You answered my questions I had after watching your video and I have clearer understanding now of the steps I can take to better effect my diabetic responses to what and how I eat. Thank you!
It's not that you didn't explain well enough in your last video, but some concepts were so novel and mind-blowing that we'll need a second take on it! ☝🏻New fan here! You are doing great!
This literally is the best information on the internet regarding the physiology of processing carbohydrates and how they effect your blood sugar . Just excellent . Thank you
This is exactly what I was looking for. I was diagnosed prediabetic at 5.8 but got it down to 5.5 in six months. My doc gave me a CGM to try and I noticed that, despite my fasting numbers being acceptable (90-100), i keeeeep spiking to 150-180 regularly. I've seen it go into the 200s a few times during extenuating circumstances, but my endocrinologist is not concerned because my a1c is fine. But man these spikes make you feel like shit! I've been looking for answers because I keep seeing conflicting evidence. Thank you so much.
Please have your doctor do a fasting insulin or C-peptide test. Chances are your pancreas is working overtime to keep your blood sugar level at a normal level but at the same time giving you hyperinsulinemia which is just as dangerous as high blood sugar. These tests can let you know if you're at risk for diabetes 5 to 10 years ahead of time. I wish I had this done before I became diabetic 4 years ago. Fortunately I have reversed my symptoms by restricting the carbs. Good luck to you,
17:09 - blood sugar spike is caused by slow pancreas reaction in producing insulin, or as it is explained in this video an absence of stored insulin. Some sources say it is a result of fructose overconsumption, and then it becomes vicious circle, because glucose spikes trigger conversion glucose to fructose which causes less and less ability to handle carbs. There is a way to go somewhat around this issue, it's described in The CR Way book - using a tease meal - an hour before eating breakfast you eat a very small amount of carbs (page 38), it will stop fasting and turn on your pancreas, and an hour later it will be ready to handle your breakfast with much smaller spike of blood sugar.
I'm an MD and find this incredibly useful. I will add it to the list I give to my patients. Thanks so much, Mario. Best wishes for your good health and long life!
Professor (Dr) Mario, You are a true medical educator, especially enlightening the diabetics. You are sharing objective and scientific information.❤🎉❤🎉
Love this channel. It is so madenning when one finds a ton of conflicting information and can never know what is reliable and what not.... Finally i can feel safe that the information shared is not overblown or cherry-picked or misleading in other ways.... Thank you!
This may be one of my favorite comments of all time, because this is exactly what I am trying to create here. It's an ambitious goal, as we all have our biases, but I guess it's worth a try, and wonderful if people appreciate the effort. Thank you! Cheers Mario
This channel is by far the most informative source of the science of glucose in the body I have ever come across. I´ve been wearing a CGM every now and then for a year (with the Veri app) and it´s so helpful to learn that "spikes" up to 140 mg/dl are nothing to worry about at all. I do though wonder that the landscape of my post meal "spikes" often are "Twin Peaks" where the second peak is lower but substantial. I would love to here Dr. Marios take on that 🙂
Thank you, Gunnar, for the kind words. Regarding your twin towers, here's a nice article about that from the Veri website: www.veri.co/learn/biphasic-curve-metabolic-health Cheers Mario
It's very useful to wear for a month or so to learn how you are responding to different foods. Much longer is probably not necessary for people without diabetes.
@@nourishedbyscience I have read the article you linked, but they are for people with diabetes and prediabetes. Would a lean and metabolic healthy individual have biphasic spike ? If i remembered correctly didn't see them in those profile from Kraft test's pattern ? I think there was a clinical study on healthy Japanese Women and there wasnt any biphasic spike if I remembered corrrectly ?
@@zhuhaibaker7816 What do you mean with "they are for people with diabetes and prediabetes?" The article says very clearly that a biphasic pattern is a sign of good glucose tolerance, and a monophasic pattern a sign of a lacking first-phase insulin response. Overall, I wouldn't worry too much about it. In real life, when we eat very differently from a clean OGTT, the pattern isn't to obvious anyways when using a CGM. I would mostly pay attention to the amplitude, not the shape of the curve. Cheers Mario
Praise God - thank you for all you share! So refreshing, practical, and helpful. And life-giving!! Instead of restrictive and leading to eating disorders!
I am so glad I found your channel. After watching all the sugar guru's proclaim their confusing theories it is a relief to hear some science based info. Well explained and in a calm way, without any drama. Thank you very much.
I really like your suggestion to combine hi-carb foods with fats and proteins so as to lower the spike. It allows me to eat staple foods like bread; now, I just have to refine the combinations and do the groceries with that in mind. Very practical.
Oh … my … goodness. I watched your previous video again and then watched this one three times. I could never understand why the same meal caused widely fluctuating blood sugar readings at different times. Now I understand. It’s like someone finally raised the blind and let the light in. Oh how I wish someone had explained all of this to me a long, long time ago. I can’t wait for your next video!
Thanks so much for this kind feedback. I still feel like there must be a more elegant way to explain the second meal effect ...! I almost re-recorded that section of the new video ... Cheers Mario
@@nourishedbyscienceIt was very easy to understand! Everything is really making sense. Had I known what was happening, I could have started adjusting a long time ago. Sadly, it was never explained to me before you explained it. You can’t imagine how much you’ve helped me. Thanks so much!!
In my mind, I see it as priming the lawnmower carburetor. After it's primed and I turn the key to start the engine the fuel has a much easier time making it up to the carburetor to be combusted. @@nourishedbyscience
Thanks a lot man. My graph is like the 2nd graph at timestamp 3.29. I was searching for an explanation and answer everywhere on the internet. Your video helped answer. Really appreciate
You can reverse diabetes, fasting no Carbohydrates whole plant based diet buy book diabetes code Ssecond book obesity code by dr Jason Fung, my Indian builder reversed his diabetes but very strict to say in remission education diabetes is ametabolic disease intolerance of carbohydrates. I am asurgeon passionate about health longevity all healthy life styles sleep stress exercise water clean breathing social connection meditation all
Thank you, Mario! It's very informative and helpful and the fact that your videos are based on scientific evidence is worth watching. I agree with you completely on the influencers in social media. Some tend to fearmonger, and some tend to dramatise for the sake of getting views sometimes as far as stating as if everyone is diabetic and everyone should not be eating cereals and white bread. Looking forward to more videos!
Great video again. I really appreciate how you deliver your information in very clear, and respectful manners. I learn a lot from a single video of your channel than multiple videos from others. Thank you!
I just purchased an OTC CGM Biosensor kit and it was enlightening. Falling into the middle group, I was not diabetic, so did not qualify for the RX ones, but the OTC ones (STELO or LINGO) dont require and RX, and either a 2 week or 4 week biosensor can be bought for around $50 per two week sensor. In any case the data and observations in using it for even two week was ENLIGHTENING. Learning what food, drink, intakes spikes/overspikes, what does not, what mitigates spikes into normal ranges was valuable. What I learned by observation, some corroborating what you mentioned here, and other info you have passed along will surely help me and others manage our bodies glucose processes. For those who are not normal, nor diabetic, I recommend one of the OTC "Biosensors" (FDA doesnt allow the non-Rx ones to be called CGM, but they are), to help you see what the heck is doing what, and learn/adapt.
Thank you Mario, I totally understand. BTW I am a physician. I know you are right as far as losing weight being most important in this conundrum… Looking forward to more videos!
Here is some number that could help others Every two months I carry out full blood test, four months ago my HbA1c was 8 and few days ago was 7.4 thanks to the CGM My C-Peptide was 661 and few days was 626 Triglyceride was 0.93 and few days ago was 0.94 All liver and kidney functions are normal including my TSH, T3 and T4 are all within range My LDL was 4.3 and few days ago 5.3 My HDL was 5.92 and few days ago 5.33 AST (GOT) was 17 and few days ago 20 ALAT (GPT) was 17 and few days ago 20 Bilirubin total well within normal range Bilirubin indirect well within normal range Homocysteine was 9.9 and few days ago was 8.35
Thank you for such valuable content, Mario! Informative yet easy to follow. As for other questions I would be interested in hearing the answer to, I have one: how does sleeping and napping relate to blood sugar? In particular, how does a 20-30 min nap after lunch affect the spikes? (in another video you did say that walking after a meal helps lowering blood sugar, which already suggests the answer to my question, but I would still be interested in hearing an actual explanation from you). Cheers from Italy!
Big fan of naps myself ;-) However, in terms of the immediate impact on blood sugar levels, taking a nap is just as bad as sitting down at a desk or on the couch right after a meal. So, I'd say, as far as blood sugar is concerned, exercise/walk > inactivity, incl. naps ...:-( There is an exception though: if someone chronically gets too little sleep at night, that has major negative effects on blood glucose control, and taking a nap will partly mitigate that negative effect: pubmed.ncbi.nlm.nih.gov/29530368/ Cheers Mario P.S.: Thanks for your kind feedback!
I’m so happy to hear about a more realistic and scientifically-backed value of what constitutes a glucose spike. I’m using a subscription app and CGM here in the US that defines a spike as >30 mg/dl rise and glucose level at 110 mg/dl or higher. That has proven pretty difficult for me as a mild prediabetic with a 5.8 A1C.
Yes, I honestly don't know where the 30 mg/dL increase = spike idea ever came from. I do think that blood sugar spikes can be a problem, even among healthy people without diabetes or pre-diabetes, but what the rationale is for calling an increase from 90 to 120 mg/dL a spike is totally unclear to me. I am glad you found the content helpful. Best, Mario
Considering Levels link to research on their site where they argue for the 30mg/dl it would be interesting to see a video where you comment on their rational and sources. Search levels and: What should your glucose levels be? What is blood sugar spike and why does it matter.
Great information and presentation, thanks so much. We are just now starting to prepare our Christmas dinner. I love roast potatoes but I don’t want the accompanying spike so I’ll be boiling and cooling them first before putting them back in the oven to roast. I’ll then have some apple cider vinegar just before I start my meal. Knowledge is power 😂. Happy Christmas Mario, from a big fan x🎉
Thanks so very much for sharing! I just found out that I’m pre-diabetic and a bit scared. I thought that I was doing fine eating a Mediterranean diet and also living Italy, over 20 years, loving my plate of pasta for lunch. Then, bam! Now, I’m seeking strategies to stay healthy. So, thanks again.
How I do appreciate your work and your videos. You are clearing up so many questions for me. I am pre diabetic, and 15# overweight. I consistently eat 1600 - 1700 calories per day. I seem stuck at my current weight, and am afraid to drop calorie intake further because I am very active. At one time in my life I almost ruined by health with a too restrictive diet for too long. My metabolism dropped with every calorie decrease, and I was not getting adequate nutrition. I try now not to obsess about food and to have a good relationship with my food. It appears that if I keep carbs under 125 per day, this has the best effect on blood sugar. With the information you have provided, my numbers are so much better and I am hoping my weight will begin to slowly drop too. Thank you for your work. You truly seem like a dedicated, kind and humble person. Refreshing to see!
Honestly the most informative video I've watched on this topic and nutrition in general. Seems to be a very engaging video, judging by the amount of comments! I'm really looking forward to the videos about exercise, stress and sleep on blood sugar regulation.
Hi, Mario! I'd like to thank you very much for taking the time to make these videos, as well as answer people's questions. I've just recently discovered your channel, and it's been so helpful to learn about blood sugar and what I can do to regulate it. I have a family history of diabetes, and am pre-diabetic and obese myself, so I've been working to reduce my weight to healthy levels as well as manage my blood sugar levels. I'm very grateful!
Diabetic on Metformin 500mg twice b4 meals, average FB average100; PPBS 140. Body fitness training 9hrs/wk under supervision. I appreciate all your suggestions. Looking forward to more information from you as I'm over 70yrs a doctor by profession.
I'm still watching, I'm less than 3 minutes in, but I had to stop to say that you are the first person that I have ever seen address this specific data directly. There is a lot of talk around it. There is mention of what the concerning levels are, but rarely, and generally on vaguely is there any other data for contrast. Thank YOU! 🙂
FWIW, my blood sugar will go up 20-25 points eating a salad for breakfast. At 5pm, that same salad will barely raise my glucose level. Even eggs for breakfast will raise my sugar 20 points. Coffee with half and half (no sugar) will raise my BG level 10 points. Usually 20-30 minutes after my meals, I go on my exercise bike for 15-30 minutes and it will keep me at a lower spike, than if I didn't exercise. I'm in the early stages of pre-diabetes. 5.7-6.0 A1C levels. I get blood work every 3 months. Twice within the past 5 years, after the holidays, I had a 7.0 A1C, when I didn't do any exercise.
@@Jack_Schularick that would definitely do it, but I check my BG before I eat as well. It's usually in the 80s and low 90s. I don't suffer from the dawn phenomenon effect with elevated levels. They also say cortisol levels will rise if you skip breakfast.
@@titaniumismagical8643 Very thought provoking. Probably a combination of both, or more: There is also that insulin independent glucose uptake in the muscle during exercise. Perhaps you just sit down in front of the computer after your breakfast, like the rest of us :) A brisk walk after breakfast on a Saturday would resolve the question, perhaps.
@@Jack_Schularick thanks, I appreciate your input. I do go on my exercise bike, usually after every meal. I begin a 15-30 minute exercise approximately 25-30 minutes after my meals. It definitely lessens a spike. Those BG numbers I posted, happens if I don't exercise. I have to be careful because I'm going into pre-diabetic A1C levels. I'm just putting my numbers out there for others. There's not much data out there yet with people who exercise after a meal and its effects. It definitely works for me.
I liked the strategies to reduce blood sugar spikes, I think thats helpful for people who are not always low carb, or who carb cycle. I'm going to do more reheated rice and potatoes. I wonder if having a small carb snack maybe 20-30 minutes before your high carb meal would blunt the insulin response for the second meal effect, or whether it would all be considered one high carb meal.
An excellent education on this topic. Thank you, doctor. I don't have diabetes or prediabetes, but up to 80% of us still get blood sugar spikes. I do. But they are waning in frequency and strength and becoming more stable. But I still act to prevent diabetes. Shotgun pellets may hit what a bullet misses. What I mean is that a combination of methods is surely better that only one. So, I have learned to take a teaspoon or two of vinegar in a cup of water within 30 minutes before eating. Rinse your mouth afterward to protect tooth enamel. Then eat veggies first, protein second and minimal carbohydrates last. Drinking a glass of water is also said to lower blood sugar. I wait for 1 hour after a meal before having coffee, as it can otherwise deplete iron, which only induces fatigue and compounds the fatigue caused by a blood sugar spike. I add a half teaspoon of cinnamon to the coffee as well instead of sugar. It is known to lower blood sugar. Some 30 minutes after a meal I do 40 squats, 40 push-ups and 40 pull-ups on a 45-degree machine I have. Or I sometimes just run on the spot (stationary running) for a few minutes instead. I have read that blood sugar is beneficially taken from the blood for the muscles when we exercise. I have also noted some simple acupressure moves that are featured for diabetics here on RUclips by a Japanese lady. RUclips search 'acupressure diabetes' to find it. Magnesium is also reported to be helpful in quelling blood sugar spikes. But since magnesium has multiple health benefits, I also take it. I am also looking at berberine. Cooking, refrigerator cooling, and then reheating rice and potatoes also lowers their glycemic index. Or, the cooled potatoes can be eaten with salad instead of reheating. Bread can also be put in the refrigerator and then toasted. Both cooling and toasting bread lowers its glycemic index. Feeling great. Get proactive and prevent diabetes. Or lower your condition into reverse in only a few months. Win yourself that prize!
Have been wearing a CGM for a few weeks now and have been trying to learn more about diabetes, carbs, etc, but this video was the most informative of any that I’ve seen. Appreciate the excellent information.
That can mean you had a blood glucose spike, which then crashed quickly at the 2 hour mark. Usually a person's blood sugar peaks between 1-1.5 hours after a meal.
I would agree with Titanum is Magical: there isn't much solid research on this, but I think this may be a less severe version of reactive hypoglycemia.
Mixing a carb food with fat before refrigerating or freezing prevents or impairs retrogradation, I've read. Which would mean that frozen ready to eat foods may contain low(er) amounts of resistant starch. Any comment?
Best, most straightforward explanations and advice about blood sugar that I've heard, out of at least a hundred videos on the topic! 👏👏 I'll be sharing with friends who would want to know about this.
I’m a retired lady doc from India Diabetic on medication (Galvas met50/500 ) twice daily Want to stop medication Your videos are very informative Thanks
About the question at 23:03, so why do diabetics experience HYPO glycemia if they don't produce enough insulin (that would drive the glucose into the cell, causing the hypoglycemia) ?
Insulin is secreted in two phases: In the first-phase insulin response, which occurs immediately when we eat carbs, the pancreatic beta-cells secrete insulin that has been previously made, that is ready to be secreted inside the cells. This process is very fast. And this process is often diminished in type 2 diabetes, in people who are at risk for type 2 diabetes, and also in people who are on a low-carb diet. If the first-phase insulin response is diminished, then the blood glucose level can rise a lot within the first 20-30 min, just because there is too little insulin in the blood to clear the incoming glucose quickly enough. In the second-phase insulin response, the pancreas makes nes insulin from scratch (from DNA to mRNA to protein), which takes a few minutes. However, if by 20 to 30 min after a meal the blood sugar level is very high already, then too much insulin may be produced in that second-phase insulin response, and too much insulin can then drive blood glucose down too rapidly and too much, which can cause a hypoglycemic episode. Hope this makes sense. Best, Mario
Very nice video, thanks Mario. I would appreciate if you always categorize your stories to normal people and diabetic ones. I’m as a diabetic had been following different strategies to lower my glucose spikes. Although I had managed to lower or delay the response but this had created asynchronous with my insulin dose which resulted in much delayed spikes. Sometimes 4 hours after my meal. This is a bit of a struggle but I believe I will get to some sweet spot
Great video, I learned many new things. I ordered my own glucose tolerance test with insulin for under $200. Because glucose control is so important, I don’t think you should downplay getting this test based on cost alone if someone feels they are having issues with glucose. What I found was that my initial insulin production was low followed by a spike. My glucose went from 96 @fasting ; 171 @ 1hr; 125 @ 2hrs. 57@ 3hrs. So I may have reactive hypoglycemia. This is new info for me, I haven’t anyone discus this previously. Again thank so much for this video. I’m looking forward to next weeks video and what is the best diet to follow?
Thank you, William. Appreciate the kind feedback. These are interesting data you share. That reactive hypoglycemia came in quite late. Usually, we are seeing it sooner than at 3 hours. Cheers Mario
I wear the monitor as a healthy person. Saw the spike with potatoes meal. This is the very best video explaining risks and strategies to deal with it for better well beeing based on science!
Thank you for your advice about a low carb diet. I don't believe in a low carb diet. I am so grateful for all your advice. I have been following your recommendations about reading labels and limiting processed foods. I do understand the second meal you described. I am doing well following what you say. Since changing my eating habits I am finding I don't crave sugars as much. My cravings and appetite have seemed to decrease. My b/p is stable. My energy level is up. I believe that by continuing on this path I will be able to get some of the inflammation down that can be aggravating my arthritis. Had to have surgery on my right hand last week due to arthritis. Thank you for doing such a great job explaining everything.
Hi Mario, I really like your channel, you do an awesome job! You base the information on science but also you apply common sense and avoid the “purist” approach 👏🏼
I would greatly appreciate your insights on other types of diabetes besides type two. While I acknowledge that about 90% of people have type two diabetes, there are still many individuals with type one and other forms of diabetes who could greatly benefit from your expertise. Thank you for your efforts in creating these informative videos; I have learned more from you than nearly anyone in the medical field, including other RUclips videos that I have watched. Once again, thank you for your time and dedication.😄😄😄😄😄
Great video! I’m just getting interested in sugar and insulin levels so I mostly have limited knowledge. You’ve made me question several of the things I assume are true about carb intake.
Hi Mario, thanks again for your incredible videos. You mentioned an insufficient first-phase insulin response can be responsible for spikes, and a resulting strong second phase insulin response can cause reactive hypoglycemia. What I'm curious about is whether anyone else has a seemingly "0th phase" response to eating, where glucose drops before it spikes? Much of my non-exercising postprandial CGM data looks this way: 1. Eat 2. Immediate (within minutes) Drop in CGM blood sugar (-5 to -40 mg/dl, depending) 3. Delayed Surge in CGM blood sugar (110-180mg/dl) 4. Reactive hypoglycemia (50mg/dl) 5. Repeat 3 and 4 several times (polyphasic glucose response) 6. Eventually stabilize several hours later (2-6 hours, depending on many factors)
If I'm exercising (e.g. uphill walking) while eating, everything changes, and I get a much more stable blood sugar level until digestion is fully complete. However, if I stop exercising before digestion is complete, I'll see 3 and 4 occur almost immediately in response. Then I have another "mode" where I have textbook perfect glucose tolerance... but this mode shows up periodically, but many things reliably throw it off - a poor night of sleep, vaccination, infection, stress, too much rest, the list goes on... This all remains quite a complex mystery - I've yet to see several of the peculiarities of my phenotype described in the literature, or elsewhere... Does any of this align with anything you've seen in your practice or read about in the literature? Thanks again! P.S. There are many more peculiarities, but this is already far too long and complex!
Hm, that is indeed curious, and not common. Thank you for sharing. I assume you have discussed this with a doctor? Also, could you share what you have tried to remedy this, other than walking? Does lower-carb help? Cheers Mario
Hi, Could you at some point address the Dawn Phenomenon and what strategies might work to bring these high morning blood sugars under control. Thank you!
Hello Mario, how are you? At 21:20 when you mention strategies to maximize the first-phase insulin response, isn't protein intake also currently recognized as a strategy? I mean, not only by reducing gastric emptying but by the effect of amino acids on insulin release?
Yes, true. Generally, dietary protein tends to increase insulin production in both the first and the second phase. However, the first-phase insulin response can only be stimulated to a point: if someone has little pre-formed insulin because they have massive diabetes and/or have been on a very low-carb diet for a long time, then no matter how much you stimulate it's release, there won't be much there. Cheers Mario
I understood! Many thanks for the reply. I'm a nutritionist in a small town in Brazil. Being able to access the information you share on your channel is truly incredible. We are always updating ourselves through articles and research, but being able to see a video that summarizes knowledge and explains the nuances is sensational, I can't thank you enough for the knowledge you have shared on RUclips!@@nourishedbyscience
@@younutre Love to hear that. Thank you for your work as well! Considering the nutritional state of the world, we need all hand on deck to right the ship ... Cheers Mario
Thanks for sharing your knowledge! Much appreciated! 1. For the second meal effect - does it mean it's best to eat, say - carb with protein/fat/fiber for both breakfast and lunch, while maybe cutting out carbs for dinner? 2. My second question is: if my sugar is 135 fasting before breakfast around 10, while my sugar 2 hours after a meal is under 140 (118 or so) , what does that mean? My fasting sugar is higher than norm yet is normalized after I eat? I researched the dawn affect and don't think it applies in my case as it's not middle of the night level. I use strips to check sugar level.
If you have a very low-carb dinner, then the next meal is breakfast the next day, and your glucose tolerance will be reduced. My general suggestion is to either always eat at least a bit of carbs or all meals as low-carb meals. Including some high-carb meals in a low-carb diet may trigger some major spikes. Fasting glucose >=126 is indicative of diabetes, even if the 2-hour time point after a standardized OGTT (or a meal) is relatively low, so I would certainly discuss this with a doctor. Best, Mario
Thank you for this very valuable information. I feel it’s our responsibility to ensure our health. By the time you get sick, the doctors have only pharmacy meds to rely on. I always thought I was informed about blood sugar but am learning so much and will make adjustments as needed.
Interesting and most importantly practical advise and recommendations. I personally could manage my 26 years diabetes much better after I went low carb. A1C 9 to 5.7 and dropped 50 lbs and cut many meds and insulin. Of course it could be only me getting good response but it has been 18 months my bg has been in between 90 and 160 all time. According my CGM.
Had baked ,cooled & reheated potato based breakfast My readings after every 30 minutes [125 ,130 135 &110] At end of 2hour I am prediabetic Thousand thanks
@saramenda9473, I am afraid that is incorrect. Hand-held glucose meters that directly measure blood glucose in a drop of blood are (a) an actual measurement of glucose in blood (rather than in the interstitial fluid, which is what a CGM sensor measures); (b) more reliable, with less variation from measurement to measurement and much lower likelihood that you'll get an extremely faulty reading. I am not against CGMs at all, and think they are extremely useful, but they are not more accurate than even a cheap hand-held glucose meter. Best, Mario
This information is very helpful. I have a question about "spikes" I struggle to control spikes, and i want to know if there are any supplements that I can take to moderate the damage that they cause. How would I protect my nerve cell membranes and kidney tubules< for example? Perhaps a You Tube clip about this would interest a lot of folks? Thanks.
Thank you for the education. I recently discovered I have glucose spikes even after eating very small amount of carbs. Sounds like I have reduced first phase insulin response. I did used to eat a lot of sugary stuff but my A1C was in normal range. What could be the cause for the reduction at the first place please? Thank you!
Thank you Mario. I am much clearer now after watching the video you suggested earlier in reply. I did experience all the signs of Hypoglycemia. It was a scary episode as I had never experienced something like that. It happened when I skipped my breakfast and lunch after having a carb-rich dinner the night before. I believe the way your body processes glucose changes as you age. I had no problem skipping meals before.
Excellent Video, Mario!! I’ve studied a lot and have heard new information, here. Thank you for providing education the average person cannot get elsewhere, particularly from their medical practitioner. Bravo!👏👏
Excellent and very helpful information. These videos have been the most helpful, detailed, and easy to understand information regarding blood sugar and its corrolating causes and possible complications.
Great explanation to all selected questions for this video. Thanks for that. However I have a question regarding snacking in between of two meals and its effect on blood sugar spike or insulin resistance as, although it is universally known that one should stick to 2 or 3 meals in 24 hours, many if not most, have a habit of snacking between any two meals. Please advise on this too. Thank you in advance.
The data are not very clear that 2 or 3 large meals are better than more smaller meals, as long as the overnight fasting window is the same. If people snack a lot all day leading to a shorter fasting window overnight, then that could contribute to excess calorie intake and weight gain, and that then could lead to insulin resistance and glucose intolerance.
Forgot to mention in my previous comment that you explained the symptoms of reactive hypoglycemia perfectly! That’s exactly what happens to me. It generally takes all day to fully recover from. Not a pleasant experience for sure. Can’t wait to hear how the person in your next video handled it!
I’ve just figured out wearing a CGM that I’ve been getting these spikes for years. Instant oatmeal has been my worst trigger. Seems to make the whole day bad as you say.
A very scientific response to the blood sugar spike issue. I often used to think when many influencers talk about blood sugar spike they say it is so bad to have spikes and must have portion control and the like. What is interesting in your response is that from scientific evidence as long as we stay below 10 mmol/l we should not be too concerned. I have another fundamental question on how the medical fraternity decides what is the level of blood glucose [HbA1C] is considered diabetic? Why 6.5% and why not 8%? What is the basis of determination? Can you provide some scientific basis please?
I've been wondering about the effects of coffee/tea/caffeine on blood sugar. I read that if you drink coffee before eating breakfast it can negatively impact your blood sugar, but if you drink it during or after a meal, it is beneficial. Would be nice for more clarification on how and why caffeine affects blood sugar.
Ah, you are the second person today who has that question. And I am sorry to say that I don't know and need to do some research before I can respond to it. Will include some information about this in a future video, or make a separate video about this topic if there are enough data to make it worthwhile. Cheers Mario
Glucose goddess made a post about that and as far as I remember it’s true, you’d better eat the coffee after the meal (it was a cappucino though, i’m not sure this applies to plain coffee)
This is a great video! I know about the resistance starch effect and it really does work. I didn’t know about freezing bread, but that makes sense too. So glad I watched this and subscribed.
I just came across your video (thanks to my RUclips algorithms 🙂), and it is so refreshing that you are not contributing to the fear-mongering content in social media that is out there. I actually feel like a normal person now and that I am not going to die tomorrow! When I see my BG at 120, I panic, but now maybe not so much! I was wondering if you could give your take on what a normal hba1c should be. Thank you, and I have subscribed. 👍🏼
Thank you so much for taking the time! I think my last check was 5.4. I don't know what it was before because I have never had it tested, but I was just curious because my fasting glucose tends to run in the low 90s. It is something that I am working on improving. Thank you, again. 🙂
Great Channel and videos Dr.Mario. As I have insulin resistance I loved your videos alot and they are really to do the point and accurate. I have one more question which couldnt find the answer in your videos yet, ma be I missed it. My question is eating frequently(Which means Breakfast in the morning, then 2 hours later a healthy snack, then lunch, 2 hours later a snack then dinner) good or bad for us? I'm also using using CGM for a week now and my blood sugar levels is in the okay range, when I eat according to your recommendations, however eating snacks causes small waves(not spikes) naturally, should we continue with healthy snacks or try to stick with 3 meals only? Thanks a lot for all those great videos.
Thank you for the kind feedback, Talat. Good question, and I may make a separate video about eating frequency at some point. For now, let me just share two recent review articles about the topic: www.ahajournals.org/doi/10.1161/CIR.0000000000000476 www.ncbi.nlm.nih.gov/pmc/articles/PMC7490164/ One bigger point though: make sure that the snacking does not shorten the overnight fasting period. In other words, if the snacking continues until well after dinner, then there could be some disadvantages associated with this for metabolic health. This is because some trials show that the opposite, i.e., an extended fasting period over night, as in time restricted eating, has metabolic benefits. Cheers Mario
Thank you very much for your excelent explanations of blood sugar controle. Still some questions: 1. Why is the first phase insulin response blunted in type 2 diabetes. Is the insulin not stored, or does is the insulin not released with high blood sugar? Or are the betacells not quick enough to make insulin? Or all of the above? And is it true that sometimes protein consumption can activate the first insulin response where carbs can't do it? 2. Does the second meal effect extend to many hours later? Most days I eat only two meals a day. The last at about 3 p.m. would that affect my meal next morning at 8 am?
Hi Jan, The first-phase insulin response is blunted whenever there is not enough pre-formed insulin stored in the beta-cells. There could also be a reduction in beta-cell mass (i.e., fewer beta-cells) in advanced type 2 diabetes. The reasons for this in type 2 diabetes are probably several, and thought to be partly related to genetic predisposition, higher age, toxic effects of chronically elevated free fatty acids and glucose, inflammatory processes etc. Pre-loading a meal with protein can enhance the first-phase insulin response to a high-carb meal eaten a bit later, so this is one of the mechanisms how adding protein to a meal can be helpful. Regarding the second meal effect: it's usually not been tested with meals very far apart. Most studies compare the glycemic impact of dinner when lunch contained vs. did not contain carbs. My best guess would be that it still matters somewhat even if the meals are further apart, as in intermittent fasting. Cheers Mario
I think deep frozen food does not undergo lots of retrigradation because the process is very fast, as opposed to the slow cooling in that happens in common kitchen fridges.
My dream: just information, no fear mongering and no dogma.
You answered my questions I had after watching your video and I have clearer understanding now of the steps I can take to better effect my diabetic responses to what and how I eat. Thank you!
Yes! Recently found Mario’s channel and am so appreciative of the content! Thank you!
It's not that you didn't explain well enough in your last video, but some concepts were so novel and mind-blowing that we'll need a second take on it!
☝🏻New fan here! You are doing great!
This literally is the best information on the internet regarding the physiology of processing carbohydrates and how they effect your blood sugar . Just excellent . Thank you
This is exactly what I was looking for. I was diagnosed prediabetic at 5.8 but got it down to 5.5 in six months. My doc gave me a CGM to try and I noticed that, despite my fasting numbers being acceptable (90-100), i keeeeep spiking to 150-180 regularly. I've seen it go into the 200s a few times during extenuating circumstances, but my endocrinologist is not concerned because my a1c is fine. But man these spikes make you feel like shit! I've been looking for answers because I keep seeing conflicting evidence. Thank you so much.
Please have your doctor do a fasting insulin or C-peptide test. Chances are your pancreas is working overtime to keep your blood sugar level at a normal level but at the same time giving you hyperinsulinemia which is just as dangerous as high blood sugar. These tests can let you know if you're at risk for diabetes 5 to 10 years ahead of time. I wish I had this done before I became diabetic 4 years ago. Fortunately I have reversed my symptoms by restricting the carbs. Good luck to you,
@@ming294 thank you💓
😢😢😢
17:09 - blood sugar spike is caused by slow pancreas reaction in producing insulin, or as it is explained in this video an absence of stored insulin. Some sources say it is a result of fructose overconsumption, and then it becomes vicious circle, because glucose spikes trigger conversion glucose to fructose which causes less and less ability to handle carbs.
There is a way to go somewhat around this issue, it's described in The CR Way book - using a tease meal - an hour before eating breakfast you eat a very small amount of carbs (page 38), it will stop fasting and turn on your pancreas, and an hour later it will be ready to handle your breakfast with much smaller spike of blood sugar.
@@emmas816 Ah, interesting 🤔 Thanks for sharing
I'm an MD and find this incredibly useful. I will add it to the list I give to my patients. Thanks so much, Mario. Best wishes for your good health and long life!
Thank you. I hope you will check out my other content on this topic.
Cheers
Mario
This channel has answers that I’ve been asking doctors for for 15 years and have gotten literally nothing from them.
Professor (Dr) Mario,
You are a true medical educator, especially enlightening the diabetics.
You are sharing objective and scientific information.❤🎉❤🎉
Love this channel. It is so madenning when one finds a ton of conflicting information and can never know what is reliable and what not.... Finally i can feel safe that the information shared is not overblown or cherry-picked or misleading in other ways.... Thank you!
This may be one of my favorite comments of all time, because this is exactly what I am trying to create here. It's an ambitious goal, as we all have our biases, but I guess it's worth a try, and wonderful if people appreciate the effort. Thank you!
Cheers
Mario
This is one of the best, most level headed videos about blood glucose I've seen. Subbed.
This channel is by far the most informative source of the science of glucose in the body I have ever come across. I´ve been wearing a CGM every now and then for a year (with the Veri app) and it´s so helpful to learn that "spikes" up to 140 mg/dl are nothing to worry about at all. I do though wonder that the landscape of my post meal "spikes" often are "Twin Peaks" where the second peak is lower but substantial. I would love to here Dr. Marios take on that 🙂
I am a recovering keto man - looks like a CGM would be a good idea for me too :)
Thank you, Gunnar, for the kind words.
Regarding your twin towers, here's a nice article about that from the Veri website:
www.veri.co/learn/biphasic-curve-metabolic-health
Cheers
Mario
It's very useful to wear for a month or so to learn how you are responding to different foods. Much longer is probably not necessary for people without diabetes.
@@nourishedbyscience I have read the article you linked, but they are for people with diabetes and prediabetes. Would a lean and metabolic healthy individual have biphasic spike ? If i remembered correctly didn't see them in those profile from Kraft test's pattern ? I think there was a clinical study on healthy Japanese Women and there wasnt any biphasic spike if I remembered corrrectly ?
@@zhuhaibaker7816 What do you mean with "they are for people with diabetes and prediabetes?" The article says very clearly that a biphasic pattern is a sign of good glucose tolerance, and a monophasic pattern a sign of a lacking first-phase insulin response.
Overall, I wouldn't worry too much about it. In real life, when we eat very differently from a clean OGTT, the pattern isn't to obvious anyways when using a CGM. I would mostly pay attention to the amplitude, not the shape of the curve.
Cheers
Mario
Praise God - thank you for all you share! So refreshing, practical, and helpful. And life-giving!! Instead of restrictive and leading to eating disorders!
Yes, praise The Lord. My first time here, God is in control, He brought me here with 3 of these exact questions.
I am so glad I found your channel. After watching all the sugar guru's proclaim their confusing theories it is a relief to hear some science based info. Well explained and in a calm way, without any drama. Thank you very much.
You and Dr Carvalho are best 2 YT experts, truly evaluating the data. Thank you
I really like your suggestion to combine hi-carb foods with fats and proteins so as to lower the spike. It allows me to eat staple foods like bread; now, I just have to refine the combinations and do the groceries with that in mind. Very practical.
Glucose goddess has done videos on this technique for many months👍🏼
Looking forward to your videos on the causes of glucose intolerance and how to reverse it.
I lost over 200 pounds so far and I realize this is an extremely important topic. Thank you 🙏 new subscriber here.
Oh … my … goodness. I watched your previous video again and then watched this one three times. I could never understand why the same meal caused widely fluctuating blood sugar readings at different times. Now I understand. It’s like someone finally raised the blind and let the light in. Oh how I wish someone had explained all of this to me a long, long time ago. I can’t wait for your next video!
Thanks so much for this kind feedback. I still feel like there must be a more elegant way to explain the second meal effect ...! I almost re-recorded that section of the new video ...
Cheers
Mario
@@nourishedbyscienceIt was very easy to understand! Everything is really making sense. Had I known what was happening, I could have started adjusting a long time ago. Sadly, it was never explained to me before you explained it. You can’t imagine how much you’ve helped me. Thanks so much!!
In my mind, I see it as priming the lawnmower carburetor. After it's primed and I turn the key to start the engine the fuel has a much easier time making it up to the carburetor to be combusted. @@nourishedbyscience
Thanks a lot man. My graph is like the 2nd graph at timestamp 3.29. I was searching for an explanation and answer everywhere on the internet. Your video helped answer. Really appreciate
Great content and explanation as usual for those of us with T2 diabetes.
You can reverse diabetes, fasting no Carbohydrates whole plant based diet buy book diabetes code Ssecond book obesity code by dr Jason Fung, my Indian builder reversed his diabetes but very strict to say in remission education diabetes is ametabolic disease intolerance of carbohydrates. I am asurgeon passionate about health longevity all healthy life styles sleep stress exercise water clean breathing social connection meditation all
Thank you, Mario! It's very informative and helpful and the fact that your videos are based on scientific evidence is worth watching. I agree with you completely on the influencers in social media. Some tend to fearmonger, and some tend to dramatise for the sake of getting views sometimes as far as stating as if everyone is diabetic and everyone should not be eating cereals and white bread. Looking forward to more videos!
Best scientist that explains this in a clear and concise manner. WOW, THANK YOU FOR ALL YOU DO AND FOR BACKING UP WITH DATA.
One of the best in depth and easily understood videos I’ve heard concerning this subject. Thanks Dr. Mario!
Great video again. I really appreciate how you deliver your information in very clear, and respectful manners. I learn a lot from a single video of your channel than multiple videos from others. Thank you!
I just purchased an OTC CGM Biosensor kit and it was enlightening. Falling into the middle group, I was not diabetic, so did not qualify for the RX ones, but the OTC ones (STELO or LINGO) dont require and RX, and either a 2 week or 4 week biosensor can be bought for around $50 per two week sensor. In any case the data and observations in using it for even two week was ENLIGHTENING. Learning what food, drink, intakes spikes/overspikes, what does not, what mitigates spikes into normal ranges was valuable. What I learned by observation, some corroborating what you mentioned here, and other info you have passed along will surely help me and others manage our bodies glucose processes. For those who are not normal, nor diabetic, I recommend one of the OTC "Biosensors" (FDA doesnt allow the non-Rx ones to be called CGM, but they are), to help you see what the heck is doing what, and learn/adapt.
Great Video Mario.Extremely informative . I now freeze all my potatoes etc . Timing is everything
it would be interesting to know if raw vs. cooked foods affect spikes.
Thank you Mario, I totally understand. BTW I am a physician. I know you are right as far as losing weight being most important in this conundrum… Looking forward to more videos!
Here is some number that could help others
Every two months I carry out full blood test, four months ago my HbA1c was 8 and few days ago was 7.4 thanks to the CGM
My C-Peptide was 661 and few days was 626
Triglyceride was 0.93 and few days ago was 0.94
All liver and kidney functions are normal including my TSH, T3 and T4 are all within range
My LDL was 4.3 and few days ago 5.3
My HDL was 5.92 and few days ago 5.33
AST (GOT) was 17 and few days ago 20
ALAT (GPT) was 17 and few days ago 20
Bilirubin total well within normal range
Bilirubin indirect well within normal range
Homocysteine was 9.9 and few days ago was 8.35
Thank you for such valuable content, Mario! Informative yet easy to follow.
As for other questions I would be interested in hearing the answer to, I have one: how does sleeping and napping relate to blood sugar? In particular, how does a 20-30 min nap after lunch affect the spikes? (in another video you did say that walking after a meal helps lowering blood sugar, which already suggests the answer to my question, but I would still be interested in hearing an actual explanation from you). Cheers from Italy!
Big fan of naps myself ;-)
However, in terms of the immediate impact on blood sugar levels, taking a nap is just as bad as sitting down at a desk or on the couch right after a meal. So, I'd say, as far as blood sugar is concerned, exercise/walk > inactivity, incl. naps ...:-(
There is an exception though: if someone chronically gets too little sleep at night, that has major negative effects on blood glucose control, and taking a nap will partly mitigate that negative effect:
pubmed.ncbi.nlm.nih.gov/29530368/
Cheers
Mario
P.S.: Thanks for your kind feedback!
I’m so happy to hear about a more realistic and scientifically-backed value of what constitutes a glucose spike. I’m using a subscription app and CGM here in the US that defines a spike as >30 mg/dl rise and glucose level at 110 mg/dl or higher. That has proven pretty difficult for me as a mild prediabetic with a 5.8 A1C.
Yes, I honestly don't know where the 30 mg/dL increase = spike idea ever came from. I do think that blood sugar spikes can be a problem, even among healthy people without diabetes or pre-diabetes, but what the rationale is for calling an increase from 90 to 120 mg/dL a spike is totally unclear to me.
I am glad you found the content helpful.
Best,
Mario
Considering Levels link to research on their site where they argue for the 30mg/dl it would be interesting to see a video where you comment on their rational and sources.
Search levels and:
What should your glucose levels be?
What is blood sugar spike and why does it matter.
Great information and presentation, thanks so much.
We are just now starting to prepare our Christmas dinner. I love roast potatoes but I don’t want the accompanying spike so I’ll be boiling and cooling them first before putting them back in the oven to roast. I’ll then have some apple cider vinegar just before I start my meal. Knowledge is power 😂.
Happy Christmas Mario, from a big fan x🎉
Clear, concise advice Mario, thank you for all your help.
Thanks so very much for sharing! I just found out that I’m pre-diabetic and a bit scared. I thought that I was doing fine eating a Mediterranean diet and also living Italy, over 20 years, loving my plate of pasta for lunch. Then, bam! Now, I’m seeking strategies to stay healthy. So, thanks again.
How I do appreciate your work and your videos. You are clearing up so many questions for me. I am pre diabetic, and 15# overweight. I consistently eat 1600 - 1700 calories per day. I seem stuck at my current weight, and am afraid to drop calorie intake further because I am very active. At one time in my life I almost ruined by health with a too restrictive diet for too long. My metabolism dropped with every calorie decrease, and I was not getting adequate nutrition. I try now not to obsess about food and to have a good relationship with my food. It appears that if I keep carbs under 125 per day, this has the best effect on blood sugar. With the information you have provided, my numbers are so much better and I am hoping my weight will begin to slowly drop too. Thank you for your work. You truly seem like a dedicated, kind and humble person. Refreshing to see!
Honestly the most informative video I've watched on this topic and nutrition in general. Seems to be a very engaging video, judging by the amount of comments! I'm really looking forward to the videos about exercise, stress and sleep on blood sugar regulation.
These videos are the clearest explanation of the subject. Thankyou.
Fantastic information and presentation. By far the clearest I’ve seen on glucose spiking and I’ve seen many! Thx
Hi, Mario! I'd like to thank you very much for taking the time to make these videos, as well as answer people's questions. I've just recently discovered your channel, and it's been so helpful to learn about blood sugar and what I can do to regulate it. I have a family history of diabetes, and am pre-diabetic and obese myself, so I've been working to reduce my weight to healthy levels as well as manage my blood sugar levels. I'm very grateful!
Thanks for the incredible clarity in your explanations and for being the voice of reason :)
Diabetic on Metformin 500mg twice b4 meals, average FB average100; PPBS 140. Body fitness training 9hrs/wk under supervision. I appreciate all your suggestions. Looking forward to more information from you as I'm over 70yrs a doctor by profession.
I'm still watching, I'm less than 3 minutes in, but I had to stop to say that you are the first person that I have ever seen address this specific data directly. There is a lot of talk around it. There is mention of what the concerning levels are, but rarely, and generally on vaguely is there any other data for contrast. Thank YOU! 🙂
Thanks!
Thank you so much for your support!
Cheers
Mario
Thanks for this video. I’ve long wondered weather resistance starch is maintained after reheating. Now I know.
thank you for creating researched, evidence-driven content that's also understandable.
You give the best information and easily understood....thank you
Thank you so much for answering all the questions I have never been able to find the answers to!!
FWIW, my blood sugar will go up 20-25 points eating a salad for breakfast. At 5pm, that same salad will barely raise my glucose level.
Even eggs for breakfast will raise my sugar 20 points. Coffee with half and half (no sugar) will raise my BG level 10 points.
Usually 20-30 minutes after my meals, I go on my exercise bike for 15-30 minutes and it will keep me at a lower spike, than if I didn't exercise.
I'm in the early stages of pre-diabetes. 5.7-6.0 A1C levels. I get blood work every 3 months. Twice within the past 5 years, after the holidays, I had a 7.0 A1C, when I didn't do any exercise.
Perhaps it's because of high level of cortisol in the morning as well.
@@Jack_Schularick that would definitely do it, but I check my BG before I eat as well. It's usually in the 80s and low 90s. I don't suffer from the dawn phenomenon effect with elevated levels. They also say cortisol levels will rise if you skip breakfast.
@@titaniumismagical8643 Very thought provoking. Probably a combination of both, or more: There is also that insulin independent glucose uptake in the muscle during exercise. Perhaps you just sit down in front of the computer after your breakfast, like the rest of us :) A brisk walk after breakfast on a Saturday would resolve the question, perhaps.
@@Jack_Schularick thanks, I appreciate your input. I do go on my exercise bike, usually after every meal. I begin a 15-30 minute exercise approximately 25-30 minutes after my meals. It definitely lessens a spike. Those BG numbers I posted, happens if I don't exercise. I have to be careful because I'm going into pre-diabetic A1C levels.
I'm just putting my numbers out there for others. There's not much data out there yet with people who exercise after a meal and its effects. It definitely works for me.
@@titaniumismagical8643 Thank you TiM. Eating carbs is a little bit like playing with fire ... So what keeps you from trying LCHF or keto?
You are so clear and thorough.i learned so much since 1971.
Thank you.
I liked the strategies to reduce blood sugar spikes, I think thats helpful for people who are not always low carb, or who carb cycle. I'm going to do more reheated rice and potatoes. I wonder if having a small carb snack maybe 20-30 minutes before your high carb meal would blunt the insulin response for the second meal effect, or whether it would all be considered one high carb meal.
An excellent education on this topic. Thank you, doctor.
I don't have diabetes or prediabetes, but up to 80% of us still get blood sugar spikes. I do. But they are waning in frequency and strength and becoming more stable. But I still act to prevent diabetes.
Shotgun pellets may hit what a bullet misses. What I mean is that a combination of methods is surely better that only one. So, I have learned to take a teaspoon or two of vinegar in a cup of water within 30 minutes before eating. Rinse your mouth afterward to protect tooth enamel. Then eat veggies first, protein second and minimal carbohydrates last. Drinking a glass of water is also said to lower blood sugar. I wait for 1 hour after a meal before having coffee, as it can otherwise deplete iron, which only induces fatigue and compounds the fatigue caused by a blood sugar spike. I add a half teaspoon of cinnamon to the coffee as well instead of sugar. It is known to lower blood sugar.
Some 30 minutes after a meal I do 40 squats, 40 push-ups and 40 pull-ups on a 45-degree machine I have. Or I sometimes just run on the spot (stationary running) for a few minutes instead. I have read that blood sugar is beneficially taken from the blood for the muscles when we exercise. I have also noted some simple acupressure moves that are featured for diabetics here on RUclips by a Japanese lady. RUclips search 'acupressure diabetes' to find it.
Magnesium is also reported to be helpful in quelling blood sugar spikes. But since magnesium has multiple health benefits, I also take it. I am also looking at berberine.
Cooking, refrigerator cooling, and then reheating rice and potatoes also lowers their glycemic index. Or, the cooled potatoes can be eaten with salad instead of reheating. Bread can also be put in the refrigerator and then toasted. Both cooling and toasting bread lowers its glycemic index. Feeling great. Get proactive and prevent diabetes. Or lower your condition into reverse in only a few months. Win yourself that prize!
Have been wearing a CGM for a few weeks now and have been trying to learn more about diabetes, carbs, etc, but this video was the most informative of any that I’ve seen. Appreciate the excellent information.
Thank you so much for this!!!
What are your thoughts on someone getting sleepy 2 hours after a meal.
That can mean you had a blood glucose spike, which then crashed quickly at the 2 hour mark. Usually a person's blood sugar peaks between 1-1.5 hours after a meal.
I would agree with Titanum is Magical: there isn't much solid research on this, but I think this may be a less severe version of reactive hypoglycemia.
Mixing a carb food with fat before refrigerating or freezing prevents or impairs retrogradation, I've read. Which would mean that frozen ready to eat foods may contain low(er) amounts of resistant starch. Any comment?
Best, most straightforward explanations and advice about blood sugar that I've heard, out of at least a hundred videos on the topic! 👏👏 I'll be sharing with friends who would want to know about this.
I’m a retired lady doc from India Diabetic on medication (Galvas met50/500 ) twice daily
Want to stop medication
Your videos are very informative Thanks
I really appreciate the scientific look at dietary factors.
Amazing presentation and content! This channel deserves a million subscribers.
Excellently presented and informative video. Thank you!
This is great information. First time this type of information is easily understood by everybody. Thank you.
About the question at 23:03, so why do diabetics experience HYPO glycemia if they don't produce enough insulin (that would drive the glucose into the cell, causing the hypoglycemia) ?
Insulin is secreted in two phases:
In the first-phase insulin response, which occurs immediately when we eat carbs, the pancreatic beta-cells secrete insulin that has been previously made, that is ready to be secreted inside the cells. This process is very fast. And this process is often diminished in type 2 diabetes, in people who are at risk for type 2 diabetes, and also in people who are on a low-carb diet. If the first-phase insulin response is diminished, then the blood glucose level can rise a lot within the first 20-30 min, just because there is too little insulin in the blood to clear the incoming glucose quickly enough.
In the second-phase insulin response, the pancreas makes nes insulin from scratch (from DNA to mRNA to protein), which takes a few minutes. However, if by 20 to 30 min after a meal the blood sugar level is very high already, then too much insulin may be produced in that second-phase insulin response, and too much insulin can then drive blood glucose down too rapidly and too much, which can cause a hypoglycemic episode.
Hope this makes sense.
Best,
Mario
Very nice video, thanks Mario. I would appreciate if you always categorize your stories to normal people and diabetic ones. I’m as a diabetic had been following different strategies to lower my glucose spikes. Although I had managed to lower or delay the response but this had created asynchronous with my insulin dose which resulted in much delayed spikes. Sometimes 4 hours after my meal. This is a bit of a struggle but I believe I will get to some sweet spot
Great video, I learned many new things. I ordered my own glucose tolerance test with insulin for under $200. Because glucose control is so important, I don’t think you should downplay getting this test based on cost alone if someone feels they are having issues with glucose. What I found was that my initial insulin production was low followed by a spike. My glucose went from 96 @fasting ; 171 @ 1hr; 125 @ 2hrs. 57@ 3hrs. So I may have reactive hypoglycemia. This is new info for me, I haven’t anyone discus this previously. Again thank so much for this video. I’m looking forward to next weeks video and what is the best diet to follow?
Thank you, William. Appreciate the kind feedback.
These are interesting data you share. That reactive hypoglycemia came in quite late. Usually, we are seeing it sooner than at 3 hours.
Cheers
Mario
Pl share your Kraft test details
I wear the monitor as a healthy person. Saw the spike with potatoes meal. This is the very best video explaining risks and strategies to deal with it for better well beeing based on science!
Excellent! Very informative.
Thank you for your advice about a low carb diet. I don't believe in a low carb diet. I am so grateful for all your advice. I have been following your recommendations about reading labels and limiting processed foods. I do understand the second meal you described. I am doing well following what you say. Since changing my eating habits I am finding I don't crave sugars as much.
My cravings and appetite have seemed to decrease. My b/p is stable. My energy level is up. I believe that by continuing on this path I will be able to get some of the inflammation down that can be aggravating my arthritis. Had to have surgery on my right hand last week due to arthritis. Thank you for doing such a great job explaining everything.
Hi Mario, I really like your channel, you do an awesome job! You base the information on science but also you apply common sense and avoid the “purist” approach 👏🏼
I would greatly appreciate your insights on other types of diabetes besides type two. While I acknowledge that about 90% of people have type two diabetes, there are still many individuals with type one and other forms of diabetes who could greatly benefit from your expertise. Thank you for your efforts in creating these informative videos; I have learned more from you than nearly anyone in the medical field, including other RUclips videos that I have watched. Once again, thank you for your time and dedication.😄😄😄😄😄
Excellent work. Thanks
Very useful information
Another great video ❤ Thank you doc ! 🙌
Great video! I’m just getting interested in sugar and insulin levels so I mostly have limited knowledge. You’ve made me question several of the things I assume are true about carb intake.
Hi Mario, thanks again for your incredible videos. You mentioned an insufficient first-phase insulin response can be responsible for spikes, and a resulting strong second phase insulin response can cause reactive hypoglycemia.
What I'm curious about is whether anyone else has a seemingly "0th phase" response to eating, where glucose drops before it spikes?
Much of my non-exercising postprandial CGM data looks this way:
1. Eat
2. Immediate (within minutes) Drop in CGM blood sugar (-5 to -40 mg/dl, depending)
3. Delayed Surge in CGM blood sugar (110-180mg/dl)
4. Reactive hypoglycemia (50mg/dl)
5. Repeat 3 and 4 several times (polyphasic glucose response)
6. Eventually stabilize several hours later (2-6 hours, depending on many factors)
If I'm exercising (e.g. uphill walking) while eating, everything changes, and I get a much more stable blood sugar level until digestion is fully complete. However, if I stop exercising before digestion is complete, I'll see 3 and 4 occur almost immediately in response.
Then I have another "mode" where I have textbook perfect glucose tolerance... but this mode shows up periodically, but many things reliably throw it off - a poor night of sleep, vaccination, infection, stress, too much rest, the list goes on...
This all remains quite a complex mystery - I've yet to see several of the peculiarities of my phenotype described in the literature, or elsewhere...
Does any of this align with anything you've seen in your practice or read about in the literature?
Thanks again!
P.S. There are many more peculiarities, but this is already far too long and complex!
Hm, that is indeed curious, and not common. Thank you for sharing. I assume you have discussed this with a doctor?
Also, could you share what you have tried to remedy this, other than walking? Does lower-carb help?
Cheers
Mario
Hi, Could you at some point address the Dawn Phenomenon and what strategies might work to bring these high morning blood sugars under control. Thank you!
Hello Mario, how are you? At 21:20 when you mention strategies to maximize the first-phase insulin response, isn't protein intake also currently recognized as a strategy? I mean, not only by reducing gastric emptying but by the effect of amino acids on insulin release?
Yes, true. Generally, dietary protein tends to increase insulin production in both the first and the second phase. However, the first-phase insulin response can only be stimulated to a point: if someone has little pre-formed insulin because they have massive diabetes and/or have been on a very low-carb diet for a long time, then no matter how much you stimulate it's release, there won't be much there.
Cheers
Mario
I understood! Many thanks for the reply. I'm a nutritionist in a small town in Brazil. Being able to access the information you share on your channel is truly incredible. We are always updating ourselves through articles and research, but being able to see a video that summarizes knowledge and explains the nuances is sensational, I can't thank you enough for the knowledge you have shared on RUclips!@@nourishedbyscience
@@younutre Love to hear that. Thank you for your work as well! Considering the nutritional state of the world, we need all hand on deck to right the ship ...
Cheers
Mario
Thanks for sharing your knowledge! Much appreciated!
1. For the second meal effect - does it mean it's best to eat, say - carb with protein/fat/fiber for both breakfast and lunch, while maybe cutting out carbs for dinner?
2. My second question is: if my sugar is 135 fasting before breakfast around 10, while my sugar 2 hours after a meal is under 140 (118 or so) , what does that mean? My fasting sugar is higher than norm yet is normalized after I eat? I researched the dawn affect and don't think it applies in my case as it's not middle of the night level. I use strips to check sugar level.
If you have a very low-carb dinner, then the next meal is breakfast the next day, and your glucose tolerance will be reduced. My general suggestion is to either always eat at least a bit of carbs or all meals as low-carb meals. Including some high-carb meals in a low-carb diet may trigger some major spikes.
Fasting glucose >=126 is indicative of diabetes, even if the 2-hour time point after a standardized OGTT (or a meal) is relatively low, so I would certainly discuss this with a doctor.
Best,
Mario
Thank you for this very valuable information. I feel it’s our responsibility to ensure our health. By the time you get sick, the doctors have only pharmacy meds to rely on. I always thought I was informed about blood sugar but am learning so much and will make adjustments as needed.
Interesting and most importantly practical advise and recommendations. I personally could manage my 26 years diabetes much better after I went low carb. A1C 9 to 5.7 and dropped 50 lbs and cut many meds and insulin. Of course it could be only me getting good response but it has been 18 months my bg has been in between 90 and 160 all time. According my CGM.
Had baked ,cooled & reheated potato based breakfast
My readings after every 30 minutes [125 ,130 135 &110]
At end of 2hour
I am prediabetic
Thousand thanks
Get a CGM finger prick is not accurate
@saramenda9473, I am afraid that is incorrect. Hand-held glucose meters that directly measure blood glucose in a drop of blood are (a) an actual measurement of glucose in blood (rather than in the interstitial fluid, which is what a CGM sensor measures); (b) more reliable, with less variation from measurement to measurement and much lower likelihood that you'll get an extremely faulty reading.
I am not against CGMs at all, and think they are extremely useful, but they are not more accurate than even a cheap hand-held glucose meter.
Best,
Mario
This information is very helpful. I have a question about "spikes" I struggle to control spikes, and i want to know if there are any supplements that I can take to moderate the damage that they cause. How would I protect my nerve cell membranes and kidney tubules< for example? Perhaps a You Tube clip about this would interest a lot of folks? Thanks.
Thank you for the education. I recently discovered I have glucose spikes even after eating very small amount of carbs. Sounds like I have reduced first phase insulin response. I did used to eat a lot of sugary stuff but my A1C was in normal range. What could be the cause for the reduction at the first place please? Thank you!
You are sooo good in explaing everything. Thank you
Thank you Mario. I am much clearer now after watching the video you suggested earlier in reply. I did experience all the signs of Hypoglycemia. It was a scary episode as I had never experienced something like that. It happened when I skipped my breakfast and lunch after having a carb-rich dinner the night before. I believe the way your body processes glucose changes as you age. I had no problem skipping meals before.
Excellent Video, Mario!! I’ve studied a lot and have heard new information, here. Thank you for providing education the average person cannot get elsewhere, particularly from their medical practitioner. Bravo!👏👏
Thank you. Appreciate that you took the time to provide such kind feedback.
Best,
Mario
Excellent and very helpful information. These videos have been the most helpful, detailed, and easy to understand information regarding blood sugar and its corrolating causes and possible complications.
Hai Sir I am from India
Firstly Thank you very much for your valuable vedios.
Secondly please upload vedios relating to 1.5 diabetes.
Great explanation to all selected questions for this video. Thanks for that.
However I have a question regarding snacking in between of two meals and its effect on blood sugar spike or insulin resistance as, although it is universally known that one should stick to 2 or 3 meals in 24 hours, many if not most, have a habit of snacking between any two meals. Please advise on this too. Thank you in advance.
The data are not very clear that 2 or 3 large meals are better than more smaller meals, as long as the overnight fasting window is the same. If people snack a lot all day leading to a shorter fasting window overnight, then that could contribute to excess calorie intake and weight gain, and that then could lead to insulin resistance and glucose intolerance.
Thank you Doctor for your excellent presentation and information ❤
Forgot to mention in my previous comment that you explained the symptoms of reactive hypoglycemia perfectly! That’s exactly what happens to me. It generally takes all day to fully recover from. Not a pleasant experience for sure. Can’t wait to hear how the person in your next video handled it!
I’ve just figured out wearing a CGM that I’ve been getting these spikes for years. Instant oatmeal has been my worst trigger. Seems to make the whole day bad as you say.
Love everything about this channel Mario.You are wonderful and impart so much info in a concise way, easily understood by the layman ❤
Thank you for your kind feedback, Amanda.
Best,
Mario
A very scientific response to the blood sugar spike issue. I often used to think when many influencers talk about blood sugar spike they say it is so bad to have spikes and must have portion control and the like. What is interesting in your response is that from scientific evidence as long as we stay below 10 mmol/l we should not be too concerned.
I have another fundamental question on how the medical fraternity decides what is the level of blood glucose [HbA1C] is considered diabetic? Why 6.5% and why not 8%? What is the basis of determination? Can you provide some scientific basis please?
🎯 Subscribed! Just found your channel and what you do is awesome. You are helping and educating so many of us.. Thank you!
Welcome aboard!
I've been wondering about the effects of coffee/tea/caffeine on blood sugar. I read that if you drink coffee before eating breakfast it can negatively impact your blood sugar, but if you drink it during or after a meal, it is beneficial. Would be nice for more clarification on how and why caffeine affects blood sugar.
Ah, you are the second person today who has that question. And I am sorry to say that I don't know and need to do some research before I can respond to it. Will include some information about this in a future video, or make a separate video about this topic if there are enough data to make it worthwhile.
Cheers
Mario
Glucose goddess made a post about that and as far as I remember it’s true, you’d better eat the coffee after the meal (it was a cappucino though, i’m not sure this applies to plain coffee)
This is a great video! I know about the resistance starch effect and it really does work. I didn’t know about freezing bread, but that makes sense too. So glad I watched this and subscribed.
I just came across your video (thanks to my RUclips algorithms 🙂), and it is so refreshing that you are not contributing to the fear-mongering content in social media that is out there. I actually feel like a normal person now and that I am not going to die tomorrow! When I see my BG at 120, I panic, but now maybe not so much! I was wondering if you could give your take on what a normal hba1c should be. Thank you, and I have subscribed. 👍🏼
Normal HbA1c is defined as
Thank you so much for taking the time! I think my last check was 5.4. I don't know what it was before because I have never had it tested, but I was just curious because my fasting glucose tends to run in the low 90s. It is something that I am working on improving. Thank you, again. 🙂
Great content. Thanks so much for this evidence based information
Re citric acid: would supplements like K and Mg citrate also have an effect on blood sugar?
Great Channel and videos Dr.Mario. As I have insulin resistance I loved your videos alot and they are really to do the point and accurate. I have one more question which couldnt find the answer in your videos yet, ma be I missed it. My question is eating frequently(Which means Breakfast in the morning, then 2 hours later a healthy snack, then lunch, 2 hours later a snack then dinner) good or bad for us? I'm also using using CGM for a week now and my blood sugar levels is in the okay range, when I eat according to your recommendations, however eating snacks causes small waves(not spikes) naturally, should we continue with healthy snacks or try to stick with 3 meals only? Thanks a lot for all those great videos.
Thank you for the kind feedback, Talat.
Good question, and I may make a separate video about eating frequency at some point. For now, let me just share two recent review articles about the topic:
www.ahajournals.org/doi/10.1161/CIR.0000000000000476
www.ncbi.nlm.nih.gov/pmc/articles/PMC7490164/
One bigger point though: make sure that the snacking does not shorten the overnight fasting period. In other words, if the snacking continues until well after dinner, then there could be some disadvantages associated with this for metabolic health. This is because some trials show that the opposite, i.e., an extended fasting period over night, as in time restricted eating, has metabolic benefits.
Cheers
Mario
You are great Dr. Mario, thanks for the fast response and have a nice day.
Thank you very much for your excelent explanations of blood sugar controle.
Still some questions:
1. Why is the first phase insulin response blunted in type 2 diabetes. Is the insulin not stored, or does is the insulin not released with high blood sugar? Or are the betacells not quick enough to make insulin? Or all of the above? And is it true that sometimes protein consumption can activate the first insulin response where carbs can't do it?
2. Does the second meal effect extend to many hours later? Most days I eat only two meals a day. The last at about 3 p.m. would that affect my meal next morning at 8 am?
Hi Jan,
The first-phase insulin response is blunted whenever there is not enough pre-formed insulin stored in the beta-cells. There could also be a reduction in beta-cell mass (i.e., fewer beta-cells) in advanced type 2 diabetes. The reasons for this in type 2 diabetes are probably several, and thought to be partly related to genetic predisposition, higher age, toxic effects of chronically elevated free fatty acids and glucose, inflammatory processes etc.
Pre-loading a meal with protein can enhance the first-phase insulin response to a high-carb meal eaten a bit later, so this is one of the mechanisms how adding protein to a meal can be helpful.
Regarding the second meal effect: it's usually not been tested with meals very far apart. Most studies compare the glycemic impact of dinner when lunch contained vs. did not contain carbs. My best guess would be that it still matters somewhat even if the meals are further apart, as in intermittent fasting.
Cheers
Mario
@@nourishedbyscience thanks👍
I think deep frozen food does not undergo lots of retrigradation because the process is very fast, as opposed to the slow cooling in that happens in common kitchen fridges.