Tips for Improving Post Meal Blood Sugars

A post-meal blood sugar spike is an elevation in blood glucose that occurs 1 to 2 hours after eating a meal. It is normal for the blood sugar to rise a little after eating a meal, even in a person without diabetes; however, the rise is usually not more than 40 mg/dL.

The importance of controlling blood sugar

High blood sugar following a meal can wreak havoc on your diabetes control and put you at greater risk for cardiovascular problems. The American Diabetes Association (ADA) recommends blood glucose be less than 180 mg/dL one to two hours after a meal. When blood sugar is persistently above this target, it can make reaching a target A1c (a marker of blood sugar control over the last 2-3 months) of less than 7% very challenging.

Most people with type 2 diabetes do not self-monitor blood glucose (SMBG) routinely after eating a meal. However, it has recently been recommended that blood glucose be monitored one to two hours after meals if A1c targets are not being reached (less than 7% according to the ADA).

The following article will review variables that affect post-meal blood glucose and practical tips for improving your post-meal blood glucose and medications to discuss with your doctor.

Learning about carbohydrates

First things first: Learn what foods have carbohydrates and how to read a nutrition label. Carbohydrates have the greatest impact on blood sugar.

Next, ask your dietitian or diabetes educator how many carbohydrates you should have at each meal. Most people do well with 45 to 60 grams of carbohydrate at each meal. Using tools like measuring cups or food scales will help you get an accurate carbohydrate count for your meal.

Understand the glycemic index

The glycemic index refers to the speed at which a carbohydrate food will raise the blood sugar. Generally, the more refined and processed a food, the higher the glycemic index will be.

Foods that are high in fiber such as whole grains, fresh fruit and vegetables, as well as beans/legumes.

Adding protein and some fat to each meal will also help lower the overall glycemic index of your meal.

Are you eating a high fat meal?

Having some fat, particularly heart-healthy monounsaturated fats such as olive oil and canola oil, is healthy and will help fill you up at a meal. However, a high-fat meal (greater than 20 grams) can cause insulin resistance.

With insulin resistance, your liver releases a larger amount of glucose (sugar) into the bloodstream.

Does your meal contain acidic foods or ingredients?

Acidity slows digestion. Try using vinegar and oil on salad instead of a cream-based dressing. Instead of white dinner rolls, try sourdough rolls. Caffeine stimulates the liver to break down glycogen. Consider swapping out your regular coffee for decaf or switching to tea.

How much sleep are you getting?

People who get less than 6 hours of sleep each night tend to have an increased appetite and are more insulin resistant.

Low blood sugar before meal

Having a low blood sugar before a meal results in food rapidly digesting, which, in turn, can result in greater post-meal blood sugar spikes. There is also a tendency to overtreat low blood sugars, which can result in significant blood sugar spikes.

Do you take mealtime insulin?

Mealtime insulin (rapid-acting insulin: Humalog, Novolog, Apidra) typically works best at improving post-meal blood sugars when given 15-20 minutes before eating.

Medications that may help improve post-meal blood sugar

Consider discussing any of the following medications with your diabetes doctor.

• Symlin: Symlin works by slowing the movement of food from the stomach to the small intestine and inhibiting glucagon's release.
• Byetta, Bydureon and Victoza: These medications are in a class of drugs called incretin mimetics. They work by enhancing insulin secretion in response to high blood sugar following a meal as well as slow down the movement of food from the stomach to small intestine.
• Precose and Glyset: These medications are in a class of drugs called alpha-glucosidase inhibitors. They work by blocking an enzyme that aids in carbohydrate digestion. Thus, some of the carbohydrate from the meal is not absorbed.

Move around after a meal

Just 10-15 minutes of light physical activity after a meal can significantly affect blood glucose control.