# 42 Factors that affect BG



## Northerner (Jan 27, 2020)

A useful list for when you're making that 'piece of cake' calculation 



ETA: Article about the table:

https://diatribe.org/42factors


----------



## everydayupsanddowns (Jan 27, 2020)

Hehe! Only 42?

 Well I suppose it is the answer to life, the universe and everything.


----------



## Northerner (Jan 27, 2020)

everydayupsanddowns said:


> Hehe! Only 42?
> 
> Well I suppose it is the answer to life, the universe and everything.


 I'm quite impressed though, it does list the main elements, and might provide a useful checklist for people experiencing difficulties to find possible causes


----------



## Ljc (Jan 27, 2020)

Could it be pinned and also put in the Useful links for people new to diabetes thread .


----------



## everydayupsanddowns (Jan 27, 2020)

Ljc said:


> Could it be pinned and also put in the Useful links for people new to diabetes thread .



Good idea Lin

I’ll add it to the ‘general’ section of the useful links thread


----------



## Northerner (Jan 27, 2020)

everydayupsanddowns said:


> Good idea Lin
> 
> I’ll add it to the ‘general’ section of the useful links thread


Mike, I've added a link to the accompanying article to my OP


----------



## Lisa66 (Jan 27, 2020)

It’s amazing isn’t it, we tend to know these,  but then when you see them listed it makes you wonder how we ever work anything out. So thank you for posting the list, it’s a reminder to cut ourselves a bit of slack from time to time and not necessarily that we’ve got something wrong. 

Oh and when I’ve worked my way through this I often believe the direction of the wind or maybe my husband wearing odd socks may also have an influence


----------



## Sally71 (Jan 27, 2020)

My daughter went to the cinema with a friend and her mum on Saturday.  When they got back they said that she had had very high blood sugar, around 20. Now there could be many reasons for this, but the main one is that she had been at dance classes from 8.30 - 11 am, due to having almost constant hypos at dance classes in the past and finding that low TBRs didn't make much difference she now leaves her pump off for the whole time.  Which sometimes works perfectly, sometimes she still goes low despite having no pump on and sometimes she goes through the roof, we are finding it impossible to predict!  My response to the information was a shrug and “oh well, never mind” which the mum found rather amusing.  Well, as long as she gave herself a correction dose and didn't just ignore the situation it will come down again won't it!  Which she had done and was well on the way back down so there's nothing more to be said really.  It is a minefield though isn't it, and just when you think you've worked it all out something unexpected happens!


----------



## mikeyB (Jan 27, 2020)

Yup, Sally, there’s always the 43rd that isn’t listed. WTF???


----------



## Thebearcametoo (Jan 27, 2020)

I love that altitude is just ?? Yeah we don’t know either but something, sometimes. For some people? *shrug*


----------



## Sprogladite (Jan 27, 2020)

They forgot to include the Diabetes Fairy


----------



## Eddy Edson (Jan 27, 2020)

mikeyB said:


> Yup, Sally, there’s always the 43rd that isn’t listed. WTF???



"WTF" could have all the different coloured arrows


----------



## Sharron1 (Jan 27, 2020)

Obviously it would all have to be colour coordinated.


----------



## nonethewiser (Jan 27, 2020)

43rd, reading articles saying cure for type 1 has been found or on horizon.

Good list good find Northie.


----------



## C&E Guy (Jan 27, 2020)

Never heard about some of those.

Is that altitude in a really tall building or in an aeroplane?

Is that the American spelling of "coeliac"?


----------



## Robin (Jan 27, 2020)

C&E Guy said:


> Never heard about some of those.
> 
> Is that altitude in a really tall building or in an aeroplane?
> 
> Is that the American spelling of "coeliac"?


 My 'tip' in the free book that DUK produced a couple of years ago was about walking at altitude. It always takes my body a few days to acclimatise on a mountain holiday, and I’m hypo city for the first few days. (and it isn’t just the extra exercise of walking up and down hills, I'm not doing anything I don’t do at home).


----------



## Northerner (Jan 27, 2020)

C&E Guy said:


> Is that altitude in a really tall building or in an aeroplane?


Altitude as in Mexico City, up a mountain or in a plane 




C&E Guy said:


> Is that the American spelling of "coeliac"?


Yes, 'DiaTribe' is an American website, so they can't spell things properly


----------



## zoombapup (Jan 27, 2020)

To be fair, I think we're all going to be safe from 37 for quite a while.


----------



## Sharron1 (Jan 28, 2020)

zoombapup said:


> To be fair, I think we're all going to be safe from 37 for quite a while.


A couple more to avoid,
A mouse running around the kitchen and the musical Tom Brown's Schooldays. Both guaranteed to increase levels dramatically.


----------



## Eddy Edson (Jan 28, 2020)

zoombapup said:


> To be fair, I think we're all going to be safe from 37 for quite a while.


Not quite!


----------



## Docb (Jan 28, 2020)

I'm fascinated by the question mark against 9.  We all make the assumption that carbohydrate turns into glucose, but how much glucose is produced from how much carbohydrate?


----------



## TwoTone (Jan 29, 2020)

The long term metformin use and vitamin B12 deficiency. The effects of a B12 deficiency is actually to mimic worsening T2D symptoms. It causes a drop in red blood cell count which in turn causes the HbA1c test to give a false high value. Low red blood cell counts also causes the blood test meter to indicate a false high value. 
Interesting reading...

Factors Affecting Blood Glucose Monitoring: Sources of Errors in Measurement

Drugs affecting HbA1c levels


----------



## stephknits (Jan 29, 2020)

I have printed it out and have already shown it to two people who have asked if I'm back on track and keeping my numbers in range.


----------



## nonethewiser (Jan 29, 2020)

44th, watching footie when team is on losing side.


----------



## Northerner (Jan 29, 2020)

Docb said:


> I'm fascinated by the question mark against 9.  We all make the assumption that carbohydrate turns into glucose, but how much glucose is produced from how much carbohydrate?


I imagine that there is no precise answer to that, as our unique gut biome plays a part in how food is digested and absorbed, hence i would vary from person to person.


----------



## Docb (Jan 30, 2020)

Agree with that Northener, and maybe a better understanding of the processes whereby carbohydrate is turned into glucose might give some leads into why there is such a large variability in the response of individuals to carbohydrate intake.


----------



## SB2015 (Jan 30, 2020)

No wonder it seems impossible at times!


----------



## Docb (Jan 30, 2020)

Yes and it prompted me to look at some numbers!  It's a long time since I did any serious chemistry but here goes.  Everything that follows is very much first approximation - not precise but trying to get a feel for things.

The mol wt of glucose is as near as dammit 180.  So, 1mmol of glucose weighs in at about  0.180g.  Round that up to 0.2g  

The average body contains about 5 litres of blood.  So, as a crude estimate, a rise of 1 mmol/l in blood glucose is equivalent to adding 5x0.2 = 1g of glucose to the system.  This is quite handy because it means that there is a one to one relationship between blood glucose level and glucose in the system.

Now, I will shortly be having my lunch which will contain around 30g of carbohydrate.  Again to a first approximation this has the potential to make 30g of glucose.  If all of this got dumped into my blood stream then it would in theory give me a 30 mmol/l spike.  It won't.  It will give me an increase of about 3 mmol/l suggesting an extra 3g of glucose has been dumped in my system.

I know it is a dynamic system and that glucose is being taken out but it still seems to me that the conversion of carbohydrate to glucose in my gut is not particularly efficient (thank goodness) and that this is the same for most people, otherwise diabetes would be rife amongst the whole population.  Also would suggest that relatively small changes in gut efficiency could give a significant change in effect of carbohydrate intake on blood glucose levels.

PS, if I have make a cock-up and got decimal points in the wrong place, then please tell me!


----------



## Northerner (Jan 30, 2020)

SB2015 said:


> No wonder it seems impossible at times!


It's why I've always had a degree of scepticism about the micro-managing of carbs down to the gram and insulin delivered in fractions of units to correspond according to a certain ratio - it's a start, of course, but you also need a pretty good understanding of your own body's tolerances and reactions in order to include those little intuitive adjustments that relate entirely to you


----------



## Northerner (Jan 30, 2020)

Docb said:


> Yes and it prompted me to look at some numbers!  It's a long time since I did any serious chemistry but here goes.  Everything that follows is very much first approximation - not precise but trying to get a feel for things.
> 
> The mol wt of glucose is as near as dammit 180.  So, 1mmol of glucose weighs in at about  0.180g.  Round that up to 0.2g
> 
> ...


Are you considering though that it's not just the glucose that is consumed that has an impact on the levels - the pancreas will produce minute amounts of insulin to correspond to the rise in blood glucose levels so it can be removed from the blood and stored in cells. The efficiency of this will depend on the insulin sensitivity of the person. So, you could get the whole 30g of glucose, but most of it gets moved into cells or converted to fat etc., so the gut may be very efficient. In fact, in a newly-diagnosed Type 1 who is producing no insulin then it's quite likely that the whole of that 30g would stay in the blood and cause a huge spike!


----------



## Eddy Edson (Jan 30, 2020)

Docb said:


> Yes and it prompted me to look at some numbers!  It's a long time since I did any serious chemistry but here goes.  Everything that follows is very much first approximation - not precise but trying to get a feel for things.
> 
> The mol wt of glucose is as near as dammit 180.  So, 1mmol of glucose weighs in at about  0.180g.  Round that up to 0.2g
> 
> ...



As Northie says, on a quick read I don't think you're taking sufficient account of the bod's efficiency in clearing glucose.

Eg: the OGTT, 75g of pure glucose.  According to some protocols, a "normal" reading at the 1 hr mark is < 10 mmol/L, so say a < 5 mmol/L rise from a pest-test level of 5 mmol/L, or something like that.  If the bod didn't quickly clear glucose, then on yr assumptions the rise would be something like 75 mmol/L, right?

Obviously, it may be that the "normal" subject might go above 10 mmol/L before the 1 hr mark, but nothing like a 75 mmol/L rise.

There's a "first insulin response", impaired in T2, by which insulin starts to be released pretty much as soon as you start eating.


----------



## Northerner (Jan 30, 2020)

Eddy Edson said:


> There's a "first insulin response", impaired in T2, by which insulin starts to be released pretty much as soon as you start eating.


I believe it's actually so fine-tuned that it starts before you begin eating, as you salivate in anticipation of the food!


----------



## Docb (Jan 30, 2020)

Take your points Eddy and Northerner.  Totally aware that we are talking about a highly dynamic system that has mechanisms for removing glucose whose efficiency varies from individual to individual.  The thing I was trying to explore, albeit in a very crude way, was the production side of the equation and trying to get a feel for whether it is something that can be forgotten about.  

Eddy, yes my crude sums would suggest 75g of pure glucose would give a spike of 75 mmol/l and that just does not happen in real life.  Could be because the "normal" body is very efficient at removing glucose from the blood.  Could be that the gut processes limit the rate at which glucose is absorbed into the blood stream.  Probably a bit of both.  I was a bit more interested in the conversion of carbohydrates in general into glucose.  My calcs assume that all that can be converted is converted instantaneously and dumped immediately into the blood.  That is obviously not the case.  This leads on to the questions of how much carbohydrate is converted, over what timescale is it converted and what controls absorption into the blood stream. 

No wonder there was a question mark against this topic in the original list.  I like question marks. Getting to grips with them is often a fruitful way of making progress in understanding.


----------



## Eddy Edson (Jan 30, 2020)

Docb said:


> Take your points Eddy and Northerner.  Totally aware that we are talking about a highly dynamic system that has mechanisms for removing glucose whose efficiency varies from individual to individual.  The thing I was trying to explore, albeit in a very crude way, was the production side of the equation and trying to get a feel for whether it is something that can be forgotten about.
> 
> Eddy, yes my crude sums would suggest 75g of pure glucose would give a spike of 75 mmol/l and that just does not happen in real life.  Could be because the "normal" body is very efficient at removing glucose from the blood.  Could be that the gut processes limit the rate at which glucose is absorbed into the blood stream.  Probably a bit of both.  I was a bit more interested in the conversion of carbohydrates in general into glucose.  My calcs assume that all that can be converted is converted instantaneously and dumped immediately into the blood.  That is obviously not the case.  This leads on to the questions of how much carbohydrate is converted, over what timescale is it converted and what controls absorption into the blood stream.
> 
> No wonder there was a question mark against this topic in the original list.  I like question marks. Getting to grips with them is often a fruitful way of making progress in understanding.



I found this kind of interesting:







UCCS = incooked corn starch; CP = corn pasta.  50g of glucose-equivalents in each case.

From https://academic.oup.com/jn/article/136/6/1511/4664360


----------



## PhoebeC (Jan 30, 2020)

Few things missing on it. There is a little link thats says for comments click here, but then it just went to the main page.

Sexual activity 
Pregnancy 
Menopause 
And just women's hormones full stop!


----------



## Docb (Jan 30, 2020)

Eddy Edson said:


> I found this kind of interesting:
> 
> 
> 
> ...



Interesting Eddy, especially the way the insulin follows the blood glucose.  Read the paper and got about half of it.  I wonder what the results would look like if they had a cohort of people with diabetes rather than a group of very healthy individuals.   Stats were a bit beyond my level so could not really work out how much variability there was between the participants.  Liked the area under graph approach to looking at the results.  Bet they did not do the analysis by hand - probably all done by the software package they reference.


----------



## littlevoice359 (Jun 3, 2022)

Northerner said:


> A useful list for when you're making that 'piece of cake' calculation
> 
> View attachment 13085
> 
> ...


It is a bit of a laundry list really, isn't it? I've come to think of T1D as like taking a car engine and pulling off a wire to one of the key sensors.  The result is that the engine might run, but how exactly is likely to be very unpredictable.  Or, another analogy is like piloting one of those leisure boats where, when you move the rudder/wheel, nothing happens for 20-30 seconds, but then you find you've over-steered and you're directly perpendicular to where you want to go. Most of my friends and family are totally oblivious to how tricky it can be to keep my blood sugar in target. I'll keep a copy of this chart on my phone to show them - might be useful that


----------

