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Continuous Glucose Profiles in Healthy Subjects under Everyday Life Conditions and after Different Meals
The mean 24-hour interstitial glucose concentration under everyday life conditions was 89.3 ± 6.2 mg/dl (mean ± SD, n = 21), and mean interstitial glucose concentrations at daytime and during the night were 93.0 ± 7.0 and 81.8 ± 6.3 mg/dl, respectively. The highest postprandial glucose concentrations were observed after breakfast: 132.3 ± 16.7 mg/dl (range 101–168 mg/dl); peak concentrations after lunch and dinner were 118.2 ± 13.4 and 123.0 ± 16.9 mg/dl, respectively. Mean time to peak glucose concentration was between 46 and 50 minutes. After ingestion of standardized meals with fast absorption characteristics, peak interstitial glucose concentrations were 133.2 ± 14.4 and 137.2 ± 21.1 mg/dl, respectively. Meals with a higher fiber, protein, and fat content induced a smaller increase and a slower decrease of postprandial glucose concentrations with peak values of 99.2 ± 10.5 and 122.1 ± 20.4 mg/dl, respectively.


This study provided continuous glucose profiles in nondiabetic subjects and demonstrated that differences in meal composition are reflected in postprandial interstitial glucose concentrations. Regarding the increasing application of continuous glucose monitoring in diabetic patients, these data suggest that detailed information about the ingested meals is important for adequate interpretation of postprandial glucose profiles.

Keywords: continuous glucose monitoring, continuous glucose profiles, healthy subjects, interstitial fluid glucose, postprandial glucose
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Tight glycemic control has been shown to reduce the risk of complications in patients with type 1 and type 2 diabetes.1,2
tight  glucose  control  management  interstitial  blood  diet  cycle  metabolism  normoglycemia  peak  postprandial  peer-reviewed  research  in  vivo  human  rhythms  circadian 
4 weeks ago by Michael.Massing
Went from dismantling democracy to joking on the emmys.
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12 weeks ago by mattgriffin
Knob-twiddling with the Novation Peak and a sequence that was already in a hardware sequence for a different project. I had to ride the volume because the Peak can get seriously snarly. / on tumblr:
ifttt  tumblr  music  SoundCloud  novation  peak 
12 weeks ago by ceej
Glucose-lowering effect of whey protein depends upon clinical characteristics of patients with type 2 diabetes. - PubMed - NCBI
Effects of WP supplementation on glycemia in T2DM depend on the baseline characteristics. Lower body weight, normal triglyceride and lower GLP-1 levels predict glucose lowering. In contrast, obesity, hypertriglyceridemia and high baseline GLP-1 predict increased glucose response.
breakfast  protein  glucose  whey  blood  response  spike  triglycerides  GLP-1  body  fat  obesity  correlation  peak  excursion  peer-reviewed  research 
12 weeks ago by Michael.Massing
Effects of Higher Dietary Protein and Fiber Intakes at Breakfast on Postprandial Glucose, Insulin, and 24-h Interstitial Glucose in Overweight Adults. - PubMed - NCBI
The HPHF treatment did not affect postprandial glucose and insulin responses or 24-h glucose total area under the curve (AUC). Higher fiber intake reduced 240-min insulin AUC. Doubling the amount of protein from 12.5 g to 25 g/meal and quadrupling fiber from 2 to 8 g/meal at breakfast was not an effective strategy for modulating insulin-mediated glucose responses in these young, overweight[, nondiabetic] adults.
breakfast  fiber  protein  glucose  metabolism  blood  interstitial  insulin  response  postprandial  peak  excursion  spike  peer-reviewed  research 
12 weeks ago by Michael.Massing
Timing of Peak Blood Glucose after Breakfast Meals of Different Glycemic Index in Women with Gestational Diabetes
There was no significant difference in subjective satiety throughout the test period. In conclusion, the low GI breakfast produced lower postprandial glycemia, and the peak PBGL [postprandial blood glucose level] occurred closer to the time recommended for PBGL monitoring (i.e., 1 h postprandial) in GDM than a macronutrient matched high GI breakfast.
breakfast  glucose  metabolism  appetite  diabetes  gestational  peak  postprandial  blood  SMBG  self  care  glycemic  index  high  timing  monitoring  excursion  spike  peer-reviewed  research 
12 weeks ago by Michael.Massing
Breakfast Protein Source Does Not Influence Postprandial Appetite Response and Food Intake in Normal Weight and Overweight Young Women. - PubMed - NCBI
No difference was found between [normal weight] and [overweight] participants or breakfasts for postprandial appetite responses. [Animal protein] had a significantly lower glucose response at 30 minutes compared with [plant protein] (-11.6%; 127 ± 4 versus 112 ± 4 mg/dL; P < 0.05) and a slower return to baseline. There was no difference in daily energy intake between breakfasts. These data suggest that protein source may influence postprandial glucose response without significantly impacting appetite response in breakfast consumers.
breakfast  animal  plant  foods  protein  glucose  metabolism  appetite  blood  peak  excursion  spike  peer-reviewed  research 
12 weeks ago by Michael.Massing
Targeting glucose metabolism for healthy aging. - PubMed - NCBI
Advancing age is the greatest single risk factor for numerous chronic diseases. Thus, the ability to target the aging process can facilitate improved healthspan and potentially lifespan. Lack of adequate glucoregulatory control remains a recurrent theme accompanying aging and chronic disease, while numerous longevity interventions result in maintenance of glucoregulatory control. In this review, we propose targeting glucose metabolism to enhance regulatory control as a means to ameliorate the aging process. We highlight that calorie restriction improves glucoregulatory control and extends both lifespan and healthspan in model organisms, but we also indicate more practical interventions (i.e., calorie restriction mimetics) are desirable for clinical application in humans. Of the calorie restriction mimetics being investigated, we focus on the type 2 diabetes drug acarbose, an α-glucosidase inhibitor that when taken with a meal, results in reduced enzymatic degradation and absorption of glucose from complex carbohydrates. We discuss alternatives to acarbose that yield similar physiologic effects and describe dietary sources (e.g., sweet potatoes, legumes, and berries) of bioactive compounds with α-glucosidase inhibitory activity. We indicate future research should include exploration of how non-caloric compounds like α-glucosidase inhibitors modify macronutrient metabolism prior to disease onset, which may guide nutritional/lifestyle interventions to support health and reduce age-related disease risk.

[Note mention of metformin in graphical abstract.]
hyperglycemia  diabetes  type  2  T2D  blood  glucose  diet  foods  legumes  berries  sweet  potatoes  SMBG  self  care  risk  cardiovascular  kidney  neuropathy  nephropathy  chronic  disease  progression  aging  caloric  calorie  restriction  acarbose  metformin  peak  excursion  spike  peer-reviewed  research 
12 weeks ago by Michael.Massing
Postprandial glucose regulation: new data and new implications. - PubMed - NCBI
Type 2 diabetes is characterized by a gradual decline in insulin secretion in response to nutrient loads; hence, it is primarily a disorder of postprandial glucose (PPG) regulation. However, physicians continue to rely on fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) to guide management.
The objectives of this article are to review current data on postprandial hyperglycemia and to assess whether, and how, management of type 2 diabetes should change to reflect new clinical findings.
Articles were selected from MEDLINE searches (key words: postprandial glucose, postprandial hyperglycemia, and cardiovascular disease) and from our personal reference files, with emphasis on the contribution of postprandial hyperglycemia to overall glycemic load or cardiovascular (CV) risk.
About 33% of people diagnosed as having type 2 diabetes based on postprandial hyperglycemia have normal FPG. PPG contributes > or =70% to the total glycemic load in patients who are fairly well controlled (HbA1c <7.3%). Furthermore, there is a linear relationship between the risk of CV death and the 2-hour oral glucose tolerance test (OGTT). Increased mortality is evident at OGTT levels of approximately 90 mg/dL (5 mmol/L), which is well below current definitions of type 2 diabetes. Biphasic insulin aspart was shown to be more effective at reducing HbA1c below currently recommended levels than basal insulin glargine (66% vs 40%; P < 0.001), and it reduced endothelial dysfunction more effectively than regular insulin (P < 0.01). Repaglinide achieved regression of carotid atherosclerosis (intima-media thickness) in 52% of patients versus 18% for glyburide (P < 0.01) over 1 year, although levels of HbA1c and CV risk factors were similar for both treatment groups. Finally, acarbose reduced the relative risk of CV events by 49% over 3.3 years versus placebo in patients with impaired glucose tolerance (2.2% vs 4.7%; P = 0.03) and by 35% over > or =1 year in patients with type 2 diabetes (9.4% vs 6.1%; P = 0.006).
All components of the glucose triad (ie, FPG, HbA1c, and PPG) should be considered in the management of type 2 diabetes. Therapy targeted at PPG has been shown to improve glucose control and to reduce the progression of atherosclerosis and CV events; therefore, physicians should consider monitoring and targeting PPG, as well as HbA1c and FPG, in patients with type 2 diabetes.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  damage  vessel  wall  epithelial  atherosclerosis  morbidity  mortality  threshold  peer-reviewed  research 
12 weeks ago by Michael.Massing
Postprandial hyperglycaemia: noxious effects on the vessel wall. - PubMed - NCBI
In recent years postchallenge or postprandial hyperglycaemia has been found to be an independent risk factor for cardiovascular comorbidities and all-cause mortality in impaired glucose tolerance (IGT) and type 2 diabetes. With the database of the Risk Factors in IGT for Atherosclerosis and Diabetes (RIAD) study, it was also shown that atherosclerosis as measured by intima-media thickness of the common carotid arteries was associated with 2-hour postchallenge glucose level when HbA1c was normal. Taken together there are now comprehensive and consistent data from pathophysiological as well as epidemiological studies that excessive post-load glucose excursions have acute and chronic harmful effects on the endothelium and vessel wall. This is supported by four outcome studies that included control of postprandial glucose to prevent cardiovascular disease: Diabetes Intervention Study (DIS), Kumamoto study, DIGAMI study, and STOP-NIDDM trial. Therefore, in addition to HbA1c and fasting blood glucose, postprandial glucose monitoring should be an integral part of treatment to prevent acute and chronic complications.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  damage  vessel  wall  epithelial  atherosclerosis  peer-reviewed  research 
12 weeks ago by Michael.Massing
Postprandial peaks as a risk factor for cardiovascular disease: epidemiological perspectives. - PubMed - NCBI
A key issue in diabetes care is selecting glucose parameters to monitor and control. The recommendations of the American Diabetes Association for glycaemic control do not address postprandial glucose (PPG), but patients with type 2 diabetes experience wide variations in glucose levels after meals. We have observed a remarkable increase in plasma glucose two hours after breakfast and/or lunch in most non-insulin-treated patients; for up to 40% of them the increase is >40 mg/dl (2.2 mmol/l). As many as 70% of patients with an HbA1c <7% have PPG values >160 mg/dl (8.9 mmol/l) after meals. Fasting plasma glucose (FPG) is a poor indicator of plasma glucose at other times. The coefficient of correlation of FPG with plasma glucose at other times ranges from 0.50-0.70. Nor is the correlation of FPG with HbA1c very strong: in hundreds of determinations of HbA1c and FPG in our patients, the coefficient of correlation was not greater than 0.73. For the same FPG value, HbA1c varied markedly, and vice versa; further, the correlation between PPG and HbA1c was no higher than that between FPG and HbA1c (r = 0.65). Thus, monitoring in type 2 diabetes should include PPG along with FPG and HbA1c. Recent data provide direct and indirect evidence suggesting that PPG is independently related to cardiovascular disease (CVD), and supporting the idea that PPG should be assessed and glucose excursions with meals should be controlled: 1. Studies conducted by other investigators and ourselves in patients with type 2 diabetes have shown that the incidence of CVD is independently related to postprandial or post-OGTT (oral glucose tolerance test) blood glucose at baseline. In addition, data collected in the general population show an association between 2-hour OGTT plasma glucose (a surrogate of PPG) and cardiovascular morbidity and mortality that is independent of FPG. Also, subjects with impaired glucose tolerance (IGT) and isolated post-challenge hyperglycaemia have an increased cardiovascular risk over subjects with normal glucose tolerance (NGT). We found that IGT subjects had a risk of carotid stenosis 3-fold higher than subjects with NGT, even after adjustment for several confounders. Thus, a modest increase in post-OGTT plasma glucose and, by extrapolation, PPG seems to have a major detrimental effect on the arteries. 2. When FPG and/or HbA1c were the targets of glucose control in studies of patients with type 2 diabetes (the UGDP, VACSDM, and UKPDS) the effects on CVD were minimal. However, when the targets of glucose control included PPG (the Kumamoto Study and DIGAMI Study) favorable effects on CVD were observed. 3. There is experimental data suggesting that acute hyperglycaemia can exert deleterious effects on the arterial wall through mechanisms including oxidative stress, endothelial dysfunction, and activation of the coagulation cascade. This evidence prompted the European Diabetes Policy Group to set postprandial targets for blood glucose control: postprandial peaks should not exceed 135 mg/dl (7.5 mmol/ml) to reduce arterial risk and should not exceed 160 mg/dl (8.9 mmol/l) to reduce microvascular risk. Thus, glucose care in diabetes is not only "fasting glucose care" or "HbA1c care" but is also "postprandial glucose care."
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  SMBG  self  care  risk  cardiovascular  excursion  peer-reviewed  research 
12 weeks ago by Michael.Massing
Peak-time determination of post-meal glucose excursions in insulin-treated diabetic patients. - PubMed - NCBI
The mean peak time after breakfast was 72+/-23 min, which was reached in less than 90 min in 80% of the patients. The apparent glucose rate of increase from pre-meal to the maximum postprandial value was 1.23+/-0.76 mg/dL/min, while the glucose rate of decrease was 0.82+/-0.70 mg/dL/min. Peak time correlated with the amplitude of postprandial excursions, but not with the peak glucose value. Also, peak times were similar after breakfast, lunch and dinner, and in type 1 and type 2 diabetic patients.
To best assess peak postprandial glucose levels, the optimal time for blood glucose monitoring is about 1h and 15 min after the start of the meal, albeit with wide interpatient variability. Nevertheless, 80% of post-meal blood glucose peaks were observed at less than 90 min after the start of the meal.
hyperglycemia  diabetes  type  2  a  T1D  T2D  blood  glucose  postprandial  spike  peak  rhythm  meal  SMBG  timing  insulin  dependent  excursion  peer-reviewed  research 
12 weeks ago by Michael.Massing
Effect of carbohydrate distribution on postprandial glucose peaks with the use of continuous glucose monitoring in type 2 diabetes. - PubMed - NCBI
We investigated the effect of carbohydrate distribution on postprandial glucose peaks with continuous blood glucose monitoring (CGMS), when consuming a moderate carbohydrate diet in energy balance in subjects with type 2 diabetes.
Twenty-three subjects with type 2 diabetes were randomly assigned to each of four 3-d interventions in a crossover design with a 4-d washout period. Identical foods were provided for each treatment with a ratio of total carbohydrate to protein to fat of 40%:34%:26% but differing in carbohydrate content at each meal: even distribution (CARB-E; approximately 70 g carbohydrate), breakfast (CARB-B), lunch (CARB-L), and dinner(CARB-D), each providing approximately 125 g carbohydrate in the loaded meal in a 9-MJ diet. Glucose concentrations were continuously measured with CGMS. Outcomes were assessed by postprandial peak glucose (G(max)), time spent > 12 mmol/L (T > 12), and total area under the glucose curve (AUC(20)).
Daily G(max) differed between treatments (P = 0.003) with CARB-L (14.2 +/- 1.0 mmol/L), CARB-E (14.5 +/- 0.9 mmol/L), and CARB-D (14.6 +/- 0.8 mmol/L) being similar but lower than CARB-B (16.5 +/- 0.8 mmol/L). Meal G(max) was weakly related to carbohydrate amount and glycemic load (r = 0.40-0.44). T > 12 differed between treatments (P = 0.014), and a treatment x fasting blood glucose (FBG) interaction (P = 0.003) was observed with CARB-L (184 +/- 74 min) < CARB-B (190 +/- 49 min) < CARB-D (234 +/- 87 min) < CARB-E (262 +/- 91 min). Total AUC(20) was not significantly different between treatments. After adjustment for FBG, treatment became significant (P = 0.006); CARB-L (10 049 +/- 718 mmol/L x 20 h) < CARB-E (10 493 +/- 706 mmol/L x 20 h) < CARB-B (10 603 +/- 642 mmol/L x 20 h) < CARB-D (10 717 +/- 638 mmol/L x 20 h).
CARB-E did not optimize blood glucose control as assessed by postprandial peaks, whereas CARB-L provided the most favorable postprandial profile.
hyperglycemia  diabetes  type  2  T2D  blood  glucose  postprandial  spike  peak  rhythm  meal  excursion  peer-reviewed  research 
12 weeks ago by Michael.Massing

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