What’s a spike?
After-meal, or “postprandial,” spikes are temporary high blood sugar levels that happen right after eating. It is normal for the level of glucose in the blood to increase a percentage after eating, even in individuals who do not have diabetes. However, if the rise is expensive, it can affect your lifestyle today and add to major health issue down the road.
The factor blood sugar tends to increase after consuming in many individuals with diabetes is a simple matter of timing. In a person who doesn’t have diabetes, consuming foods containing carb causes two important responses in the pancreas: the immediate release of insulin into the blood stream, and the release of a hormone called amylin. The insulin begins working practically right away (to move glucose out of the bloodstream and into cells) and finishes its job in a matter of minutes. The amylin keeps food from reaching the small intestine too quickly (where the nutrients are absorbed into the blood stream). As an outcome, the minute blood glucose starts to rise, insulin exists to sweep the incoming glucose into the body’s cells. In many cases, the after-meal blood sugar increase is barely obvious.
However, in people with diabetes, the circumstance is like that of a batter with very slow reflexes facing a pitcher who tosses 98-mph fastballs: The timing is all fouled up. Rapid-acting insulin that is injected (or infused by a pump) at mealtimes takes roughly 15 minutes to start working, 60 — 90 minutes to “peak,” or reach maximum efficiency, and 4 hours or more to complete working. On the other hand, amylin is either produced in inadequate quantities or not at all, so the motion of food from the stomach to the intestinal tracts is not slowed the method it ought to be. As an outcome, food digests even quicker than normal. This combination of slower insulin and faster food can cause the blood sugar level to rise quite high not long after eating. When the mealtime insulin finally begins, the high is followed by a sharp drop.
Why are spikes an issue?
Although after-meal blood glucose spikes are temporary, numerous spikes a day, day after day, can raise your glycosylated hemoglobin, or HbA1c level, and a high HbA1c level has been shown to raise the risk of long-lasting diabetes complications.
Your HbA1c test result reflects your typical blood glucose level for perpetuities of day (before and after meals) over the past 2 to 3 months, with the more current weeks affecting the result more than earlier weeks. So if your pre-meal blood glucose average is 130 mg/dl for a provided three-month period, and your post-meal average is 240 mg/dl, your HbA1c will probably reflect a total average someplace in the middle of these two numbers.
Interestingly, research has actually shown that for individuals with an HbA1c below 7.5%, post-meal blood sugar readings have a greater influence on HbA1c than pre-meal readings. To puts it simply, reducing your pre-meal readings will just get you up until now. If you want your HbA1c level to be as near normal as possible, you need to pay attention to your after-meal numbers too.
The long-lasting effects of high blood glucose levels after meals have been studied thoroughly. For people with Type 1 diabetes, considerable after-meal increases have actually been revealed to produce earlier onset of kidney disease and to speed up the development of existing retinopathy, the eye issue most frequently related to diabetes. In people with Type 2 diabetes, high blood glucose after meals is a risk aspect for cardiovascular issues.
However the problems are not restricted to long-term complications. Whenever blood sugar levels rise especially high, even momentarily, quality of life suffers. Energy decreases, brain function fails, physical and athletic capabilities end up being lessened, and state of minds end up being changed. An Australian study of youths with Type 1 diabetes indicated that short-term high blood glucose negatively affects thinking performance, coordination, and feelings and moods. A research study carried out on individuals with Type 2 diabetes showed that sharp increases in blood glucose level slowed psychological performance, decreased attention, reduced energy levels, and caused sensations of unhappiness and tension.
Furthermore, the impacts of a bout of post-meal high blood sugar do not disappear immediately when blood sugar go back to normal. Each episode of high blood glucose can alter the way specific genes function, leading to the production of harmful chemicals called totally free radicals, which cause swelling and damage to the linings of the capillary for hours, if not days. So plainly, post-meal spikes represent a difficulty worthy of attention.
The specific timing of blood sugar spikes can differ from individual to individual and meal to meal. Nevertheless, usually, after-meal peaks have the tendency to take place about one hour and 15 minutes after the start of a meal. So inspecting your blood sugar (using a blood sample from a fingerstick) about an hour after ending up a meal should supply an excellent sign of how much of a spike is happening. Check prior to and after breakfast, lunch, and supper a number of times to identify how much of a spike is happening after each of these meals. It is most common to see considerable spikes after breakfast, however check after each meal a minimum of a couple of times simply to see what is happening.
When analyzing your numbers, take your pre-meal readings into account. For instance, a pre-meal blood sugar of 210 mg/dl followed by a 1-hour post-meal reading of 240 mg/dl shows just a 30-point increase, whereas a 110 mg/dl followed by a 240 mg/dl shows a 130-point rise.
So precisely how high is expensive after a meal? There is no universal agreement on this concern. The American Diabetes Association advises keeping blood sugar listed below 180 mg/dl one to two hours after the start of a meal. The European Diabetes Policy Group suggests keeping it listed below 165 mg/dl at the peak, and the American Association of Clinical Endocrinologists and International Diabetes Federation recommend keeping it listed below 140 mg/dl after consuming. Nevertheless, no specific guidelines are offered by any of these groups for Type 1 versus Type 2 diabetes, insulin users versus non-users, or children versus adults.
Based upon my experience, I suggest the following after-meal objectives for the following groups. These numbers are typically achievable, cause a decent HbA1c level, and do not interfere with day-to-day lifestyle:
- Adults who take mealtime insulin: below 180 mg/dl
- Teenagers (12 — 18): listed below 200 mg/dl
- School-age children (6 — 11): below 225 mg/dl
- Preschool-age and toddlers (5 or younger): below 250 mg/dl
- People with Type 2 diabetes who do not take mealtime insulin: below 140 mg/dl
After-meal readings that are regularly above these levels should be attended to by you and your health-care team (see methods in the sections below).
Besides keeping track of with a standard blood glucose meter, a few other alternatives exist for identifying post-meal spikes. Continuous glucose tracking (CGM) systems provide glucose readings every number of minutes and supply trend charts that make it simple to see precisely what is taking place after meals and at other times of the day. (See an example of a trend chart here.) Animas, Medtronic, and Dexcom all make CGM devices.
Individuals can buy a CGM for long-term or ongoing use, or, additionally, some specialized diabetes centers offer them on a temporary or loaner basis. (Feel free to call my workplace for a loaner if your companies do not provide them.) CGM systems include a small sensor filament that is inserted simply below the skin, a little radio transmitter connected to the sensing unit, and a portable receiver that shows your data. The systems are all uploadable to a computer system for analysis of the info.
Another method to assess after-meal blood glucose control is with a blood test trade-named GlycoMark. GlycoMark determines the level of a specific kind of sugar (1,5-anhydroglucitol, or 1,5-AG) that ends up being depleted whenever the kidneys are spilling glucose into the urine; this usually occurs when blood sugar goes beyond roughly 180 mg/dl. The test outcome shows blood sugar levels over the prior one to two weeks. Ask your diabetes doctor if this test is available near you.
Medical techniques to surge control
A common method to reducing after-meal blood glucose spikes is to take more insulin. But unless blood glucose levels stay high for three to 6 hours after eating, taking more insulin is not going to fix the problem. In truth, increasing mealtime insulin will more than likely result in low blood sugar prior to the next meal.
Here are some strategies that might work better:
Select the right insulin (or other medication). The right insulin or medicine program can make or break your capability to control after-meal spikes. In basic, insulins and other medications that work rapidly and for a brief time will work much better than those that work slowly over a prolonged period.
For example, rapid-acting insulin analogs (brand names Humalog, NovoLog, and Apidra), which start working 10 — 15 minutes after injection and peak in about an hour, cover the after-meal blood sugar increases better than Regular insulin, which takes 30 minutes to begin working and 2 — 3 hours to peak. If you use a morning injection of NPH insulin to “cover” the carb consumed in the middle of the day, your blood sugar level after lunch and after any daytime snacks is likely to be extremely high. This is likewise the case if you take a premixed insulin (75/25, 70/30, or 50/50) twice daily. For fewer spikes, consider taking a rapid-acting insulin prior to each meal or snack and using a long-acting “basal” insulin such as Lantus, Levemir, or Toujeo for protection between meals.
If you use oral diabetes medicines, your option of pill can also affect your after-meal blood glucose control. Sulfonylureas (glyburide, glipizide, and glimepiride) stimulate the pancreas to secrete a little additional insulin throughout the day, without regard to meals. Since these medications cannot concentrate the insulin secretion sometimes when it is required most, after-meal blood glucose levels can run very high. Nevertheless, there are two other oral medications, repaglinide (Prandin) and nateglinide (Starlix), which also promote the pancreas to release more insulin but do so in a much faster and shorter way. When taken at mealtimes, these drugs might produce better after-meal control than a sulfonylurea.
Another class of oral diabetes medicines called alpha-glucosidase inhibitors (which includes the drugs Precose and Glyset) decreases after-meal blood sugar levels by partially blocking the transportation of sugars throughout the intestines and into the blood stream. However, these medications can in some cases cause gas, bloating, and intestinal upset, so the pros of taking them don’t always surpass the cons.
Time your bolus insulin effectively. For people who take rapid-acting insulin at mealtimes, the timing of the bolus can have a huge influence on after-meal blood sugar levels. Boluses given too late to match the entry of glucose from dietary carbs into the blood stream can produce substantial blood glucose spikes right after eating. A properly timed bolus, on the other hand, can lead to outstanding after-meal control.
Unless you have gastroparesis (slowed stomach emptying, generally caused by nerve damage), it is best to give bolus insulin doses prior to consuming. The length of time previously? It depends generally on what you are eating and on your pre-meal blood glucose level.
Determining the pre-meal blood sugar part is fairly simple: the higher your blood sugar, the earlier the bolus must be provided. If your pre-meal blood sugar is well above your target, it is best to give the bolus then wait at least 30 minutes prior to eating. Near your target blood glucose? Wait 15 minutes. Listed below target? Either take the bolus and eat right now, or take the bolus after consuming.
The “what you are eating” part is a bit more complicated. Basically, the higher the glycemic index of the food, the earlier the bolus must be offered. The glycemic index is a ranking of how quickly a food is broken down during digestion and raises blood sugar. Foods with a high glycemic index (higher than 70) include most cold breakfast cereals, breads, potatoes, rice, and treat chips. They have the tendency to cause a substantial increase in blood glucose about 30 — 45 minutes after they are eaten. For meals including generally high-glycemic-index foods, it is best to bolus 15 — 20 minutes before eating. This will enable the insulin peak to coincide as closely as possible with the blood sugar peak.
Foods with a moderate glycemic index (approximately 45 — 70) digest a bit slower, resulting in a somewhat less pronounced blood sugar peak roughly 45 — 60 minutes after consuming. Examples include ice cream, orange juice, cake, carrots, pizza, and meals that consist of a range of foods. It is best to bolus 5 — 10 minutes before eating foods with a moderate glycemic index.
Foods with a low glycemic index (listed below 45) have the tendency to cause a sluggish, gradual blood sugar increase. The blood glucose “peak” is usually modest and may happen an hour or two after eating. Examples of foods with a low glycemic index consist of pasta, milk, yogurt, and cooked, dried beans. For these types of foods, bolusing right at the start of the meal, during the meal, or right after the meal normally works best.
Does earlier bolusing make a distinction? Definitely. Research has shown that just giving mealtime boluses before eating instead of after consuming can reduce the post-meal spike by about 50 mg/dl.
Use a “super bolus.” For individuals who use insulin pumps, one method to have more insulin working right after consuming and less working several hours later is to provide what John Walsh, coauthor of the Pumping Insulin books, calls a “very bolus.” This is done by significantly lowering the basal rate for 3 hours prior to consuming, then including the quantity of insulin that wasn’t offered as basal insulin to the normal pre-meal bolus. For instance, if your normal basal rate in the morning is 0.6 units per hour, you could set a temporary basal rate of 10% (90% reduction), for the 3 hours before breakfast, then bolus an extra 1.8 systems at breakfast.
Attempt a GLP-1 receptor agonist or Symlin. Numerous injectable artificial hormonal agents, exenatide (Byetta, Bydureon), liraglutide (Victoza), albiglutide (Tanzeum), dulaglutide (Trulicity), and pramlintide (Symlin), can considerably reduce post-meal blood sugar levels. These hormonal agents sluggish stomach emptying, which keeps carbohydrates from raising the blood sugar too quickly after meals. Byetta, which is authorized for use only in people with Type 2 diabetes, likewise blunts hunger and promotes the development of insulin-producing cells in the pancreas. Symlin, which is authorized for use in people with either Type 1 or Type 2 diabetes who take rapid-acting insulin at mealtimes, is a replacement for the hormonal agent amylin. It helps to diminish hunger, and it furthermore blunts post-meal glucagon secretion from the pancreas. (Glucagon is a hormone that raises blood sugar level by promoting the liver to launch kept glucose.)
See also: Hormones Affecting Blood Glucose Levels
Like much of diabetes management, medicine is only part of the story in avoiding after-meal spikes: Diet and exercise can play a role as well. Here’s how:
Believe lower GI. As pointed out previously, the glycemic index is a rating of how rapidly a food raises the blood glucose level. While all carbs (other than for fiber) convert into glucose ultimately, some types do so much faster than others.
Many starchy foods (such as breads, cereals, potatoes, and rice) have a high glycemic index; they digest quickly and transform into blood sugar rapidly. However, some starchy foods (such as pasta, beans, and peas) have lower glycemic index values. Foods that have dextrose in them — such as glucose tablets and gel and candies such as SweeTarts, Smarties, Spree, Runts, Nerds, and AirHeads — have the tendency to have a really high glycemic index. Table sugar (sucrose) and fructose (fruit sugar) have moderate glycemic index worths, while lactose (milk sugar) is slower to raise blood glucose.
A number of books, notably Dr. Jennie Brand-Miller’s Glucose Revolution series, consist of substantial info about the glycemic index, in addition to lists of glycemic index values for hundreds of foods.
As a basic rule, changing to lower-glycemic-index foods will help to decrease your after-meal blood sugar spikes. There are a number of attributes that slow down the rate at which foods are absorbed and raise blood sugar. Here are a few of them:
- Foods that contain soluble fiber (such as vegetables, oats, and psyllium) are digested more gradually than low-fiber carb foods and than foods that are high in insoluble fiber that has been finely ground, such as whole wheat flour.
- High-fat foods are absorbed more slowly than low-fat foods.
- Solids are absorbed more slowly than liquids.
- Cold foods are digested more gradually than hot foods.
- Under-ripe and undercooked foods are digested more gradually than completely ripe or well-cooked foods.
- Whole foods (such as unprocessed grains, vegetables, and dried beans) are digested more slowly than milled or processed foods.
Another food property that affects the rate of food digestion is level of acidity. This is why sourdough bread has a much lower glycemic index worth than routine bread. Research has actually shown that adding acidity to a meal through vinegar (straight or taken in as part of a salad dressing or other condiment) can minimize the one-hour post-meal blood sugar rise by 50% or more.
Divide your meal. The quantity you eat has the best impact on your blood sugar level after you eat. One method to reduce your blood sugar increase after meals, for that reason, is to eat less. But you don’t need to starve: rather, save a portion of your meal for a “snack” one or two hours later. That method, you get all the food you need, but it doesn’t raise your blood glucose at one time.
If you use mealtime insulin, you must still offer yourself your full mealtime dose prior to consuming any of the meal. For example, if you generally have a bowl of cereal and juice for breakfast, you would take enough insulin to cover both, however then just eat the cereal for breakfast, and hold off the juice until mid-morning.
Get moving. Physical activity after consuming can lower post-meal spikes in a number of ways. If you took insulin prior to your meal or treat, the improved blood flow to the skin surface triggered by exercise is most likely to make the insulin soak up and act faster. Muscle activity likewise diverts blood flow away from the intestinal tracts, resulting in slower absorption of glucose into the bloodstream. In addition, the glucose that does get in the bloodstream is most likely to be used by the working muscles, rather than saved for later use.
How much activity is needed to experience these benefits? Not much. 10 or 15 minutes (or more) of mild activity will generally finish the job. The key is to avoid sitting for extended time periods after eating. Instead of reading, watching TV, or working on the computer system, go for a walk, shoot some hoops, or do some chores. Aim to arrange your active jobs (household chores, yardwork, shopping, walking family pets) for after meals. Also attempt to schedule your exercise sessions for after meals. On “date nights,” resist the urge to sit and talk for hours or to head directly for a movie. Rather, head out dancing, bowling, or skating.
Prevent hypoglycemia. Low blood sugar is troublesome in many methods. Among the body’s common reactions to hypoglycemia is to accelerate the rate at which the stomach clears. That indicates food digests and raises blood sugar even more rapidly than usual. While this is certainly desirable when you’re low, it does contribute to post-meal spikes. Preventing hypoglycemia before meals and treats, for that reason, is yet another effective strategy for managing post-meal blood glucose levels.
Also read: Type 2 Diabetes and Hypoglycemia
Time to strike!
Given the lots of short- and long-term advantages of post-meal blood sugar control, it is definitely worth the effort to start determining and examining your after-meal control. If your blood sugar levels are higher than they ought to be, talk with your health-care group about brand-new or different medical treatments that might assist. And have a look at your individual choices in regards to food and activity. Even without a completely functioning pancreas, there is still a plethora of choices for taking on those spikes!