In our previous blog on postprandial blood sugars we saw that high levels are associated with a myriad of complications. Largely, we know that the food intake corresponds with blood sugar response, but in some cases the dose of insulin or oral drug may be inappropriate. The approach to management of postprandial hyperglycemia (PPH) can focus on different aspects including diet, exercise and medication or insulin
The four pillars in the management of Postprandial hyperglycemia in diabetic patients are:
- Post meal exercise
- DIETARY MANAGEMENT
The postprandial blood glucose is dependent on both the quality and quantity of carbohydrate in the meal. Easily digestible food such as white bread, rawa/ suji, sago, plain white rice, etc lead to spike in blood glucose and insulin which dies down equally fast resulting in faster return of hunger. High fiber foods such as fruits and vegetables, sprouted pulses, nuts are more slowly digested and absorbed causing a lower and delayed glycemic response.
Certain category of foods have definite benefits on decreasing postprandial glucose excursions
i) Fruits and vegetables have dual benefit on the postprandial blood glucose excursions:
- Firstly- they have low calorie density, high fiber and water content
- Secondly- their antioxidant phyto-nutrients taper down the inflammatory oxidative process that follows post meal
ii) High biological value proteins (Ex. Milk, curds, Egg white, lean meat, fish, skinless poultry meat, and whey)- the proteins from these food sources are almost completely digested and absorbed in the body and hence are called high biological value proteins. Including more protein rich foods in the diet can help to increase satiety of the meal, Increase basal metabolic rate due to high thermogenic effect, and help prevent obesity.
iii) Nuts -Almonds, pistachios or peanuts when consumed as a part of the meal can reduce the post-prandial blood glucose area under the curve . Nuts are also rich sources of mono unsaturated fatty acids (MUFA), Folic acid, Fiber, Phytosterols, and Magnesium
Physical activity directly lowers post-prandial glucose and also the excess abdominal fat . Basically, every time we make movement the muscles release insulin. So more release of insulin will result in better glucose control especially among those who are not naturally producing enough insulin (insulin insufficiency). Among those who are insulin resistant as well increased physical activity leads to improved cell sensitivity to insulin.
The type and intensity of exercise undertaken needs to be in consultation with the physician. Even though strength training/ anaerobic exercises are beneficial, aerobic exercises such as walking, jogging, swimming, badminton, etc are more safe
There are several classes of drugs available. While the discussion of all of them cannot be done in detail here, we are looking at some of them that can be specifically useful in treating high post-meal blood sugars. So once food is eaten, the carbohydrates in the meal are broken down to release glucose. Drugs that can slow down this breakdown of carbohydrates or prevent absorption of the available glucose or stimulate the secretion of insulin to regulate the blood sugar surge post-meal can all be effective in reducing postprandial hyperglycemia. Drugs such as acarbose (Glucobay, Acarex, Glubose, Diabose, etc) and miglitol (Miglit, Diamig, Elitox, Mognar, Glock, Glyset, etc ) block the action of an enzyme in the small intestine that normally breaks down carbohydrate into glucose thereby causing slow entry of glucose into the bloodstream. This gives the pancreas sufficient time to release insulin and gradually bring down the blood sugars. Meglinitides such as Repaglinide (Eurepa, novonorm, Regan, Repide,etc ) and nateglinide (Starlix) stimulate the pancreas to release insulin in a glucose-dependent fashion and hence these are also effective for regulating the meal-related glucose surge
Insulin treatment is used in type 2 diabetics when oral agents fail to achieve normal blood glucose levels. Specific to the treatment of postprandial hyperglycemia in diabetics are combination of basal and short acting insulin. The rapid acting insulin analogues such as Insulin Aspart (NovoLog) and Lispro (Humalog) are taken 15 min before meals and are rapidly absorbed thereby helping to lower postprandial sugars. Their action is not very long lasting also so their effectiveness lasts only till the meal-related glucose gets cleared from the bloodstream.
However, we strongly recommend that insulin type and dosage should be started under strict supervision and consultation with a specialist
Monitoring post-meal blood sugars at frequent intervals can help understand the effectiveness of the diet , exercise or medical treatment that is being followed for diabetes management. Many-a-times we just keep following the same routine for several months without realizing that it’s actually not working for us. We do know the risks associated with persistently high postprandial blood sugar levels and hence should ensure appropriate care and management of the same.