One hour or two hour postprandial?

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One hour or two hour postprandial?


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Old 01-29-2011, 03:13   #1
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Default One hour or two hour postprandial?

Can anyone explain the difference and why different people are told to test at different times?

Someone on another board mentioned recently it was the spike at one hour that is most important... but I've always been told to test at two hours, and I've been doing this off and on for 8 years.

My two hour numbers are always 70 to low 100s... just to see, I've tested at one hour a couple times and my highest is after breakfast... when I had eaten well, it was 140 at one hour and 92 at two hours - and today I had a 1/2 a fast food chicken biscuit and it went to 170 at one hour but was 98 at two hours. My one hours for all other meals and snacks were under 120. And this is the first fast food breakfast I've had in probably 6 months, so it's not something I do on a regular basis.

Just curious as to what the difference is... is two hour all that matters, or should I be conscious of what my one hour is as well?

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Old 01-29-2011, 03:21   #2
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In my opinion, the spikes do matter. I try to keep mine under 140 at all times. If that's when, as the studies have shown, the higher levels start causing damage to our kidneys/retinas/fingers & toes, then I want to do everything I can to prevent going over 140.

So that's the reason: the 1-hour interval tells you how high you spiked on whatever you ate. The 2-hour interval tells you if you're dropping back down to the pre-meal level, but if you aren't testing before you eat, then you're missing some information, because you won't know the exact size of the spike.

JMO . . .

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Old 01-29-2011, 03:29   #3
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I'm still new to all this, but I also test any new food I eat at both 1hr and 2hr, and sometimes at a 4hr also.

As Shanny said, keeping it under 140 (about 7.8 for the non-USA folks) at all times is important. If a food spikes you to 170 that's pretty high and can certainly cause some damage. Also, the higher the spike the more your body has to work to try to manage it (or if insulin-dependent, the more insulin you'll require).

All food for thought.

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Old 01-29-2011, 03:36   #4
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Okay... makes sense. I don't know why one hour testing has never been suggested to me before. The 170 was a one time thing, I cut it in half, knowing the full thing would be too much, esp in the morning. But I don't eat that stuff regularly... and one spike shouldn't be that worrisome, it would be if I did that on a regular basis (right?).

All but that one 1-hour results have been under 140, and it's only that high in the morning. After snacks, lunch and dinner, my 1-hour is under 120.

It would be great to have a running record of my number at all times, just not feasible - those strips add up. I have tested before I eat sometimes, just out of curiosity, and it's always been 80-90.

I did do an hour by hour play by play yesterday and my numbers are pretty even through the day, though I did get low before lunch with a 63.

So overall I think I'm doing pretty well... good to know

Thanks!

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Old 01-29-2011, 05:37   #5
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You have the right idea. Spikes will and do happen, even to the most diligent. It is keeping the spikes down to a minimum that is important.

You have found that the 2 hour test is great, so concentrate on the 1 hour after eating. Shanny is correct that knowing the premeal blood glucose level is important. Then you will know how much of a spike you get, and this will tell you whether you need to reduce the portion size or consider eliminating some foods.

Most medical insurance companies are getting more stringent in allowing testing two times per day for Type 2's on oral medication. Some doctors are good in that they will argue with the companies to get you extra strips for a few months to allow your to test until you are more comfortable.

Good luck.

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Old 01-29-2011, 15:45   #6
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When I was dx'd my doctor told me testing was purely optional for a Type 2. I am so glad I found these forums where people taught me the correct times to test. I normally do a 2 hour test and am around 110-120. Last week I had one of those free HbA1c's at a local store. It was a lot higher than my bg average. So I started testing at 1 hour. I noticed spikes of 145-155 at one hour, so now I have cut back on certain foods. Some people will tell you spikes don't matter but in my case I think they do. So now I try to vary testing. I also throw in a 3 or 4 hour every once in awhile to make sure I don't get a delayed spike.

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Old 01-29-2011, 17:07   #7
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If a one-hour spike was high but came down promptly, would you still worry? I'd be inclined to think my body was handling it properly and not be concerned.

Two-hour postprandial testing - I did some research. Sorry if I've already posted this.

Postprandial Blood Glucose

1. American Diabetes Association

* ADA, American Diabetes Association
* CVD, cardiovascular disease
* DCCT, Diabetes Control and Complications Trial
* FPG, fasting plasma glucose
* MPG, mean plasma glucose
* OGTT, oral glucose tolerance test
* PPG, postprandial glucose
* PPGE, postprandial glucose excursion
* UKPDS, U.K. Prospective Diabetes Study

Individuals with diabetes are at increased risk of developing microvascular complications (retinopathy, nephropathy, and neuropathy) and cardiovascular disease (CVD). The Diabetes Control and Complications Trial (DCCT) (1) and U.K. Prospective Diabetes Study (UKPDS) (2) showed that treatment programs resulting in improved glycemic control, as measured by HbA1c, reduced the microvascular complications of diabetes. The effect of these treatment programs on reducing CVD was less clear. However, some epidemiological studies suggest that there may be a relationship between glycemic levels and CVD.

In the management of diabetes, health care providers usually assess glycemic control with fasting plasma glucose (FPG) and premeal glucose measurements, as well as by measuring HbA1c. Therapeutic goals for HbA1c and preprandial glucose levels have been established based on the results of controlled clinical trials. Unfortunately, the majority of patients with diabetes fail to achieve their glycemic goals. Elevated postprandial glucose (PPG) concentrations may contribute to suboptimal glycemic control. Postprandial hyperglycemia is also one of the earliest abnormalities of glucose homeostasis associated with type 2 diabetes and is markedly exaggerated in diabetic patients with fasting hyperglycemia.

Several therapies targeted toward lowering PPG excursions are now available and have been shown to improve glycemic control as measured by HbA1c. However, many questions remain unanswered regarding the definition of PPG and, perhaps most importantly, whether postprandial hyperglycemia has a unique role in the pathogenesis of diabetic complications and should be a specific target of therapy. To address these issues and to provide guidance to health care providers, the American Diabetes Association (ADA) convened a consensus development conference on 24–26 January 2001 in Atlanta, Georgia.

A seven-member panel of experts in diabetes, endocrinology, and metabolism heard selected abstracts and presentations from invited speakers. The panel was then asked to develop a consensus position on the following questions:

1.

How is PPG defined?
2.

What is the relationship among PPG, FPG, and HbA1c?
3.

What is the contribution of PPG to the long-term complications of diabetes?
4.

Under what circumstances should people with diabetes be tested for PPG?
5.

What are the benefits and risks of specifically lowering PPG in an effort to achieve better glycemic control?
6.

What additional research needs to be performed to clarify the role of PPG in the medical management of diabetes?


Next Section
QUESTION 1: HOW IS PPG DEFINED?

The word postprandial means after a meal; therefore, PPG concentrations refer to plasma glucose concentrations after eating. Many factors determine the PPG profile. In nondiabetic individuals, fasting plasma glucose concentrations (i.e., following an overnight 8- to 10-h fast) generally range from 70 to 110 mg/dl. Glucose concentrations begin to rise ?10 min after the start of a meal as a result of the absorption of dietary carbohydrates. The PPG profile is determined by carbohydrate absorption, insulin and glucagon secretion, and their coordinated effects on glucose metabolism in the liver and peripheral tissues.

The magnitude and time of the peak plasma glucose concentration depend on a variety of factors, including the timing, quantity, and composition of the meal. In nondiabetic individuals, plasma glucose concentrations peak ?60 min after the start of a meal, rarely exceed 140 mg/dl, and return to preprandial levels within 2–3 h. Even though glucose concentrations have returned to preprandial levels by 3 h, absorption of the ingested carbohydrate continues for at least 5–6 h after a meal.

Since people with type 1 diabetes have no endogenous insulin secretion, the time and height of peak insulin concentrations, and resultant glucose levels, are dependent on the amount, type, and route of insulin administration. In type 2 diabetic patients, peak insulin levels are delayed and are insufficient to control PPG excursions adequately. In type 1 and type 2 diabetic individuals, abnormalities in insulin and glucagon secretion, hepatic glucose uptake, suppression of hepatic glucose production, and peripheral glucose uptake contribute to higher and more prolonged PPG excursions than in nondiabetic individuals.

Because the absorption of food persists for 5–6 h after a meal in both diabetic and nondiabetic individuals, the optimal time to measure postprandial glucose concentration must be determined. Practical considerations limit the number of blood samples that can be obtained. In general, a measurement of plasma glucose 2 h after the start of a meal is practical, generally approximates the peak value in patients with diabetes, and provides a reasonable assessment of postprandial hyperglycemia. Specific clinical conditions, such as gestational diabetes or pregnancy complicated by diabetes, may benefit from testing at 1 h after the meal.

http://care.diabetesjourn...rg/content/24/4/775.full

************************

But how long after a meal should you test? And do you start counting from when you start eating or when you finish?

A lot of people with diabetes are confused about this. But it is for questions like these that the American Diabetes Association and other organizations have developed guidelines, position papers, and consensus statements.

The American Diabetes Association's Consensus Statement on Postprandial Blood Glucose concludes that generally we should test two hours after the start of a meal (and women with gestational diabetes or pregnancy complicated by diabetes could benefit from testing after one hour). Testing two hours "after the start of a meal is practical, generally approximates the peak value in patients with diabetes, and provides a reasonable assessment of postprandial hyperglycemia."

Because of this, we should shoot for a target level of under 140 two hours after eating, says the American College of Endocrinology Consensus Development Conference on Guidelines for Glycemic Control. This panel says that people who don't have diabetes generally peak about an hour after the start of a meal and rarely exceed 140 mg/dl.

While some people still prefer to test one hour after starting a meal, most prefer to follow the guidelines. The best thinking in my view came from Helen, who wrote on a diabetes mailing list, "If I aim for pre-meal levels to occur an hour after eating, I chance going low two hours postprandial and for sure three hours postprandial. My blood glucose level tends to decline from hour two to hour three. Therefore I do not test one hour postprandial—there is nothing I would do with that information other than aggravate myself."

Guidelines for Testing and Everything

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Old 01-29-2011, 18:13   #8
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Your own testing shows that your highest peak is closer to one hour than two. If the reason for your testing is to know how high that meal pushed you then you need to test at 1 hour. Since my rule is "never over 140", I am testing for the highest peak - so 45min to 1 hour after the first bite. In iffy cases or new foods I test again at 1.5 hours and possibly 2 hours as well since certain foods or combinations of foods do create a delayed spike.

The ADA advice allows you to spike as long as it comes back down within the 2 hour time frame. If you wait 2 hours to test then you are testing for your body's ability to bring the spike down. Many of us do NOT follow the ADA advice on this. We simply won't further risk our health by allowing the spikes to occur. Testing only at 2 hours allows you to be above the damage line for an hour or so every time you eat - potentially 5-6 hours a day at a level that can hurt you.

Each person needs to decide for themself how well they want to control it - not the ADA, not the doctor, not the diabetes educator. This is your decision. If you develop complications will it make you feel better to say "Not my fault, I followed the advice of...". I suggest reading Blood Sugar 101 to help you decide on the right way for you.

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Old 02-03-2011, 02:21   #9
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Okay, I am seeing both sides. Part of me thinks as long as you are able to bring that number back down quickly, then that's what is important... but if you're saying being over 140 AT ALL is dangerous... gosh, like I need more stress? LOL

So, I guess my next question is this: If my two hour numbers are usually in the 70s... would it be "safe" to further restrict my carbs so that my one hour numbers are lower? I would think that if I did that, I would be crashing at two hours after every meal.

So if I'm going 75 --> 142 --> 79 every two hours, that doesn't seem like it's healthy according the info you guys have posted. What the heck do I do?

Now, not ALL of my one hour numbers are up at the 140 level... a good portion of them are under 120... so I guess that's a healthier "spike"

Color me confused...there's just so much to try to understand. Took me years to figure out my thyroid and I still get confused with that. LOL

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Old 02-03-2011, 02:31   #10
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I also try to not go over 140 at all, but if that's about where you top out & then you drop right back, I don't see how that's terribly dangerous, especially considering all the hormones charging around in your bloodstream right now. The jumping-off place of 140 is more like you don't want to go above that very often, and you don't want to stay there very long. Studies DO show that damage begins to occur about that level. Research Connecting Organ Damage with Blood Sugar Level

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