invasive way to assess overall glucose variability is the “Glycomark” test.
Glycomark measures an enzyme in the blood that is excreted whenever glucose
levels exceed 180 mg/dl. So a “high” result indicates that glucose is rarely
exceeding 180. A “low” result indicates considerable time peaking above 180.
Someone whose A1c is near normal but has a low glycomark score is likely peaking
quite high, albeit temporarily, after meals. They may also be experiencing
alternating above-target and below-target glucose levels throughout the day.
1,5 – anhydroglucitol
past 10-14 days
“Normal” is >14
>10 is “good”
Why Do We Spike?
reason for post-meal spikes in people with diabetes is 2-fold. First, exogenous
insulin works much slower than insulin produced by the pancreas. This not only
lags behind the digestion/absorption of most carbohydrates, but it also fails to
adequately suppress the production of glucagon (a glucose-raising hormone) in
the postprandial phase. Second, the lack of the amylin hormone and a deficiency
of the GLP-1 hormone in people with diabetes contributes to an accelerated rate
of gastric emptying and a more rapid appearance of glucose in the bloodstream
following meals. Slower insulin plus faster digestion equals a spike in the
blood glucose level.
Insulin/Meds Work Too
behind pancreatic insulin
Glucagon is not properly
Food Works Too Quickly
Lack or absence of
post-meal glucose levels, we must look for ways to make insulin appear sooner,
food digest later, or ideally, a combination of the two. This is similar to the
race between the tortoise and the hare. If we want them to run side-by-side, we
must find ways to make the hare slower or the tortoise faster.
Insulin Appear Earlier
Slowing Food 1: Using the Glycemic Index
for slowing digestion is to select foods that have low glycemic index ratings.
These foods are somewhat resistant to digestion and take longer to digest when
compared to high-glycemic index foods. Technically, the glycemic index
represents the percentage of carbohydrate in a food that appears in the blood
stream as glucose within two hours of consuming the food.
convert to blood
the magnitude of
rise for the
first 2 hours
G.I. Number is %
or rise relative
to pure glucose
(100% of glucose
within 2 hours)
GI = 37
Only 37% of spaghetti’s
carbs turn into blood glucose in the first 2 hours.
The rest will convert to
blood glucose over the next several hours.