rrtmd Posted November 12, 2016 Posted November 12, 2016 I'm having difficulty understanding the rise in glucose starting about 30 minutes after a meal that occurs in type 1 diabetics. Obviously enough, they lack insulin to cope with postprandial glucose. However, everything I read seems to indicate that gastric emptying for a typical meal in anyone doesn't start until about an hour after the meal, reaches 50% about 2-3 hours afterwards, and isn't finished until 4-5 afterwards. Even ignoring that type 1s might exhibit gastroparesis which would slow down emptying even more, it seems contrary to what a typical graphs show for type 1 postprandial glucose concentrations. I thought initially it was because the studies were just using glucose solution, but those I found that used regular types of meals indicated a similar results. Indeed, the studies in general don't seem to produce results that correlate well with what physiologists indicate is normal gastric emptying. So where is the glucose coming from that produces the 30-60 minute spike in these studies?
Function Posted November 12, 2016 Posted November 12, 2016 (edited) I'm no professional in gastrointestinal motility, so I can't confirm, neither deny the times you give, but there's such thing as a gastrocolic reflex; when eating, not only your stomach 'starts' working (a rather complex mechanism mediated by cholinergic pathways), but also your small and large intestines, which may contribute to absorption of glucose and, downstream, a rise of glycemia. Edited November 12, 2016 by Function
rrtmd Posted November 13, 2016 Author Posted November 13, 2016 "...which may contribute to absorption of glucose and, downstream, a rise of glycemia."??? Actually, I was thinking along those lines myself. The thing is that type 1s currently calculate their insulin dose based upon the carb content and types of food in the meal they are about to eat. Somehow that seems erroneous. Even ignoring the possibility of gastroparesis, the meal will be sitting in their stomach presumably at least an hour, and won't be fully distributed to the small intestine for up to 4-5 hours. It seems like it would be more rational to calculate the dose based, at least to some extent, on what they ate during the PREVIOUS meal.
BabcockHall Posted December 12, 2016 Posted December 12, 2016 The size and composition of the meal are probably factors which go into how quickly the stomach empties a given meal.
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