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

Hi Iain

I should have qualified that reference with the context that while FPG
makes a proportionally large contribution to A1Cs above 8.5%, the
persistent foundation of the high A1C is revealed to be postprandial
as you chip away at the FPG and get closer to 7. So while it's
important to resolve FPG and that may be achieved through refining
overnight and early am basal rates, the postprandial glucose levels
still need to be addressed.

In terms of priority, resolving high FPG may take weeks of overnight
basal rate testing (a person can reasonably be expected to wake up
several times in the night just a couple of nights in one week, so it
may take several weeks to get the basals straightened out). A week of
seven-point glucose profiles can be a quick way  to identify daytime
excursion patterns and it's perhaps quicker to iron out daytime basals
through testing basal rates during waking hours as well.

Both FPG and postprandial glucose need to be addressed, it's just a
question of in which order.

Does that make sense?


On Wednesday, July 6, 2011, Iain Jenkins <email @ redacted> wrote:
> 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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