As a sidebar to my recent post wrapping up my Carb Nite experiment, I wanted to touch on a train of thought I had about blood glucose levels, low carb/ketogenic diets, and diabetes.
When I published my blog post discussing the results I was seeing with the carb nite meals and my own blood glucose results I received a few, almost shocked, comments about the high levels (200 - 300 mg/dL with one measurement over 300) that I saw following the high carb meals. Quoting one of the comments; "Those blood glucose peaks are at dangerous, diabetic levels."
It got me thinking: What is a "dangerous" blood glucose level? Does this mean I'm diabetic? I was fascinated by these questions.
Dangerous Blood Glucose Levels
First, the question of what is a dangerous level of blood glucose. Since I didn't know that answer, I did some research. I found that a truly dangerous level of hyperglycemia (high blood glucose level) occurs more in the range of 600 mg/dL, and is a condition known as "Hyperosmolar Hyperglycemic Nonketotic Syndrome" (HHNS). This most likely occurs with Type 2 diabetics, often when they have some other illness and are unable to rehydrate effectively, thereby raising the ratio of glucose in the blood. The body tries to reduce that level by increasing urination but that only exacerbates the situation. This condition can lead to seizures, heart attack, stroke and coma. I saw references to death rates with this condition as high as 40%, recognizing that these patients are typically very sick to begin with.
My glucose levels didn't spike nearly as high as this and I'm convinced that this couldn't happen simply through food -- however glycemic they are.
Chronic vs Acute
To understand the concept of "dangerous" I think it's important to separate chronic versus acute conditions. HHNS is an acute and very dangerous condition. It lasts for a short period of time (the patient would either get the condition corrected or would die), is very pronounced and it is an immediate threat.
Someone with pre-diabetes or diabetes has a dangerous condition because it is chronic. It's a condition that lasts over a long period of time, in this case many years. The damage is done because the blood glucose, and insulin levels, are elevated constantly and regularly, several times a day.
In the case of glucose and insulin spikes as a result of something like Carb Nite it is more what I would characterize as hormesis. Hormesis is a phenomenon where a brief exposure to something that would normally cause harm actually triggers a response from the body that is positive. There are numerous examples of this process. Two that come to mind are exercise and vaccines. When we exercise we cause damage to muscles. Our bodies respond by rebuilding the muscles and actually making them come back stronger in preparation for future challenges.
While it may not technically be considered hormesis, you can think of vaccinations in the same way. We expose our bodies to something that would normally be bad for us (a weakened virus for example.) This triggers a response by the body, which forms antibodies strengthening our immune system against a potential future exposure to that same virus.
The Carb Nite Solution is really a form of hormesis is some respect. If we agree that constant exposure to high levels of glucose and insulin is harmful over a long period of time, then brief spikes of such exposure (say one night a week) might create that same hormetic effect, stimulating the body to be better able to deal with it. (Improve insulin sensitivity.)
So while the glucose, and by extension insulin, spikes in this experiment were indeed very high, they were acute and not chronic. In fact, by my HgA1C numbers, on average, there is little damage being done by the glucose in my system (even after the experiment.)
If a Diabetic Doesn't Consume Carbohydrates . . .
Looping back to the title of this post, the old saying; "If a tree falls in a forest and nobody is around, does it make a sound?" I won't attempt to answer that, but by extension; "If a diabetic doesn't consume carbohydrates, are they diabetic?"
I have heard diabetes (at this point lets consider Type 2) described as a disease characterized by the inability to properly metabolize carbohydrates. When a type 2 diabetic switches to a very low carbohydrate diet, they typically see rapid, positive results. When you have an inability to handle carbohydrates, and you stop consuming them, then you should eliminate most of your problems.
But if the diabetic starts consuming carbohydrates they likely will quickly see issues with high blood sugar return, and over time the damage to their body will start to accumulate again.
I would guess that how quickly the problems return would depend on how damaged their metabolism was to begin with -- how weak is their pancreas (and the beta cells within) and how limited their ability to produce insulin.
In my case, I was pre-diabetic back when I started a low carb approach. With this experiment, the high glucose spikes reveal that my metabolism still has difficulty processing carbohydrates. (The damage of some 50+ years of abuse has taken its toll.) As long as I continue a low carb approach, I have none of the symptoms, nor blood glucose and A1c measures of pre-diabetes. So am I pre-diabetic as long as I'm on a low carbohydrate diet, or not. If a tree falls in a forest . . .