50 g sugar empty stomach vs. 150 g with much food

From a pancreas/diabetes/health perspective, which is worse: Consuming 50 grams of sugar (say, one big bottle of apple juice) on a empty stomach and thus having a big sudden jump in blood sugar , or consuming 150 grams of sugar throughout the day (but each time accompanied with fat, fiber, and protein to slow down the spike?)
Is it the suddenness of the sugar spike that does the harm, or the total amount of sugar consumed?

If it’s actual sugar, once you’re done chewing & swallowing it’s on its way to the bloodstream. Sugar gets digested and into the blood within about 15 minutes, no matter what it’s hiding behind. If you’re talking 150g of other carbs, then the amount of fat in the food you’re eating can slow the process down. Bottom line based on my experience as a diabetic, every meal is different and I only use sugar or glucose tablets if I have to get my blood sugar up right damn now.

Oops, I misread your question.

The suddenness of the sugar spike doesn’t seem to do much harm, it’s just tricky to predict how much of a spike you’re going to get and how long your glucose level will be higher than it should be: humalog takes 2 hours to do its thing, Lantus works slowly for 24 hours, and if you eat white sugar, 15 minutes later it’s all in your bloodstream and your blood sugar will be high until the insulin gets a chance to chip away at it. If you’re eating more complex carbs like grain or vegetables, then it can take a couple hours to get into your bloodstream, so the net highest-level of blood glucose will probably be lower.

Actually, I think your first answer was also on point. Any added sugar is going to be absorbed quite quickly from chewed up food, whatever that food is. Perhaps not quite as quickly as a pure sugar solution like apple juice, but it won’t bear any relation to the glycemic index of the food - the notion of low glycemic index and slow release only applies to the digestion of carbohydrate that is an integral part of the foodstuff.

Ah Ok thanks. So all that talk about glucemic index actually does NOT work for simple sugars, only complex ones? (So for instance, eating a cheeseburger or steak alongside of a cup of Pepsi will not make the Pepsi’s sugars’ effect more “muted” in the body?)

Low GI just means “slow to digest”, and it’s usually estimated for a single foodstuff. It’s a function not just of the composition but of the structure - in other words, your body may have to digest fat & fiber to break down the structure to access the carbohydrate.

For an unstructured loose mixture of similar proportional composition, any carbohydrate will be more readily accessible. If mixed-in carbohydrate is in the form of highly soluble simple sugars, I agree with Ethilrist that it will still tend to get absorbed quickly as soon as the mixture is mashed up in your belly.

There will be some effect, just as eating food slows alcohol absorption. But I’ve never seen GI data expressed for a mixture of things eaten together, so I don’t think GI data is going to be a good guide to the size of effect.