Re: Great diabetes basics from Joslin

On Mon, 10 Aug 2009 06:55:35 -0700 (PDT), Tim Shoppa
<shoppa@xxxxxxxxxxxxxxxxx> wrote:

On Aug 8, 5:59 pm, Kurt <kurtwheeling1...@xxxxxxxxxxx> wrote:
I would sure like to hear their side of this story. It's hard to
believe that they would be "aghast" that you test at 2 hours post-
prandial since Joslin recommends a 2 hour post-prandial number.

www.joslin.org/Files/Clinical-Guidelines-for-Pharmacological-Manageme...

As far as testing at 1 hour, most endos probably would find that a bit
odd but not be aghast about it. I realize in this newsgroup it is the
gospel, but certainly not in the legitimate diabetes community.
Admittedly, I do sometimes test at 1 hour and my endo is never aghast
when I mention that I do. As a matter of fact I'd find it hard to
believe that any endo would really care how much you test unless asked
for their opinion on it. Testing at one hour does seem a bit of a
waste, especially for someone who eats low carb higher fat because the
fat will delay a spike.

I find it's hard to make sense of the 1 hour number, since a half hour
delay in my insulin bolus or a half hour delay in my food absorption
can make such a huge difference at 1 hour.

Kurt, as usual, over-simplifies and distorts.

We are all different.

Those who inject insulin have a different response timing to those of
us who don't. Additionally, those of us who don't vary enormously in
the nature of the various factors leading to the level and timing of
our post-prandial spike.

No-one here advocates testing at one hour as a set timing. Further, we
rarely even agree on whether to set the reference time at before or
after the meal. Jennifer's test, test, test advice sets a starting
point of one AND two hours. But that is a starting point, not an end
point, and everyone I know who has used that advice successfully (and
that is in the many hundreds now) very quickly found their own peak
timing based on those one and two-hour tests, and settled on that.

What Kurt deliberately ignores is that I and others here recommend
finding that the individual discovers their own peak timing. For me
that happens to be one hour, for others it may be 45 minutes, for
others it may be two hours or another timing. And it may also vary by
time of day and by meal proportions.

What I, and many others, disagree with is the set mantra from the
doctors and diabetes authorities, including the ADA, Joslin and Mayo,
that testing at two hours is appropriate and useful for all diabetics
of all types.

What I advocate is that each person finds their most consistent peak,
which may be different at different times of day, and use that timing
to review the meals that caused that peak.

As a separate issue I don't eat low-carb high-fat. I eat low-spike,
which happens to be much lower in carbs than I ate pre-diagnosis but
also happens to be lower in fat than pre-diagnosis too. Everything is
relative. And again Kurt uses over-simplistic slogans to set up a
straw man.

Cheers, Alan, T2, Australia.
--
d&e, metformin 2000 mg
Everything in Moderation - Except Laughter.
http://loraldiabetes.blogspot.com (Lancet Change - St Swithun's Day)
http://loraltravel.blogspot.com (Jerash, an Ancient City in Jordan)
.

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