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Re: [IPk] Re: ip-uk-digest V4 #131



Hi Melissa,

I was thinking that the OP was sounding surprised by the high A1C, maybe
because the readings seen on the meter seemed good, so maybe the unmonitored
overnight was causing problem to a large degree.B  The ref you supplied seems
also to agree (for the stated A1C):

<quote>
Both FPG and postprandial PG values contribute to the A1C value. When
the A1C values are higher (>>8.5%),the major contribution is from
the FPG levels, but as the A1C value approaches the target value of
b	$7.0%,there is a greater contribution from the postprandial PG values.
<quote>

Iain.

--- On Wed, 6/7/11, Melissa Ford <email @ redacted> wrote:
Hi Iain

Recent reearch has shown that for most people, postprandial glucose
levels make a much greater contribution to A1c than overnight bgs.
Here's how that works: if your blood glucose is (say) 9 mmol/L when
you wake up, 12 mmol/L for 3 hours after breakfast (until lunch, then
(say) 13 mmol/L for a few hours after lunch (until dinner), then you
get it down to 10 mmol/L before you sleep, you've spent the whole day
with 10-15 mmol/L blood glucose levels (assuming that you have a spike
just after the meal, before before settling down to 12/13 mmol/L for a
couple of hours.)

If you think about it, daytime is when your blood sugar has more
opportunities to go up from
stress and food. If a person exercises regularly and chooses to get
his or her bg up to 10-12 mmol/L before the workout, the body still
"reads" that as hyperglycaemia even if the person calls it "hypo
prevention".

Dawn phenomenon can of course cause bgs to rise overnight, from about
3 to about 6/7 am, but 4 hours of hyperglycaemia a day and target
values the rest of the day still gets a person to an A1C of around 7%
according to paediatric research at Stanford (looked for the info
online and couldn't find it quickly, will try to track it down). The
8.9% that J's experiencing is probably driven at least to some degree
by postpranial hyperglycaemia.

The research summarised in this article regarding the contribution of
postprandial hyperglycaemia to A1C values was conducted in type 2s,
but the findings have spurred similar research in type 1 (much of
which is in progress, but it stands to reason that the results won't
be wildly different) :
http://www.theberries.ca/FALL2008/Understanding_HbA1c.html

Cheers

Melissa
.
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