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The Role of the EPC

With more stable glucose levels, there is an increase in ENDOTHELIAL PROGENITOR CELLS, or EPCs, which “patch” damage within blood vessel walls.  Having more EPCs in circulation can help keep blood vessels in a healthy state.

Damage to inner lining of blood vessels (endothelium) leads to vascular complications
EPCs “patch” endothelial injuries
EPC count increases with reduction in glycemic excursions


The simplest way to evaluate the degree of post-meal glucose spikes is with fingerstick blood glucose measurements.  Ideally, this should be performed about an hour after completion of a meal, which is when glucose levels tend to hit their highest point.  For those who want to know more precisely when their glucose peaks, fingersticks can be performed every 15 to 30 minutes after a meal, and stopped when the glucose begins its downward descent.

Fingerstick BG Checks
Capillary (finger) sample
Check BG 1 Hr after completion of meal
(or) every 15, 20 or 30 min until 2 consecutive BG reductions occur  (No addl. Food/insulin until test is completed)


Meter Check Example

In this example, where glucose levels were checked an hour after breakfast, lunch and dinner for 3 consecutive days, there is evidence of a significant peak after breakfast only.  Note that the post-lunch high glucose followed a low – and was likely a “rebound”.  The post-dinner highs were preceded by pre-meal highs, so there was little “net rise” that took place.  Collecting data for at least a few more days might shed more light on whether the glucose is truly well-managed following lunch and dinner.


Breakfast Lunch Dinner
Pre 1h Post Pre 1hr Post Pre 1hr Post
117 281 157 166 191 204
90 302 58 247 89 147
151 264 77 152 235 222


Excessive after-meal peak following breakfast; not after lunch or dinner


Measurement of Postprandial Peaks

However, it is difficult to know exactly WHEN to perform a fingerstick in order to catch the glucose at its peak. Different meals, medications and post-meal activities can influence the timing of the peak. This is why Continuous Glucose Monitoring (CGM) is the preferred tool for assessing postprandial glycemia. CGMs track glucose levels every 1 to 5 minutes, so the “peak” is never missed.  For those patients who do not have a personal-use CGM, the clinical team can loan out a PROFESSIONAL system for a week or two. The device can be downloaded and analyzed after it is returned to the clinic.

Blinded CGM

Dexcom G6 Pro


10 days of data

Analysis software shows post-meal patterns

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