Ok, so I'll start with the "what happens when we eat".

Yes, you typically "spike out" at the 1 hour mark. That is NORMAL and nothing to worry about as long as by the "2 hours after the first bite" you come back down into range.

The Doc may set your range based on your total health but absent of that, for the best long term outcome you want to be "below 8.0" at 2 hours after eating.

You say you sometimes go "low" - that is a relative term. As long as you are not going below 4.0 then there is nothing to worry about. That would be "low" but it would be the bottom end of "normal/safe low".

Should you be on medication?

Maybe

Medication for diabetes is split into two very broad groups. Meds to help with pesky Fasting/Between Meal numbers and pesky Post Meal numbers.

In general, in Canada, if your Fasting Numbers (so overnight or any time you haven't eaten for about 4 or 5 hours) are between 4.0 and 6.0 (with occasionally up to 7.0 being acceptable) then you don't need Metformin or a Basil Insulin.

If your post meal numbers, in general stay below 8.0 (measured at 2 hours after the first bite) but possibly as high as 10.0 (in some cases) then you don't need the various meds or Bolus Insulin to deal with after eating numbers.

If you don't (stick test) enough to see if either of those situations exist, then your Doc will rely on your A1C to decide whether to medicate.

Diabetes Canada guidelines are "A1C below 7.0, don't medicate" - so medicate above or down to 7.0 as a target.

For those of us (myself included) who treat "without meds" then the recommendation is to maintain an A1C of 6.5 "or less" for the best possible long term outcome.

I'm retired Airforce so understand completely - being on meds could leave you "not deployable".

Most Doctors in Canada, save Endocrinologists, just don't understand diabetes well enough so I could see why they might be confused.

They "treat" from something called a "consensus guideline" - a kinda flowchart that tells them what to do - just follow the boxes down the chart. It's written so they don't have to understand a single thing about diabetes and can still treat "most cases".

And absent of meds or some other hormone imbalance there is no (allowance) in the guidelines for "going low" - there is no "box" that tells them what to do if it is not medication induced.

But the (confusion) is nothing more then there "limited understanding" of the entire diabetes picture.

At least they don't "medicate to correct lows".

Yes, almost all of my lows happen at night.

The "lifesaver" is called the Symogyi Effect.

The brain constantly monitors our blood sugar levels. It doesn't care if we go through the roof but if we get low it sends out a signal to correct the issue.

It only becomes a problem if meds are involved. Insulin is the worst one because it will keep burning sugar no matter what the brain wants. A couple of oral meds are almost as bad (Sulfonylurea's are the worst of the bunch) and meds are actually one of the leading causes of death amongst Type 1 diabetics.

But if you are not on a "low causing med" (including a number of non-diabetes medications) or have some other medical condition that messes with blood sugar, then our system just won't let us go super dangerous low, it will self correct.

This is a CGM graph of two of my night time lows. The "blue band" is the safe zone. You can see my system let me get a little low for "somewhat less than an hour" before a sugar dump brought me back into the safe zone without any intervention on my part.

Type 2 is metabolic disorder so we each have a "unique diabetes" but do share common traits.

Why do you spike at 1/2 hour instead of an hour or even an hour and a half is because of two separate factors.

The first is the "type of carbs you ate". Some carbs, particularly "non-resistant starches" such as are found in "white foods" (potato, rice, bread, pasta etc) are "naturally" metabolized super fast.

Our saliva and stomach acid are almost super charged into breaking down those starches into simple sugars which are easily and quickly absorbed once they hit the small intestine (which sucks all the good out of what we eat).

Now mixing them (or any other sugars and starches for that matter) with Protein will slow down the process a bit - mixing them with Fat will really slow it down (relatively speaking) but they will still be absorbed "quickly" - somewhat less than a hour "in the average person".

But again, digestion is driven by our metabolism - and we are each unique. Maybe yours works "faster than most".

So you may have simply experienced a "double whammy" - you ate some carbs that naturally get absorbed quicker than others AND your digestive system works a little faster than average so you "peaked out" at 30 minutes instead of an hour.

But don't get hung up on "precise timings". CGM data will show you how you are reacting to different foods. Picking numbers like "1 hour to peak" is just an "average" which means half the time it's longer, the other half is shorter.

Diabetes is a game of averages and where you end up. Is your Average blood sugar good? And at the "designated times to test" - when you first wake up before eating/drinking or 2 hours after a meal, are your numbers where they need to be.

If they are then "what they did in between" is of little consequence because "where they are" provides all the information that is "diagnostically relevant".

With the lows there is a few different "points of concern".

4.0 is looked at as kinda as low as you typically want to be.

I occasionally drop into the high 3's myself (more than few 3.8's on my meter) and have been below 3 (2.8) one time (recorded by a CGM and confirmed with a stick test), but for me those are rare.

If you drop below 4.0 then it is "good practice" to get about 15 carbs into you - about 4oz of regular fruit juice (apple/orange) will fix that nicely.

If you get down closer to 3.0 on a few occasions then maybe it's a good idea to keep some glucose tablets on hand (get them from the pharmacy) - they will get your sugars up quickly. And you absolutely need them if you venture down in the 2's.

In the lower 2's you will usually get the sweats, shakes, may lose balance, consciousness and may seize - you can experience some of these symptoms even at (higher - in the 3's or 4's levels) in some cases but they are "dangerous" if you are reading in the 2's.

If you somehow get all the way down to 1.9 it's game over. The brain will die because it needs a sugar level of "at least" 1.9 to function.

Now, if you are not on Meds that are "artificially" bringing your sugar levels down, then unless you have some other major hormone defect (which usually involves either the adrenal glands, the pituitary or the thyroid) then we have a "built in guardian system" that will correct the low all on it's own.

It will let your sugars drop down to somewhere between 2.8 and 3.2 and then it sends out a signal to the liver for a "sugar dump" (liver stores sugar for when we are not eating - kinda like a "gas tank") and it will bring you back above 4.0 in relatively short order (like 15 minutes).

(this got long so I will address your spike at 30 min vice 1 hour in a follow-up post)