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RE: [IP] CGMS and reasonable post prandials

JAMA  Vol. 295 No. 14, April 12, 2006
Activation of Oxidative Stress by Acute Glucose Fluctuations Compared With
Sustained Chronic Hyperglycemia in Patients With Type 2 Diabetes

Conclusions:  Glucose fluctuations during postprandial periods and, more
generally, during glucose swings exhibited a more specific triggering effect
on oxidative stress than chronic sustained hyperglycemia. The present data
suggest that interventional trials in type 2 diabetes should target not only
hemoglobin A1c and mean glucose concentrations but also acute glucose


John S Wilkinson, 
Rome, New York

-----Original Message-----
From: email @ redacted
[mailto:email @ redacted] On Behalf Of Bob Kerns
Sent: Monday, July 17, 2006 8:32 PM
To: email @ redacted
Subject: RE: [IP] CGMS and reasonable post prandials

 How high should our peaks be? As low as possible. Even if the peaks do no
more harm than their  impact on your A1c, reducing your variability will
allow a beter A1c without increasing your risk of hypoglycemia.

"Close to 400" is high.

 Anyway, the technique you describe -- using a lowered temp basal, and
taking that insulin as an immediate bolus -- has a name: Superbolus. It
really does help.

-----Original Message-----
 From: email @ redacted
[mailto:email @ redacted] On Behalf Of
Susan Fisher
Sent: Monday, July 17, 2006 15:10

What are we to expect as our PEAK after eating?

The ADA guidelines are for 2 hrs after eating.

I want to know what you think is a reasonable number 30 m to 1 hr after 

I fear that THIS is where my bad a1c's lie :( 

My dexcom has proved my basals accurate to slightly overagressive 
(downward trends) while fasting.   My overnights are rock stable.   
Everything is stable.

But if I eat more than 30 g at a meal, I skyrocket to close to 400... 
but am of course back in range by the 2 hr to 3 hr point.  

I never imagined my peaks were that bad :(

I see symlin in my future :( bah!   For now, I am bolusing 30 m. prior 
to eating.   Next step is to bolus extra and temp basal LOWER after 
eating (attack the peak with a little extra, but don't crash 2 hrs 
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