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Why Does Acute Kidney Injury Cause Metabolic Acidosis?

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Acute kidney injury (also called acute renal failure) nursing NCLEX review lecture on the nursing management, stages, pathophysiology, and causes (prerenal, intrarenal, postrenal). What is Acute Kidney Injury? It is the SUDDEN decrease in renal function that leads to the build up of waste in the blood, fluid overload, and electrolyte imbalances. What are the causes of Acute Kidney Injury? There are three causes, which are based on location. The first is known as prerenal injury and this is an issue with the perfusion to the kidneys that leads to decreased renal function. A second cause is known as intrarenal injury, and this is due to damage to the nephrons of the kidney. Lastly, postrenal injury is due to a blockage located in the urinary tract after the kidney that can extend to the urethra. This is causing the back flow of urine, which increases the pressure and waste in the kidneys. Stages of Acute Kidney Injury: There are four stage of acute kidney injury, which include initiation, oliguric, diuresis, and recovery stage. The initiation stage starts when a cause creates an injury to the kidney and then signs and symptoms start to appear. This leads to the oliguric stages. The patient will void less than 400 mL/day of urine during this stage and will experience increased BUN/creatinine levels, azotemia, hyperkalemia, hypervolemia, increase phosphate and decreased calcium levels along with metabolic acidosis. After this stage the patient can progress to the diuresis stage and this is where the patient will void 3-6 Liters of urine per day due to osmotic diuresis. The patient is at risk for hypokalemia, dehydration, and hypovolemia. The last stage is recovery and the patient's glomerular filtration rate has returned to normal. Therefore, the kidneys are able to maintain normal BUN and creatinine levels, electrolyte, and water levels. Quiz on Acute Kidney Injury: http://www.registerednursern.com/acut... Notes: http://www.registerednursern.com/acut... More NCLEX Renal Lectures: https://www.youtube.com/playlist?list... Subscribe: http://www.youtube.com/subscription_c... Nursing School Supplies: http://www.registerednursern.com/the-... Visit our website RegisteredNurseRN.com for free quizzes, nursing care plans, salary information, job search, and much more: http://www.registerednursern.com Check out other Videos: https://www.youtube.com/user/Register... All of our videos in a playlist: https://www.youtube.com/watch?v=pAhHx... Popular Playlists: NCLEX Reviews: https://www.youtube.com/playlist?list... Fluid & Electrolytes: https://www.youtube.com/playlist?list... Nursing Skills: https://www.youtube.com/playlist?list... Nursing School Study Tips: https://www.youtube.com/playlist?list... Nursing School Tips & Questions" https://www.youtube.com/playlist?list... Teaching Tutorials: https://www.youtube.com/playlist?list... Types of Nursing Specialties: https://www.youtube.com/playlist?list... Healthcare Salary Information: https://www.youtube.com/playlist?list... New Nurse Tips: https://www.youtube.com/playlist?list... Nursing Career Help: https://www.youtube.com/playlist?list... EKG Teaching Tutorials: https://www.youtube.com/playlist?list... Dosage & Calculations for Nurses: https://www.youtube.com/playlist?list... Diabetes Health Managment: https://www.youtube.com/playlist?list...

Metabolic Acidosis Aggravates Experimental Acute Kidney Injury

Volume 146 , 1 February 2016, Pages 58-65 Metabolic acidosis aggravates experimental acute kidney injury Ischemia/reperfusion (I/R) injury and metabolic acidosis (MA) are two critical conditions that may simultaneously occur in clinical practice. The result of this combination can be harmful to the kidneys, but this issue has not been thoroughly investigated. The present study evaluated the influence of low systemic pH on various parameters of kidney function in rats that were subjected to an experimental model of renal I/R injury. Metabolic acidosis was induced in male Wistar rats by ingesting ammonium chloride (NH4Cl) in tap water, beginning 2days before ischemic insult and maintained during the entire study. Ischemia/reperfusion was induced by clamping both renal arteries for 45min, followed by 48h of reperfusion. Four groups were studied: control (subjected to sham surgery, n=8), I/R (n=8), metabolic acidosis (MA; 0.28M NH4Cl solution and sham surgery, n=6), and MA+I/R (0.28M NH4Cl solution plus I/R, n=9). Compared with I/R rats, MA+I/R rats exhibited higher mortality (50 vs. 11%, p=0.03), significant reductions of blood pH, plasma bicarbonate (pBic), and standard base excess Continue reading >>

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  1. AMZMD

    The human body is in a constant process of maintaining equilibrium. The byproducts of burning fat for energy (ketones) are deposited in the blood for excretion. As the ketones build up in your system, the pH of your blood drops and you become acidotic. As stated above, your body is trying to maintain equilibrium, so it will do certain things to eliminate as much acid from your system as possible, as quickly as possible. One way is to vomit, which dumps huge amounts of H+ instantly. Other reactions are increased respirations to eliminate CO2, as well as dumping the ketones and H+ out through your urine.
    As a side note, the dumping of H+ through urine causes the retention of potassium and you become hyperkalemic (aka "too-much-potassium-emia"). This inhibits myocardial function and can put you into cardiac arrest. This is why extreme no-carb diets are a very bad thing!
    Hope that helps!

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Want a chronic kidney disease stage 3 diet? Try this for a chronic kidney disease stage 3 diet click here http://kidney.diethere.net/kidney-dis... - the best diet for kidney disease Read the testimonials from other followers of the kidney diet secrets. These are all extracts from testimonials that people who have used the Kidney diet to drastically change their lives and regained health; The Kidney Diet Secrets Guide Book was easy enough for an active guy like me to follow. It took sometime, but I managed to do it. No more kidney stones for 3 years. I know it will never come back once you really beat the root cause. This book taught me to get rid of kidney stones right from the roots. I was diagnosed with acute renal failure 7 months ago. I thought it was the end for me as the doctor's tone of voice implied. I did my research, and came across your guide. That was one of the best days in my life....being a business consultant, I had to travel a lot by land and by air...I thought I would never be able to follow the Kidney Diet Secrets guide but I was wrong. 11 months after, I'm still easily eating kidney-healthy diet and it never took control of my life. Thanks again! My family and I used to be very frustrated because the doctors wouldn't give us enough information for my father who has kidney failure for 3 years. 'eat a low protein diet' is never enough. How low is low? etc. This book solved everything about that. Now my father does not experience fatigue and is as happy as ever. Thanks!" I had chronic kidney disease (CKD) for 6 years before I got a hold of this book. Few weeks later after I had my regularly scheduled laboratory test for kidney function, my doctor was amazed my kidneys were progressing. It continues until today after all these months. I really am thankful to have come across this amazing guide. Easily the Best book in Kidney Disease anywhere. And the recipes included are simply the best! I had to endure having high blood pressure since I was 40, diagnosed with acute renal failure a few months later and I was advised to get ready for dialysis by my doctor. After having through your book and following your advise, It's been 1 year and 5 months I still haven't undergone dialysis. I owe it to you and your diet method Rachelle. Thank you. My Doctor Was Amazed...I promised to give you a testimonial if it worked for me. And surely enough.. it did!...the doctor was amazed how my creatinine got back to normal range pretty quickly. Everything is laid out in an easy and understandable manner. Not a single medical jargon! I definitely recommend the book to anyone with chronic kidney disease - even if you only get a couple of tips from it, they have got to be the tips that will save you from dialysis or a transplant! Glad I found your guide! "Its a Must for Kidney Patients..." This book, in my opinion, is a must for kidney patients. It wasn't easy at first, but I'm very much used to it now. Well written and easy to understand, it gave me a much better understanding of CKD and what I need to do to live a longer and healthier life. Dialysis is not something I want to experience. For those seeking information on Kidney Disease and how to best deal with it, the biggest frustration is the lack of good information available. The author explains why not much has been done about educating the public with kidney disease. A lot of good information I haven't found anywhere up until today! "GFR Shoot up in a few weeks!" The book spells out how diet and restricting certain foods can stop and even reverse kidney disease. I had a blood test done and found that my GFR was only 26 - Stage 4 Kidney Disease - that was a huge shock to me since it went from above 60 down to 26 in five months! That was a huge motivator for me to do try out the Kidney Diet Secrets and it worked! You need to check out the Kidney Diet for yourself and you can do it RISK FREE. Find out information on kidney diet, kidney diet secrets, diet kidney disease, kidney disease diet, diet for kidney disease, chronic kidney disease diet, polycystic kidney disease diet, kidney disease diet plan, chronic kidney disease treatment, diet for chronic kidney disease, stage 3 kidney disease diet, low protein diet kidney disease, low protein diet for kidney disease, kidney disease diet restrictions, diets for kidney disease, kidney disease diets, diet for stage 3 kidney disease, diet for polycystic kidney disease, chronic kidney disease stage 3 diet, chronic kidney disease diet plan, stage 4 kidney disease diet, kidney disease diet recipes, diet and kidney disease, diabetic kidney disease diet, best diet for kidney disease, how to treat chronic kidney disease, diet plan for kidney disease, diet for people with kidney disease, diet for kidney disease patients, just go to http://kidney.diethere.net or dietkidneydisease to see videos:, http://youtu.be/pzA1GuZASI8, http://youtu.be/uvIpUcWH2tE, http://youtu.be/bN08Utq_6aM

Metabolic Acidosis And The Progression Of Chronic Kidney Disease

Metabolic acidosis and the progression of chronic kidney disease 1Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA 2Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY 10461, USA 1Division of Nephrology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA 2Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Ullmann 615, Bronx, NY 10461, USA Received 2014 Jan 8; Accepted 2014 Mar 31. Copyright 2014 Chen and Abramowitz; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( ) applies to the data made available in this article, unless otherwise stated. This article has been cited by other articles in PMC. Metabolic acidosis is a common complication of chronic kidney disease. Accumulating evidence identifies acidosi Continue reading >>

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  1. INM8_2

    after taking a break from keto and undoing most of what i had accomplished, i have learned from the errors of my carb-laden ways and returned. i've kept up with the sub in the mean time and noticed that there are always questions regarding protein shakes and keto. here is my recipe for a very keto-friendly shake:
    8 oz silk purealmond unsweetened almond milk
    2 oz heavy cream
    1 scoop isopure protein isolate powder
    edit: if you don't already have one, invest in a blender bottle. the shaker thickens up the cream and negates the thinness of the almond milk. it will feel a lot more substantial when you drink it.
    the macros break down as follows:
    335 calories (100%)
    1 g carbs (1%)
    24 g fat (66%)
    26 g protein (33%)
    remember to be extremely careful in what protein powders you select as a lot of them are loaded with carbs. protein isolates, in my experience, are definitely the way to go. for ~$45 for a 3 lb container of isopure (from amazon), you can get enough protein to make 44 shakes (serving size is 2 scoops, but i only use 1).
    anyhow, it's great to be back in the fold and good luck to everyone in reaching and/or maintaining their keto goals!

  2. weightistoodamnhigh

    I use the same but also add a scoop of casein powder, a tbsp of coconut oil and blend with ice cubes in a bullet.
    The whey/isolate is good for quick energy while the casein takes it a little longer. The fats quell hunger and I can last a good 6 to 8 hours before refuel.

  3. Unremoved

    Are you saying you use a scoop of isolate as well as a scoop of the casein? I'm all for quelling hunger. My only concern is that I tend to be top-heavy on my proteins and tend to struggle to maintain fats in any given day. I use coconut oil in the coffee, but aside from that and the occasional dark cut of meat, hitting 65% on my macro is rough.

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Understand acute kidney injury (formerly called acute renal failure) with this clear explanation from Dr. Seheult of http://www.medcram.com. This series covers causes, symptoms, diagnosis and treatment of acute renal failure. The difference between pre-renal and post-renal failure, and the BUN Creatinine ratio are also illustrated. This video 1 of 3 on acute kidney injury. Speaker: Roger Seheult, MD Clinical and Exam Preparation Instructor Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine. Co-founder of http://www.medcram.com MedCram: Medical topics explained clearly including: Asthma, COPD, Acute Renal Failure, Mechanical Ventilation, Oxygen Hemoglobin Dissociation Curve, Hypertension, Shock, Diabetic Ketoacidosis (DKA), Medical Acid Base, VQ Mismatch, Hyponatremia, Liver Function Tests, Pulmonary Function Tests (PFTs), Adrenal Gland, Pneumonia Treatment, any many others. New topics are often added weekly- please subscribe to help support MedCram and become notified when new videos have been uploaded. Subscribe: https://www.youtube.com/subscription_... Recommended Audience: Health care professionals and medical students including physicians, nurse practitioners, physician assistants, nurses, respiratory therapists, EMT and paramedics, and many others. Review for USMLE, MCAT, PANCE, NCLEX, NAPLEX, NDBE, RN, RT, MD, DO, PA, NP school and board examinations. More from MedCram: Complete Video library: https://www.youtube.com/c/medcram Subscribe: https://www.youtube.com/subscription_... Facebook: https://www.facebook.com/MedCram Google+: https://plus.google.com/u/1/+Medcram Twitter: https://twitter.com/MedCramVideos Produced by Kyle Allred PA-C Please note: MedCram medical videos, medical lectures, medical illustrations, and medical animations are for medical educational and exam preparation purposes, and not intended to replace recommendations by your health care provider.

Acute Kidney Injury: Complications Associated With Acute Kidney Injury

Acute Kidney Injury: Complications associated with Acute Kidney Injury Acute Kidney Injury: Complications associated with Acute Kidney Injury Does this patient have complications associated with acute kidney injury? Acute kidney injury (AKI) is often associated with systemic complications including volume overload; electrolyte and acid-base disturbances, particularly hyponatremia, hyperkalemia and metabolic acidosis; nutritional and gastrointestinal disturbances; anemia and bleeding diatheses, and increased risk of infection. It is often difficult, however, to differentiate complications related to the AKI per se from those related to the underlying cause of AKI. See reviews of specific conditions below for appropriate tests, if any. How should patients with complications associated with AKI be managed? Disturbances of volume homeostasis are extremely common in the setting of AKI. Although effective intravascular volume depletion is a common contributing factor in the development of AKI it is an uncommon complication of AKI. Volume depletion as a result of renal salt and water wasting occasionally develops in patients with non-oliguric AKI; more commonly it may develop during reco Continue reading >>

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  1. musio

    I've read a few posts on here about using a glucosemeter so I was just looking for some pointers.
    How many times should i take a reading?
    When (after meals/before?)
    From what i understand, it should read 5.6 or below for keto?
    Why haven't i read about this method on the net? As ketostix could be unreliable and this is a sure thing since you are taking your blood and can see how food effects you, I thought there would be much more on the net rather than the cobwebs i've tried to google!
    Thanks for any tips!

  2. ausbuilt

    there's plenty of information on BG levels and ketosis- do you know there are forums like this relating to diabetics- its where i learned loads; also I learned loads from books (and a few emails) from Dan Duchaine.
    OK its not that you use an BG meter to "detect" ketosis, because a BG meter by nature reads BLOOD GLUCOSE levels.
    However, you have to understand what ketosis is.
    first, for your body to burn energy, there is a process called the citric acid cycle (Krebs cycle):
    http://en.wikipedia.org/wiki/Citric_acid_cycle
    you will notice the following from that link:
    Major metabolic pathways converging on the TCA cycle
    Several catabolic pathways converge on the TCA cycle. Reactions that form intermediates of the TCA cycle in order to replenish them (especially during the scarcity of the intermediates) are called anaplerotic reactions.
    The citric acid cycle is the third step in carbohydrate catabolism (the breakdown of sugars). Glycolysis breaks glucose (a six-carbon-molecule) down into pyruvate (a three-carbon molecule). In eukaryotes, pyruvate moves into the mitochondria. It is converted into acetyl-CoA by decarboxylation and enters the citric acid cycle.
    2. In protein catabolism, proteins are broken down by proteases into their constituent amino acids. The carbon backbone of these amino acids can become a source of energy by being converted to acetyl-CoA and entering into the citric acid cycle.
    3.In fat catabolism, triglycerides are hydrolyzed to break them into fatty acids and glycerol.
    In the liver the glycerol can be converted into glucose via dihydroxyacetone phosphate and glyceraldehyde-3-phosphate by way of gluconeogenesis. In many tissues, especially heart tissue, fatty acids are broken down through a process known as beta oxidation, which results in acetyl-CoA, which can be used in the citric acid cycle. Beta oxidation of fatty acids with an odd number of methylene groups produces propionyl CoA, which is then converted into succinyl-CoA and fed into the citric acid cycle.[12]
    The total energy gained from the complete breakdown of one molecule of glucose by glycolysis, the citric acid cycle, and oxidative phosphorylation equals about 30 ATP molecules, in eukaryotes. The citric acid cycle is called an amphibolic pathway because it participates in both catabolism and anabolism.
    SO what this means is, your body moves from Glycolysis (burning glucose) to gluconeogenesis (burning amino acids from broken down protein- i.e muscle break down!) when blood sugar/glucose is below 5.6-5.8 mmol/L (this is called fasting glucose levels- ie. the level of blood sugar when you eat nothing! i.e when you wake up having gone 8+ hours without food..)
    however if there is not enough aminos available (usually because of AAS which retain nitrogen, -the "N' in the -NH3 amine molecule that makes an amino acid) the body moves from gluconeogenesis to ketosis (converting tri-glycerides to ketones, which in turn are used for energy in the krebs cycle.
    see also, in the order that they happen:
    http://en.wikipedia.org/wiki/Glycolysis
    http://en.wikipedia.org/wiki/Gluconeogenesis
    http://en.wikipedia.org/wiki/Ketosis
    so to get into ketosis, your BG reading MUST be at a fasted level; however this does not mean you are in ketosis immediately- usually it means you're in gluconeogenesis... and it can take 48 hours 60 hours to get into keto, unless you do cardio, or.. speed things up with met or 'slin..
    The use of BG monitor is so that when you take ZERO (or close to zero) carbs, you will move into gluconeogenesis, and then ketosis- however if you're above 5.6 on the BG, then its IMPOSSIBLE to be in ketosis..
    now how do you know you're in gluconeogenesis? easy.. you eat ZERO carbs, yet your BG readings are ABOVE 5.6 (usually around 6.0-6.2)...
    if you take AAS/T4 or T3 and met or 'slin you FORCE your body to move through/past gluconeogenesis VERY quickly... I can get a reading on keto stix in 10-12hours using AAS/T4/'slin.. as AAS retain aminos, and T4 and 'slin ALSO promote protein synthesis (anabolism) rather than burning aminos for energy.. so you have 3 actions to stop your body using aminos for energy..
    at any rate, the BG meter is useful to see that you are allowing yourself to get into keto (must be at fasted blood glucose levels),and also when eating keto meals, will tell you if protein intake is to high/fats to low- you will read above 5.6 even if taking in ZERO carbs....
    I haven't made any of this up, but don't forget diabetics are told ketosis is to BE AVOIDED and that its A BAD state for your body to be in... which is true- its the least preferred method of energy use, and its catabolic..
    as for measuring- a normal non diabetic should have close to fasted BG levels at 2-4 hours after eating. You need to measure at 15/30/60min post meal to make sure you haven't spiked above 5.6 with what you consumed.. Edited February 2, 2011 by ausbuilt

  3. Fatstuff

    ausbuilt said:

    there's plenty of information on BG levels and ketosis- do you know there are forums like this relating to diabetics- its where i learned loads; also I learned loads from books (and a few emails) from Dan Duchaine.
    OK its not that you use an BG meter to "detect" ketosis, because a BG meter by nature reads BLOOD GLUCOSE levels.
    However, you have to understand what ketosis is.
    first, for your body to burn energy, there is a process called the citric acid cycle (Krebs cycle):
    http://en.wikipedia.org/wiki/Citric_acid_cycle
    you will notice the following from that link:
    Major metabolic pathways converging on the TCA cycle
    Several catabolic pathways converge on the TCA cycle. Reactions that form intermediates of the TCA cycle in order to replenish them (especially during the scarcity of the intermediates) are called anaplerotic reactions.
    The citric acid cycle is the third step in carbohydrate catabolism (the breakdown of sugars). Glycolysis breaks glucose (a six-carbon-molecule) down into pyruvate (a three-carbon molecule). In eukaryotes, pyruvate moves into the mitochondria. It is converted into acetyl-CoA by decarboxylation and enters the citric acid cycle.
    2. In protein catabolism, proteins are broken down by proteases into their constituent amino acids. The carbon backbone of these amino acids can become a source of energy by being converted to acetyl-CoA and entering into the citric acid cycle.
    3.In fat catabolism, triglycerides are hydrolyzed to break them into fatty acids and glycerol.
    In the liver the glycerol can be converted into glucose via dihydroxyacetone phosphate and glyceraldehyde-3-phosphate by way of gluconeogenesis. In many tissues, especially heart tissue, fatty acids are broken down through a process known as beta oxidation, which results in acetyl-CoA, which can be used in the citric acid cycle. Beta oxidation of fatty acids with an odd number of methylene groups produces propionyl CoA, which is then converted into succinyl-CoA and fed into the citric acid cycle.[12]
    The total energy gained from the complete breakdown of one molecule of glucose by glycolysis, the citric acid cycle, and oxidative phosphorylation equals about 30 ATP molecules, in eukaryotes. The citric acid cycle is called an amphibolic pathway because it participates in both catabolism and anabolism.
    SO what this means is, your body moves from Glycolysis (burning glucose) to gluconeogenesis (burning amino acids from broken down protein- i.e muscle break down!) when blood sugar/glucose is below 5.6-5.8 mmol/L (this is called fasting glucose levels- ie. the level of blood sugar when you eat nothing! i.e when you wake up having gone 8+ hours without food..)
    however if there is not enough aminos available (usually because of AAS which retain nitrogen, -the "N' in the -NH3 amine molecule that makes an amino acid) the body moves from gluconeogenesis to ketosis (converting tri-glycerides to ketones, which in turn are used for energy in the krebs cycle.
    see also, in the order that they happen:
    http://en.wikipedia.org/wiki/Glycolysis
    http://en.wikipedia.org/wiki/Gluconeogenesis
    http://en.wikipedia.org/wiki/Ketosis
    so to get into ketosis, your BG reading MUST be at a fasted level; however this does not mean you are in ketosis immediately- usually it means you're in gluconeogenesis... and it can take 48 hours 60 hours to get into keto, unless you do cardio, or.. speed things up with met or 'slin..
    The use of BG monitor is so that when you take ZERO (or close to zero) carbs, you will move into gluconeogenesis, and then ketosis- however if you're above 5.6 on the BG, then its IMPOSSIBLE to be in ketosis..
    now how do you know you're in gluconeogenesis? easy.. you eat ZERO carbs, yet your BG readings are ABOVE 5.6 (usually around 6.0-6.2)...
    if you take AAS/T4 or T3 and met or 'slin you FORCE your body to move through/past gluconeogenesis VERY quickly... I can get a reading on keto stix in 10-12hours using AAS/T4/'slin.. as AAS retain aminos, and T4 and 'slin ALSO promote protein synthesis (anabolism) rather than burning aminos for energy.. so you have 3 actions to stop your body using aminos for energy..
    at any rate, the BG meter is useful to see that you are allowing yourself to get into keto (must be at fasted blood glucose levels),and also when eating keto meals, will tell you if protein intake is to high/fats to low- you will read above 5.6 even if taking in ZERO carbs....
    I haven't made any of this up, but don't forget diabetics are told ketosis is to BE AVOIDED and that its A BAD state for your body to be in... which is true- its the least preferred method of energy use, and its catabolic..
    as for measuring- a normal non diabetic should have close to fasted BG levels at 2-4 hours after eating. You need to measure at 15/30/60min post meal to make sure you haven't spiked above 5.6 with what you consumed..
    in a nutshell?

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