CE Course

Learning Objectives

More than ever, emphasis is being placed on the stability of glucose levels – spending as much time as possible within one’s target range and less time above or below-target. Post-meal glucose excursions can be particularly challenging for people with diabetes. This program covers the identification and measurement of post-meal glucose spikes, immediate and long-term effects, as well as medical and lifestyle strategies for minimizing them.

Post-prandial hyperglycemia is an often overlooked issue in the treatment and management of all forms of diabetes. We will explore this issue in some detail in this program.

Let’s begin by defining the risks caused by post-meal spikes. We will then focus on various methods for identifying the spikes, and look at strategies for improving post-meal glucose control. These strategies will include both lifestyle interventions and medical interventions that are proven to help reduce glucose spikes that can occur after meals.

Let’s review the learning objectives for this course.

Upon completion of this course, the learner will be able to:

1. Define the risks associated with postprandial hyperglycemia.

2. Identify three methods for detecting postprandial glucose spikes.

3. Apply lifestyle and medical interventions to improve postprandial glucose control.

Postprandial Spikes Defined

Post-meal spikes are defined as the net rise that occurs after meals, before exogenous or endogenous insulin brings the glucose back down towards normal. Different professional organizations have established desirable maximum “peak” glucose levels in the postprandial phase. Unfortunately, these same organizations offer little to no guidance on how to achieve these goals! This is something that we will spend considerable time examining during today’s session.

The net rise that occurs from before eating to the highest point after eating

ADA Goal:

<180 mg/dl 1-2 hrs after start of meal

AACE Target:

<140 mg/dl 2 hrs post-meal

European Diabetes Policy Group:

<165 (to prevent complications)

International Diabetes Federation:

< 140 mg/dl 2 hrs after meal

Practical After-Meal Goals

Realistically, it is often necessary to establish more liberal expectations based on a patients’ age and stage of life. In most children, it is acceptable to achieve post-meal glucose levels below 200. In fact, for very young children (infants and preschoolers), it is reasonable to keep post-meal glucose below 240 mg/dl. During pregnancy, we must pay very close attention to post-meal peaks, as the renal threshold for glucose in a developing baby is much lower than that of an adult. When glucose levels are above 140 mg/dl, the baby will excrete the glucose into the amniotic fluid and then reconsume it. This can lead to a potentially harmful condition known as fetal macrosomia.

Children:

< 200-240 @ peak

(< 100 pt. Rise)

Adults:

< 180-200 @ peak

(< 80 pt. Rise)

Pregnancy:

< 120-140 @ peak

(< 60 pt. Rise)

Postprandial Spikes: Immediate Problems

Quality of life is affected by extreme glucose excursions – physically, intellectually, and emotionally. Even when temporary, periods of hyperglycemia can contribute to tiredness, difficulty focusing, a reduction in strength, speed, agility and stamina, changes in mood and personality, and (ironically) enhanced hunger. But it doesn’t end there. The sudden decline in glucose following the peak can produce symptoms of hypoglycemia. These “false” symptoms, referred to as “relative hypoglycemia”, can affect a person’s state of mind and may lead to inappropriate consumption of carbohydrates.

Symptoms:

Tiredness

Difficulty Concentrating

Impaired Athletic Performance

Decreased desire to move

Mood Shifts

Enhanced Hunger

Hypo Sytmpoms afterwards