So what is the basic recommendation here?
Eat meat, nuts, vegetables, no starch, no fruit? A ketogenic diet?

It looks like the recommendation is to avoid blood sugar spikes primarily. I would think that insulin is less of a worry because insulin doesn't necessarily mean that sugar is in the system (dairy for example).

Some clarification would be greatly appreciated. Thanks

Dr. Davis, my husband has the opposite problem, can you (or anyone else) explain it?  His 1-hour postprandial glucose never exceeds 90 and yet he has an HBA1C of 5.9.  We have checked his glucose at different times and it never goes over 100.  He is on a very low carb diet.  

His HBA1C indicates an average blood glucose of 123, but we never see readings this high.  Is there something else that can glycating hemoglobin and thus show an elevated HBA1C reading?

What would be considered an optimal (or at least good) HbA1c level? And same for fasting glucose?

I have noticed my fasting glucose tends to vary, between 80-95, with my HbA1c at 4.6.

Curious also if there is any data on HbA1c correlating directly with triglyceride levels.

My own trig values are higher than I like, around 125-150, yet I limit carbs, use fish oil, and think my HbA1c number is relatively decent.  So wondering if carbs/glucose isn't my problem, what else raises triglycerides?

Dr Davis, do you have any recommendations on blood glucose test meters, as far as brand/model? Also, I'd prefer something that doesn't require a prescription, if possible.

Anon--

The only two causes I am aware of are 1) iron deficiency anemia, and 2) hemoglobin variants.

Also, are you confident of the accuracy of your blood glucose meter? You can check it by running side-by-side glucoses with a blood draw.

I've had good experiences with One Touch Ultramini, Aviva, Relion, and Accuchek meters. All are available without prescription.

This is exactly why everybody should have a blood glucose meter, and know their numbers.

While I have not been diagnosed as having type 2 diabetes, I was darned close.  My meter, and the information found here and in the blogs that link to and from it, have helped me to lose about 3 pounds per week for the past 6 months, and not be hungry or feel deprived.

I was like Jonathan.  Until 6 months ago my fasting glucose was always under 100.  Now that I am managing to keep my average BG reading, including post prandial readings, under 95, I have stopped suffering from the inflammatory symptoms I've had for a decade.

My meter and initial 100 test strips was the best under $50 purchase I've ever made.

Thanks for the USEFUL information I get at The Heart Scan Blog.

Hi All. I eat a low carbs diet and I have the a high fasting glucose, 95-105, but a low postprandial, 85-100.

I also exercise everyday and do Intermittent Fasting.

What could be the mechanism working here?

Thanks for your ideas.

Alfredo E.

David Mendosa has a good blog/site/comments... on diabeties for many things A1C, food, low carb, etc. Check him out at www.mendosa.com
Look under "health central" or

http://www.healthcentral.com/diabetes/c/17/75106/david-guide-a1c-6-0

For A1C guidance.

He seems to lean away from strict AHA, ADA, and government things that do not work for him.

His meter data is getting a little dated, and he does not specify exact things like he states vitamin D, as opposed to stating: D3. And he seems to be a little soft about major statements, possible law suit shy.

I'm curious why you believe that gaining control over postprandial glucose will result in lower *fasting* glucose.  Is there a mechanism for this?  I've found that my fasting glucose hasn't fallen since I started the TYP diet 3 months ago; it's still in the mid to high 90s -- even though my one hour glucose is rarely much higher than that.

Responding to Dr. Davis' comment:
"The only two causes I am aware of are 1) iron deficiency anemia, and 2) hemoglobin variants.

Also, are you confident of the accuracy of your blood glucose meter? You can check it by running side-by-side glucoses with a blood draw."

I don't think he has iron deficiency anemia unless high ferritin level indicates that?  His ferritin level was 320 at the time he got the HBA1C of 5.9.  What are hemoglobin variants?

We have the Accuchek meter and have also had fasting and post-prandial lab tests done and the meter seems to be in the ballpark.

Thank you very much for your reply.

My fasting was below 100. My A1C was 6.5. A OGTT spiked at 202. My doctors told me as long as my fasting BG was good, I did not have to worry as I only had insulin resistance not diabetes. That was 10 yrs ago.

A year ago I bought a glucometer and started eliminating foods that spike my BG. My last A1C was 5.5.

I wish I could get a hold of the results of my OGTT from 40 yrs ago. I was told it was slightly abnormal but I did not have diabetes. How much damage has been done from elevated postprandial blood sugars?

Dr. Davis,

Would you anticipate that a healthy 25 year old would obtains similarly high postprandial sugars to those meals?  Or do young, healthly, slim people have high glucose tolerance, and hence low postprandial responses to sugar?  I've seen many articles featuring sports stars who subsist on high carb, low fat diets, such as rafael nadal, roger federer, tiger woods... I find it hard to believe they exceed 120 mg/dl postprandially...

David

Please help with an explanation ! My last meal of the day (with NO carbs) is around 4PM. At 9-10PM, my glucose test shows about 100-105. But... in the morning the test shows 125-130. How is it possible?!

Veeerrrrry interesting!

I have been on an extremely resrricted carb diet for several months.  My One Touch (and my wife's, she's T1 on a pump) my glucose levels never vary from 100-120 with the vast majority right around 110-113. Tests are run about once a day at various times including 1-2 hours post prandial.

At my PCP's office (she's also an endocrinologist) today, her office machine complained of an HbA1C of 20+ and wouldn't give a reading, while it did report my other lipid levels, most moderately elevated as usual.

Tubes were drawn for processing by a lab.  Of course it's the weekend and I'm obsessing about it... sigh.
I worry that my low carb lifestyle might be masking what would be high glucose readings which is not very logical, or if something is wrong with my blood such as anemia.  A quick google and here I am.

I wonder if this is common for extremely low-carber diabetics?

Am on low doses of Diovan, HCTZ and colchicine...

Thanks to all for any thoughts.
-Ron

Thanks to all who commented ;)

Lab work came back with an HbA1C of 5.9, so the office machine was just being stupid as hoped/mostly expected.

Good luck to everyone else.

This MedScape article doesn't make sense.  It claims that <6 may be too low...That >7 has a better all cause mortality.
http://www.medscape.com/viewarticle/720391

FYI, another possible cause of abnormally high HbA1c is Vitamin B12 and/or folate deficiency.  This causes anemia with low red blood cell turnover, so any given Hb molecule is floating around longer, and thus has a higher probability of glycation.

So.. I just started testing my blood sugar again today... first reading was 90
Then I had lunch. Rice and curry with coconut milk (probably loaded with sugar) and it went from 156 to 258 to 124 in 2.5 hours after that meal... I am a little concerned.

Think I will go back on my low carb diet ASAP!

Let me correct my numbers... I didn't have them in front of me when I wrote the previous post so here they are:

Lunch was Rice, shrimp, coconut milk based curry pot

Blood levels:
60 min after - 193
90 min after - 217
130 min after - 258
2.5 hrs after - 140

This morning I had a reading of 89 and after having my protein shake with cream and water it was 106...

Def going to go back to my low carb diet asap!
Thanks for a great blog full of valuable information and help to get back on track.

This is a recent day of testing. 90 minutes after eating 50 grams of processed brown flax, my BG was about 117, but it also depends on what I eat the night before. 2 hrs after eating 8 oz hummus with tahini, my BG was 101. 1 hr after eating a 143 gram (quick rolled) oat cake with 95 grams chocolate syrup with a lot of sugar and water, my BG was 120. Next day fasting BG was 120. Carbs do a good job of BG stabilization, although I'm trying to decrease some carbs and lower my fasting BG. I will try soymilk, and less carbs.

Hi, Let me add my 2Cs. The objectives for diabetics and pre-diabetics are poles apart and confusing the two can  lead to irreparable loss for the pre-diabetics and those with insulin resistance.  

For diabetics, when the disease is well established, the focus is on minimizing the harm i.e. to minimize the blood sugar level. Elevated blood sugar does so much harm in the long run that it should be kept under control through any means possible: diet, exercise, medicine, weight loss etc. When one plan and/or drug regimen fails to control the blood glucose level, it is replaced by another, all the time focusing on maintaining optimum blood glucose levels resulting in normal (for diabetics) readings on fasting glucose, HbA1C etc. I am not fully aware but possibly there is no mainstream healthcare regimen or drug that focuses on  reversing the disease or trying to minimize diabetes damages (other than those caused by high blood glucose) like destruction of pancreatic cells.

For pre-diabetics and those with insulin resistance, the focus should NOT be on lowering blood glucose level DIRECTLY. For pre-diabetes, it is possible to keep on "travelling" towards diabetes in reality but assuming otherwise just because some "local" interference does not let the blood sugar rise. So if you start taking any alpha-glucidase, your postprandial reading will not rise much. But this does not mean that you have controlled pre-diabetes. The causes are all there like being over-weight, lack of exercise bla bla. And your body's normal ability to regulate blood sugar keeps on deteriorating ultimately leading to a point when the alpha-glucidase alone will not be sufficient. So when pre-diabetes is treated like diabetes, it can lead to actual diabetes. This is because here the focus should not be on lowering blood glucose levels or "treating" the condition but REVERSING it. In other words the goal should be to transform the body back to the point where it can naturally process the foods while keeping the blood glucose levels and HbA1C levels in normal range. All this without the help of any drugs or special diet or aids. And for this the usual solutions are already well known: weight-loss, exercise etc.

The moral of the story is that if you are pre-diabetic, you can keep yourself happy by eating almonds, vinegar or psyllium with meals to "show" you that your post-prandial glucose levels are in range. This can be done by eating a low-carn diet or taking diabetes drugs. But if keep the same weight, continue the same eating habbits, and do no exercise then you are possibly doing nothing to prevent a preventable disease.

Hi, Let me add my 2Cs. The objectives for diabetics and pre-diabetics are poles apart and confusing the two can  lead to irreparable loss for the pre-diabetics and those with insulin resistance.  

For diabetics, when the disease is well established, the focus is on minimizing the harm i.e. to minimize the blood sugar level. Elevated blood sugar does so much harm in the long run that it should be kept under control through any means possible: diet, exercise, medicine, weight loss etc. When one plan and/or drug regimen fails to control the blood glucose level, it is replaced by another, all the time focusing on maintaining optimum blood glucose levels resulting in normal (for diabetics) readings on fasting glucose, HbA1C etc. I am not fully aware but possibly there is no mainstream healthcare regimen or drug that focuses on  reversing the disease or trying to minimize diabetes damages (other than those caused by high blood glucose) like destruction of pancreatic cells.

For pre-diabetics and those with insulin resistance, the focus should NOT be on lowering blood glucose level DIRECTLY. For pre-diabetes, it is possible to keep on "travelling" towards diabetes in reality but assuming otherwise just because some "local" interference does not let the blood sugar rise. So if you start taking any alpha-glucidase, your postprandial reading will not rise much. But this does not mean that you have controlled pre-diabetes. The causes are all there like being over-weight, lack of exercise bla bla. And your body's normal ability to regulate blood sugar keeps on deteriorating ultimately leading to a point when the alpha-glucidase alone will not be sufficient. So when pre-diabetes is treated like diabetes, it can lead to actual diabetes. This is because here the focus should not be on lowering blood glucose levels or "treating" the condition but REVERSING it. In other words the goal should be to transform the body back to the point where it can naturally process the foods while keeping the blood glucose levels and HbA1C levels in normal range. All this without the help of any drugs or special diet or aids. And for this the usual solutions are already well known: weight-loss, exercise etc.

The moral of the story is that if you are pre-diabetic, you can keep yourself happy by eating almonds, vinegar or psyllium with meals to "show" you that your post-prandial glucose levels are in range. This can be done by eating a low-carn diet or taking diabetes drugs. But if keep the same weight, continue the same eating habbits, and do no exercise then you are possibly doing nothing to prevent a preventable disease.

I have a 16 year old daughter who HBA1c is 11.7 (yes very high).  I have been working with her especialist to bring it down.  The problem is her daily readings are normal for a type 1 diabetic. I know the monitors can be cheated however I am pretty confident that most of the time she does the right thing.  I also know that sometimes she does not.  However I am wondering if there are any other things that can cause this annomoly?

Thanks for subjecting yourself to these experiments!  Very interesting.  I have a friend who reacts poorly to wheat but tolerates spelt.

Wheat is eaten everywhere in the world. I'd hope GM crop scientists design a variety which can solve this problem.

If I am not mistaken, corn is also the result of the domestication of wild grasses existing some 8,000 years ago. Fooling with mother nature put us on a collision course with consequences.

My concern is that the body could be reacting without symptoms. Could  these ancient grains cause inflammation even though there is no obvious reaction? I have lived 7 years without gluten and have no desire to add it back to my diet. Before I eliminated gluten I was very ill. It is not worth the risk to me.

Dr. Davis,

In your experience, in terms of small LDL and the like, what's better: a high peak of 150 that's brought down relatively quickly or a lower peak, but extended over a longer duration?

Thanks,
David

Anne--

Please don't interpret these casual observations to mean that we should eat einkorn.

My goal with this little experience is to gain an understanding of where along the way of wheat's 10,000+ year human consumption history did things go wrong.

It seems to me that humans could have gotten away with eating einkorn much more freely, with fewer health problems than with modern wheat. I still would like to know where the extreme adverse effects were acquired, however. I suspect this occured in the 1960s and 1970s with the hybridization experiments conducted in Mexico. more on that later.

Anon--

No data. I suspect that the high peak is worse, but that is based on no formal data.

FODMAPs comprise a monosaccharide (fructose), a disaccharide (lactose), oligosaccharides (fructans and galactans), and polyols.

In one study, as obese people lose weight, the balance between the Firmicutes and the Bacteroidetes changes - the latter increasing in abundance as an overweight person gets slimmer.

Fructans, found in wheat, are fermented by bacteria in the large intestine into short chain fatty acids.


Besides human metabolism, the digestion of wheat is also affected by how it is metabolized by the particular intestinal flora inhabiting a person.


Sources:

Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach

An obesity-associated gut microbiome with increased capacity for energy harvest


Food tables: fructose



Fructose in the diet appears to be even more dangerous in the presence of trans-fats.


Source:

High Levels of Fructose, Trans Fats Lead to Significant Liver Disease, Says Study

"The investigators found that mice fed the normal calorie chow diet remained lean and did not have fatty liver disease. Mice fed high calorie diets (trans-fat alone or a combination of trans-fat and high fructose) became obese and had fatty liver disease.

"Interestingly, it was only the group fed the combination of trans-fat and high fructose which developed the advanced fatty liver disease which had fibrosis," says Dr. Kohli. "This same group also had increased oxidative stress in the liver, increased inflammatory cells, and increased levels of plasma oxidative stress markers.""

Your experience with einkorn and emmer is interesting. They do not seem to cause you the problems that wheat does, and that evidence supports the theory that they are less harmful than wheat.  But the same evidence makes another theory equally plausible: that foods such as wheat harm you through pathways that form only through repeated exposure.  Under this theory, einkorn and emmer could be just as harmful as wheat but, being novel to your diet, haven't had enough time for their pathways to form.

It would be interesting, then, to learn what happens if you were to incorporate einkorn or emmer into your diet more regularly.

This abstract would seem to support your view that it may be a modern phenomenon.

Journal of Medicinal Food
Effects of Short-Term Consumption of Bread Obtained by an Old Italian Grain Variety on Lipid, Inflammatory, and Hemorheological Variables: An Intervention Study

http://www.liebertonline.com/doi/abs/10.1089/jmf.2009.0092

Michael

Naturopath David Getoff recently did a podcast on this subject, it is worth listening to: http://naturopath4you.com/mp3s/Gluten%202010%20Final.MP3

Just wondering if you have experimented with fermenting the wheat or sprouting wheat and then drying it to make bread. I've read  that making bread through this method helps celiac problems and wondered if there is a connection  since soaking and/or sprouting neutralizes the phytic acid and supposedly aids in digestion and keeps blood sugars from rising as much.

Wondering if there is a difference in European wheat types verses American. I have illness, vomiting and nausea when I consume wheat here in the US. But when I tried it in France, Germany and Switzerland, I did not have any problems. I thought it might be the way US wheat is processed, but it might be the wheat type, as well.

Thank you,
Janet Creamer