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Spike Measurement

Another less 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 (AG)  “GlycoMark”

Laboratory Blood Test


Measures Duration & Magnitude of High BG Excursions for past 10-14 days


“Normal” is >14 mg/ml


>10 is “good”


Why Do We Spike?

The underlying 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 Slowly
Lag far behind pancreatic insulin
Glucagon is not properly suppressed
Food Works Too Quickly
Lack or absence of amylin hormone
GLP-1 deficit

Spike Control

To manage 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.

Make Insulin Appear Earlier

Make Food Appear Slower

Slowing Food 1: Using the Glycemic Index

One strategy 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.

All carbs (except fiber) convert to blood glucose eventually
G.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestion
G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream 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.


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