The 2012 International Children with Diabetes Conference — Friends for Life (Continued)
Strike the Spike — Strategies for Combating After-Meal Highs
Mr. Scheiner followed up his excellent talk on managing hypoglycemia with a discussion of how to "strike the spike" — managing hyperglycemia following meals. He gave a number of practical lifestyle and medicinal approaches to controlling post-meal highs.
1. Test blood sugars one hour after eating. Mr. Scheiner explained that this is when blood sugars tend to reach their peak.
2. Compare average blood sugars to standard deviation to determine problem areas. When standard deviation is more than half the average, this represents a time of day to address. (As a reminder, standard deviation is a measure of dispersion — the more spread out blood glucose levels are, the higher the standard deviation.) For example, if average blood sugar after lunch is 150 mg/dl, and the standard deviation is 100 mg/dl, glucose levels are too variable (and, if after a meal, are probably spiking too high). Mr. Scheiner recommended aiming for a standard deviation that is less than one third of the average (e.g., an average of 120 mg/dl and a standard deviation of less than 40 mg/dl). Average or standard deviation can usually be found on download reports for blood glucose meters and CGMs.
3. There are a number of food-based strategies associated with lower glucose levels after meals:
A. Eat lower glycemic foods and consume foods higher in fiber and fat.
B. Eat solid foods rather than liquids (liquids raise blood glucose faster) and eat colder foods rather than warmer ones.
C. Exercise following meals.
D. Split meals into parts (e.g., part now, part 60-90 minutes later).
E. Eat vegetables before starches when having mixed meals.
F. Make lunch the highest carb meal of the day.
4. There are also a variety of medicinal approaches to preventing after-meal hyperglycemia:
A. Use rapid-acting insulin (e.g., Humalog, Novolog, and Apidra) instead of regular insulin.
B. Take boluses prior to meals. Mr. Scheiner explained that it takes rapid-acting insulins about 20 minutes to start working, around one hour to peak, and around three to four hours to finish lowering blood sugar.
C. Try Symlin (a synthetic derivative of the hormone amylin). Mr. Scheiner cautioned, however, that the drug can lead to nausea, must be injected, and insulin doses must be adjusted or delayed. As a reminder, amylin is usually released in conjunction with insulin — especially after eating — because it helps the body maintain flatter blood sugar profiles. It does this in three ways: by slowing gastric emptying (allowing sugar to enter the bloodstream more slowly), making people feel full more quickly and thus eat less, and inhibiting post-meal secretion of glucagon, a hormone that makes the liver release extra sugar into the bloodstream.
D. Try GLP-1s (e.g., Victoza, Byetta, and Bydureon). Although these drugs are only FDA approved for use in type 2 diabetes, Mr. Scheiner explained that GLP-1s are being used by people with type 1. We were encouraged to see that Novo Nordisk recently completed a 42-patient phase 1 trial investigating the use of Victoza in type 1 diabetes. We expect that over the next few years, more data on GLP-1 use in type 1 diabetes will be published.
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NOTE: This information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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