How to prevent post meal glucose spikes in type 1 diabetes
People with type 1 diabetes have had it tough over the years. They still do. It’s not an easy disease to manage. Yet, it is manageable. 10 years ago the only way to know what was happening with your glucose levels all day was to finger prick test a whole lot. This obviously wasn’t good for your fingers or your state of mind.
This is why the availability of continuous glucose monitors like the Freestyle Libre and Dexcom have been such a step forward. Many localities are now making it easier for people with type 1 diabetes to access these devices and it appears to be paying off. Granted, they come with some drawbacks but the data they provide is invaluable when assessing glucose trends.
One benefit we have noticed in clinic is being able to see peoples post meal glucose results after eating. This has been for some interesting reading too. Without realising it a lot of our patients were finding they had post meal glucose spikes. When testing only on their finger at meal times they wouldn’t have been aware this was even happening. In fact, most patients found their pre meal levels are unaffected. In other words, despite the post meal glucose spike, once the rapid insulin had finished working, their glucose levels had returned to normal. Therefore, once we noticed these spikes, increasing the insulin was not an option for the risk of hypo.
Over the course of many weeks we’ve been finding patterns across lots of patients and are now implementing strategies to stop this happening. This blog discusses some of the methods we have been putting in place.
Strategies to prevent post meal glucose spikes
There are 4 ways I have been finding that work. Unfortunately, there isn’t much medical evidence to support this. Therefore, this blog post is mostly anecdotal.
1. Change the timing of the rapid insulin.
The first way to prevent post meal glucose spikes is the timing of the rapid insulin. Some foods get into your system really fast. If you aren’t sure which ones I’d suggest checking out my earlier blog on the glycaemic index by clicking here. Rapid acting insulin takes about 30 minutes to get going and over an hour to peak. So it’s always playing catch up to food. Especially, if the food is quick releasing.
In order to prevent this, you can move the time of the injection. Rather than injecting at the meal or even, after the meal, move the injection 15-30 minutes prior to eating. I admit this isn’t always the most practical advice. It works well for meals which are repeatable and unlikely to be interrupted like breakfast. If this isn’t an option perhaps you can try option 2.
2. Change to more slowly releasing food
The second thing you can do to prevent post meal glucose spikes is change the type of food you are eating. Rather than relying on quickly releasing foods like white bread or cereal, change these for more slowly releasing foods, like wholemeal bread or overnight oats. This can help the insulin keep up with the glucose entering your body and can prevent glucose spikes.
3. Add fat and protein to the meal
Fat and protein mimic the same effect as slow releasing foods. A full meal with protein, vegetables and carbohydrates will always take longer to get into your system, than just carbohydrates by themselves. You can use this to your advantage. If, for example, breakfast is a problem and you’re having cereal. Replace the cereal with a slice of toast and an egg. The protein and fat in the egg slows down the absorption of the carbohydrate. This helps prevent post meal glucose spikes.
4. Lower the total carb content
It is carbohydrates which cause the spike in glucose levels. Therefore, lowering some patients total carbohydrate intake has had some success in my clinic. Doing this has very little evidence to support its use but I have found it is working for some people. Perhaps they are just paying more attention to their diet and insulin but some patients have really reduced their post meal glucose spikes.
If there is anything to this, I suspect its because a lower carbohydrate intake leaves less potential for glucose to go high. It makes sense really. If less glucose is entering the system, there’s less chance it will cause a post meal glucose spike.
And there we have it. Four quick strategies I have been using in clinic to help prevent post meal glucose spikes. I hope you found it useful and I will be back soon.