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High glucose spikes are common in 'healthy' people

Continuous glucose monitoring shows levels vary throughout day in people considered normoglycaemic

Ingrid Torjesen

Wednesday, 25 July 2018

A study* published in the journal PLOS Biology has revealed that "normal" blood glucose levels are often not normal at all – straying much farther from the healthy ranges than we assumed.

The most common ways to measure blood glucose are by testing a fasting blood sample, which will reveal the level at that particular point in time, and by testing levels of glycated haemoglobin, "HbA1C," which reflects average blood glucose for the last three months. However, neither of these measurements reveals the dynamic changes that occur throughout the day. More recently, continuous glucose monitors have been used by some patients with diabetes and these have illustrated the level of variations throughout the day in diabetes.

In this study, researchers at Stanford University used continuous glucose monitoring in 57 "healthy" participants to show that large fluctuations in blood glucose happen in “healthy” people.

The researchers concluded that people can be classified into three distinct "glucotypes" or glucose behaviours: those whose glucose does not vary much (low), those who spike often (severe), and those in between (moderate).

People considered normoglycaemic had glucose levels in the prediabetes and diabetes range 15% and 2% of the time respectively.

"We were very surprised to see blood sugar in the prediabetic and diabetic range in these people so frequently," said Michael Snyder, professor and chair of genetics at Stanford and senior author of the study.

"The idea is to try to find out what makes someone a ‘spiker’ and be able to give them actionable advice to shift them into the low glucotype."

To assess how different people react to the same meal, the researchers provided three different standardised breakfasts to 30 of the participants: corn flakes with milk, bread with peanut butter, and a nutrition bar. Each of their responses to these meals was unique, suggesting that people metabolise the same nutrients in an individualized way.

Certain foods such as corn flakes caused a large glucose spike in most participants, and as food has a major impact on glucose fluctuations, the research team is building models to predict the foods that personally affect each individual.

Synder said: "Our next study will delve into the physiological causes of glucose dysregulation." He continued, "These include not only genetic variation, but also microbiome composition, and pancreas, liver, and digestive organ functions." In this manner the Stanford team hope to better control glucose dysregulation and prevent diabetes and its associated complications such as cardiovascular disease.

*Citation: Hall H, Perelman D, Breschi A, Limcaoco P, Kellogg R, McLaughlin T, et al. (2018) Glucotypes reveal new patterns of glucose dysregulation. PLoS Biol 16(7): e2005143. Doi: 10.1371/journal.pbio.2005143.

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