How many hours since a meal has elapsed
Before bg tests will ring true?
How many tests when blood glucose is tapped
Til we have enough points for a clue?
And then how can we process postprandial curves
With no CGMs for Type 2?

(with apologies to Bob Dylan)

One of the stricter schools of thought regarding "tight control" is that we should never let our blood glucose levels rise above 140, nor let them ever drop below 80 -- and if we really want to be vigilant about it, we should keep our peaks below 120. That said, there will always be some irresistable or unavoidable food, or some threshold serving size or combination, that in the past has sent our blood glucose levels soaring through the roof, and if we're being "good little diabetics", we will monitor the heck out of the expected excursion and, if we're on insulin, try to micromanage it.

In the same vein of tight control, we are taught that our peak postprandial glucose numbers will take place somewhere between one and two hours after eating, hence the standard 60-, 90-, or 120-minute postprandial checks. The presumption is that if we read "safe" numbers at two hours after eating, we're home free.

Anyone who's complained about the "pizza effect" or who's celebrated mastering square-wave or dual-wave boluses will quickly tell you what a load of manure that presumption is. You'll get a similar reaction from anyone who's been diagnosed with gastroparesis or any medical condition resulting in delayed or slowed digestion.

So, how do we know whether or not that sort of assumption applies to us, as individuals? Are we creating a whole generation of people with diabetes who think pizza is "safe" to eat because their 2-hour postprandial readings are in the 130's and they never see the 220 hit in the fourth or fifth hour?

Also, is there a threshold for a particular ingredient (or combination thereof) for each of us individually where you or I could eat, say, 1 6" whole wheat pita (22 g carb) and be "safe" but 1 9" whole wheat pita (31 g carb) and spike for the next six hours -- regardless of whatever else we've eaten or drunk at the same time?

Part of this line of questioning comes because I've been seeing normal -- even "low" -- postprandial numbers after meals I expect to spike me and cause me to stay high for an extended period of time. Now, it could be the cold affecting me (it's been doing some really nasty things to my hands and fingers), but it could be something else. Thursday night's dinner, with The Other Half's folk in Virginia, was their version of spaghetti and meat sauce: semolina ("white") pasta and jarred (high sodium, high-fructose corn syrup-sweetened) sauce, doctored with (cheapest, i.e., high-fat) ground beef -- as opposed to my whole-wheat pasta in measured portions, home-made sauce from no-salt-added canned tomatoes with no "extra" ingredients, and 93% lean ground beef. It was the sort of dinner I expected to spike me long and hard -- so why, an hour and a half later, was I reading 99 (aka "blood sugar nirvana")?

I decided to check again about an hour later, figuring if I only made it to 99, I'd probably be dropping and ready for the folks' usual evening snack ritual -- but at three hours, I was up -- at 128. Okay, maybe I peaked high at two hours and I'm coming back down? Curious. Maybe a glycogen response? (Really?) An hour later I tested at a (for me) effing scary 149!! I was still over 140 when I turned out the lights because I needed some sleep, even though at over 130 I was higher than "pre-bed" guidelines. (As I said, this sort of food spikes me long and hard.) The obvious question is, what sort of hidden damage is happening because I'm not catching the peaks and the areas under curve?

I've said several times that it would be instructive for people with Type 2 diabetes who are not on insulin to be put on a continuous glucose monitor for a week or two, and obsessively logging our food and sleep during that period of time, to get a better idea of what foods we can and cannot eat, and in what quantities. It has already proven to be, in individual cases, a beneficial tool for people on multiple daily injections of insulin (whether they have type 1, type 2, or another type of diabetes) to help monitor the best times and ways to split up their long-acting and meal insulin doses.

For folk like me, though, I envision using a CGM in the same way as a 24-hour Holter monitor test is used to log continuous heart function while the patient goes through his normal activities. It's information that could help us to improve our diets, the administration of our medications, and -- ultimately -- our lives. In the mean time, an extra vial or two of strips and hourly testing-and-logging will have to do.