Perspectives on Diabetes Care

Managing Post Meal Hyperglycemia

Aug 9, 2013, 01:00 AM

After a long week at work trying to solve diabetes problems, it was indeed a pleasure to be able to sit back and listen to several of the breakout sessions from AADE13. Don’t get me wrong – I would LOVE to be there in person, but the timing just did not work out for me this year.  I decided to listen to Gary Scheiner speaking on Strike the Spike: Strategies to Manage Post Meal Hyperglycemia.  I have heard Gary speak before and I have always enjoyed his practical and personal style.

A few of the situations Gary mentioned in which it is important to manage post meal glucose would be 1) in pregnancy, 2) as a way to provide feedback regarding meal choices (which is my personal favorite) and 3) as a better representation of the true 24 hour glucose. He also mentioned that the risk of complications, particularly macrovascular complications seem to be more closely associated with post prandial (PP) glucose values.

Gary listed some of the immediate problems of elevated PP glucoses:

• Tiredness / decreased energy levels
• Difficulty concentrating
• Impaired athletic performance
• Decreased desire to move or be active
• Mood swings
• Diminished creativity and memory
• Enhanced hunger

I plan to share this information with my patients– perhaps some immediate gratification or hope of improvement will motivate them to improve their PP glucose values.

The “meat” of the presentation for me was the discussion about insulin or meds that work too slowly and foods that work too quickly resulting in elevated PP glucoses.

Gary suggested:

1. Substitute higher fiber foods or foods with a lower glycemic index. Patients may need to experiment with this to see how different foods affect their PP glucose.
2. Splitting the meal - eating part at regular meal time and the remainder 60-90 minutes later to prevent such a large load of glucose at one time.  This sounds similar to the old “6 small meals” advice.  The problem is getting my patients to eat SMALL meals.
3. Post meal activity slows digestion and can prevent PP glucose spikes. Gary suggests taking a casual walk, do household chores, dancing – just move for 30 minutes after the meal. 
4. Add acidity to the meal such as salad dressings with vinegar, tomatoes or sourdough bread products.  The acidity has been shown to slow digestion.
5. And meal sequencing.  It seems that eating veggies before starchy foods helps to delay digestion.  Also making lunch the highest carb meal seems to help stop PP glucose spikes.

This was definitely an interesting topic and one that will influence my interactions with my patients next week.
 
For those of you fortunate enough to attend AADE13, I hope you return home with new energy and enthusiasm. For those of you that were unable to attend, please consider attending the Virtual Meeting next year – it is a fun way to keep informed.