours. When people come to the reality that the experts are so far apart in their opinions to make them credible we can come to our own opinions.

I stand by my opinion that 60 minutes works for me. Maybe you missed the part where I said it what "I" liked and not what I recommended for everybody on this forum. I don't care what all the experts, journals, and testbooks say about my own personal way of testing my blood glucose levels. I control very well without them.
Posted 1/1/2006 5:36 AM (GMT 0)
Ok, people.. let's calm down here a bit...

For a different spin on this situation you could be me and have run out of test strips two weeks ago, have no insurance and had to go online to find cheap strips that work with an entirely new meter just so I can start testing again. Since all of us have different levels of pancreatic function and are all on completely different drug regimens as well as different diets the testing and results will differ for all of us anyway.

There actually are some things you can do to avoid spikes after a meal or help your way through them. If you take a tablespoon of psyllium fiber (sugar free) in a glass of water and drink it down right after your meal it will level out your post meal spikes and prevent those highs and will also slow down your carb absorption in your small intestines. It is a very simple thing to do and works very well.

If you have a spike in progress you can help by drinking a couple of glasses of water to dilute your blood and help out your kidneys and you can do some brisk exercise to drop the numbers a bit very quickly. At work? Going up and down stairs is perfect exercise that can be done at work.

Just my 2ยข here but hope this helps.
Posted 1/3/2006 6:41 AM (GMT 0)
Dear jeannie,
to control pp spikes,i found that chewing a tablet of Acarbose(Glucobay)25 mg, with the first bite of food ,three times a day went a long way,and was a real help!Early on while using acarbose i had abdominal discomfort which settled down nicely later on.Miglitol is another drug in the market to control pp spikes and the advantage is one needs only to "swallow" the tablet just before food.
sharer
Posted 1/3/2006 5:37 PM (GMT 0)
Sharer,

I understand that those meds (which are prescription) block some of the absorption of carbs in the lower intestine and for myself, I would rather avoid the carbs in the first place. I guess they would have their place if you were going to a pasta festival or pie eating contest, but for me, I try to do the carb management before it gets into my mouth. If I over indulge I use the psyllium. It has a proven track record of preventing spikes and it's totally 'natural'. The action is a physical blocking of absorption rather than a biochemical one. Just my choice.
Posted 1/3/2006 6:35 PM (GMT 0)

As a postcript to Jeannies post; one of the major actions of "BYETTA" is that it delays stomach empting into the intestine, 1) to curb hunger and control insulin production  2) to slow carb absorbtion.  So Byetta has this benefit already built in.

scool Warren
Posted 1/3/2006 8:23 PM (GMT 0)
As a postscript to Warren's postcript; one of the minor actions of "Byetta" is an uncontrolable hunger for small desert dwelling invertibrates and small mammals and the need to sun oneself on a large rock after eating... tongue NOT! Just making a joke here about the synthisized lizard spit... Wish I could afford it. It's an amazing drug. Wonder who thought to check gila monster saliva for blood sugar lowering properties? I wonder how they got the samples.... ?
Posted 1/3/2006 9:22 PM (GMT 0)

LOL  Im guessing that some guy laying in a hospital after a "lizard bite" had some doctor order a blood screen and VOILA...his blood sugar was droping through the floor.  The rest is history as some bright junior lab assistant found this out and .......Byetta!!!

And don't be so envious...Im one of the few people that hasn't been sick as a dog for months with this stuff.  Its amazing, but tends to make everyone want to toss their cookies!!

scool Warren
Posted 1/4/2006 12:13 AM (GMT 0)
Dear Warren add Jeannie,
i live in the southern part of India where "rice"is still the staple diet;it converts to 76% carbs per 100 grams and my people don't cook protein -rich food as the main meal,hence the need for acarbose.Also off-the shelf foods are a new phenomenon here,so very little choice.I read somewhere that the Gila monster can turn off it's pancreas when it's hibernating!No such luck for us.
sharer
Posted 1/6/2006 3:40 AM (GMT 0)
Coming back to my original question of afternoon blood glucose readings,can anybody tell me their afternoon readings compared to morning and night(or evening) readings.The afternoon values concern me the most.Please reply!
sharer
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