In need of help navigating life with diabetes? You backside always Ask D'Mine! Yep, our weekly Q&A column by veteran type 1 and diabetes author Wil Dubois is here for you.

High blood sugars (aka hyperglycaemia) induce not-so-pleasant feelings and can be a suicidal when they tiptoe toward possible diabetes ketoacidosis (DKA). Today, Wil dives into a question pool on why even short-lived after-meal spikes can exist a big deal than you mightiness think.

{Got your own questions? Email us at AskDMine@diabetesmine.com }

Jeremy, type 2 from Arkansas, asks: Why is it so bad if your blood sugar spikes two hours after eating if you dumbfound IT rachis down to where IT's conjectural to beryllium in 3-4 hours? What's the big wheel? I cerebration what counted the most was not how high it went, only how much clip it spent up in the stratosphere. Am I wrong?

Wil@Ask D'Mine answers: The truth is, you could cost right that it's no big shot at all. Or, you might be playing Russian Toothed wheel with alone unitary empty sleeping room, instead of only when one smoke.

Here's the plow: You, Pine Tree State, and everybody else in the D-family are caught in hard, changing multiplication. The present-day methods of treating diabetes are being questioned by some really smart people, piece simultaneously, some other really stylish people are sceptical those doing the wondering. Everything may be about to alteration. Operating room perhaps not. But if it does, it wouldn't be the first time. Consider this: Everyone knows that too high descent shekels is hopeless. But it wasn't all that long since that no one knew that. The connection between high sugar and diabetes complications was discovered only 26 years ago. I mean, obviously, many folks suspected there might make up a connection before that, but the science just wasn't there to back IT up.

That all changed with the Diabetes Control and Complications Trial, the famous DCCT. What the DCCT looked at was the effects of, essentially, trying harder. At the time, the gold standard for diabetes treatment—and this was for type 1s—was not to die. Advisable, not to die too earlyish, anyway. Standard treatment at the time was a couple of intermediate-set out insulin shots a day, and using a piddle glucose tryout kit American Samoa a procurator for understanding what the overall rip sugar levels might equal. DCCT compared that to what is immediately today's gold standard: Basal/Bolus multiple unit of time injectant with a newfangled twist called a fingerstick meter to attempt to keep in blood lettuce at "normal" levels.

The results of this new understudy therapy were then heavy that the meditate was stopped-up early, and the volunteers in the ascendence group—those exploitation the standard treatment of the day—were shifted to the new more intensive treatment, because it was judged as dishonorable to livelihood anyone in the control group.

Scientific discipline had come a long way since the infamous Tuskegee experiment.

The rest, American Samoa they say, is history. The study changed diabetes treatment oecumenical. That was great. Many lives were greatly built and others, candidly, were redeemed by the search and the shift to more intensive treatment. The DCCT besides created our current treat-to-A1C culture: Using whatever combination of meds—for both eccentric 1 and case 2 diabetes patients—to drag average blood sugar below a zone consider "safe."

And where would that be? Healthy, for perspective, folks without the Big D typically have A1C levels below 5.7, and complications seem to be a bigger issue above 9, so it stands to reason out that PWDs (people with diabetes) should represent somewhere in betwixt. This number—usually between 6 and 7—has been a kinetic objective all over the years, simply that's beside the point for nowadays's discourse. What's not beside the degree is that every bit intensive handling took hold, clinicians started noticing something odd: PWDs with identical A1Cs were not faring the same. Many folks with, say, A1Cs of 6.8 where thriving; piece other folks with A1Cs of 6.8 were falling apart at the seams.

Huh?

Clearly, there was much to the picture than just average glucose plumbed by the A1C. Just what was information technology? Well, equitable as the fingerstick meter in the 1990s helped shed new light on blood glucose, a new engineering would reveal one of these days more newfound secrets concealment below our skins. The Second Coming of Christ of continuous Glucose Monitoring (CGM) gave researchers the next level of understanding: Equal A1Cs are created by widely different inputs. Actually, we all have intercourse this instinctively: You can get 100 by averaging 75 and 125; or you can get 100 by averaging 50 and 150. The results are the synoptical, but how you got there couldn't be Sir Thomas More divers. No one had thought a great deal about that before, when it came to blood glucose, until CGM came along and successful it obvious.

Once CGM (continuous glucose monitors) became a tool in the workshop of clinical research, IT was clear that some the great unwashe's line of descent sugar took some pretty wild rides compared to other people's. And then how did these unfounded rides, these excursions, fit into the picture of diabetes complications? Could that atomic number 4 the explanation as to why some PWDs were doing worsened than others?

Some clinical researches thought and so. Others didn't.

As you might expect, thither's been no shortage of disagreement on this subject over the in conclusion a couple of years; with the largest issue not organism indeed much if glucose variably is the smoke torpedo in increased complication risk, just what kinda variability increases that risk. Some distinguished scientists support the some-excursion-is-a-bad thing belief. Others, that the daily ups and downs are harmless, but that yo-yo A1Cs are the ogre.

If our best eggheads can't figure it out, I doubt that I can, either. In retention an open mind, course, both could be true.

When was I basic diagnosed with diabetes, I was told it was a game of averages: Keep your A1C in a safe blank, and you get to keep your eyes, kidneys, and toes. Spikes were no more big gun. Then again, I started noticing something: Excursions made me feel like crap. If I made the (common and tardily) mistake of partaking in excess carbs, I paid for IT. A my Dexcom squawked at me and flashed two arrows up, my muscles ached, my energy plummeted, I was irritable. Likewise, if I hammered the high down with a rage bolus and found myself in free-light, I paid a carnal price once again.

To me, it was clear that if I could experience rapid swings physically—like the punches of a prize fighter pummeling Maine—it conscionable couldn't be a upstanding thing for my body. And IT didn't demand often resourcefulness for me to think that getting the shit kicked away of Maine by a booty fighter on a diarrhoeic basis could lead to close to lasting damage.  I remember that the first time I understand about the excursion hypothesis, I was nodding my psyche as I tilled through the words, Yeah, that sounds about right.

But that's not to diss the yo-yo possibility, either. The human body doesn't like change much, and I can see where nerve-racking to force IT to adjust, re-adjust, and ray-re-adjust to changing average sugar environments could constitute corrosive as considerably.

Time and science will work the resolution. I have trust in that. But what are we to cause meanwhile while we wait for diabetes' latest secrets to be revealed? If you want to feeling at this equally a war, we need both a strategic vision and tactics to win. As a scheme, get your A1C into the current best-guess target zone, and do what you can to keep it there. Then, tactically, consider one day at a time and do what you fanny to minimize those nasty little excursions.

And if you don't like military analogies, think of this approach arsenic hedging your bets.

This is not a health chec advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-on that point-through-that knowledge from the trenches. Bottom Line: You still need the guidance and fear of a licensed medical professional.