I think there’s reasonably good evidence that whenever our BG rises above some threshold, like above 140 mg/dL or 160 mg/dL, we are accumulating damage.
that’s the part where I don’t know if that’s true – I mean from what I understand studies showing this are all in cell culture, right? Or are there studies showing that the number of spikes above 140 mg/DL in humans is correlated with long-term complications?
There’s evidence that the higher the spike, the faster the damage accumulates. But the danger of a flatline at 170 vs a spike to 250 followed by a plunge to 45? I simply don’t know, other than the fact that a deep hypo can trigger a lethal cardiac arrythmia.
Again I’m curious about the data on this – if you know of the studies on the idea that a high spike leads to faster damage accumulation (in humans, not cells or rodents), I would love to see it, because the last time I was digging around I couldn’t really find anything great in humans about this. As for the idea of which is worse or better, I can see both sides. The latter example would have both a hyper- and hypoglycemic response, which could be worse. But on the other hand, perhaps there changes in gene expression that occur once your blood sugar is high for X amount of time that do not get activated if you spike to 300 and then quickly plummet down.
This is such a tough thing to really analyze in real-world situations, because as many of us have seen, a fast spike is harder to correct than a slow rise, so the two are never really parallel.
I mean, if we are slowly rising, many times it might be corrected and reversed before it ever gets to 300. But with a fast spike, it may not be stopped before it gets to 300.
Additionally - if you are comparing actual numbers of the high BG’s - with a slow rise to 300, simply by definition of it being a slow rise, you have spent more time out of target than a rapid spike to 300.
Furthermore, how could they ever separate those two things for analysis? Who among us would volunteer to say they only have either fast spikes or slow rises, so we could be used for analysis? All of us experience both of those from time-to-time.
I think that is why those two things are very difficult to compare.
While it would be interesting to know, I do not think it matters too much in our daily existence because ultimately everyone is trying to avoid both rapid spikes and slow spikes.
I agree that everyone is trying to stop both slow and fast spikes. In a perfect world everyone would always aim to eliminate both… but I think that many people (or at least we) experience some tradeoff between aiming for a low number and aiming for a stable number. For instance, fast spikes are sometimes inevitable for us – the question is how do you approach them? Would you rather sledgehammer them into submission and aim to catch a low as your BG plummets down, or carefully dose based on your bolus wizard – which will bring you down in 4 to 6 hours or possibly not at all? The latter will produce more stable numbers but a higher overall A1C. The former runs a risk of lows on top of highs, increases total variability, possibly increases TDD, but it also reduces time spent high if executed properly.
So even though it’s impossible to answer this question, it’s very important because it does practically affect the treatment strategy.
You could definitely do all sorts of interesting stats on CGM data if you had a big dataset of people’s CGM traces and their diabetes complication outcomes. You can capture variability and changeability in all sorts of different ways, including making multiple indices for each person on which they can differ and comparing them in predictive utility. It absolutely could be done with the right dataset and the right researchers; the issue is we need to collect the CGM data and then wait quite a while before you can get that outcome data. Also, the clinical trial researchers generally don’t know those types of stats; you need people very familiar with intensive longitudinal data analysis methods (probably not common in the diabetes research world) to do all the cool things.
If diabetes were only a functioning pancreas and immune system. As long as we can prevent severe lows and try not to linger in the high area too long, we are content.
It’s an impossible dream to imagine being in the sweet zone (flatliner) for us so I don’t waste my time thinking about it.
This has been my life story!!! I am driving myself crazy now that I have the Dexcom G6. I so want to be in normal range more but am either not as smart as many diabetics or my body and circumstances just do not seem to cooperate! I do so much praying and know I am Blessed to be as healthy as I am with spiking all of my life! I actually do not remember life without needles. Maybe I will be able to do better as I learn more. Honestly I have been diabetic so long I feel like my Doctor puts me in control instead because he says I know my body better than anyone. This may be true but seems like with all new technology he could be more help. Endocrinologist’s are far and few between and many do not accept new patients. In all of my years of diabetes I never saw an Endo until I was pregnant…” 42 years ago. He was great but retired and have had little luck since. Good luck to you and Blessings to all diabetics!!}
Make sure to run basal tests to see if your basal is correct. My son had grown and apparently we hadn’t kept up with his basal requirements, we added 0.4 extra units per hour by accident and his control has improved measurably.
