After-Meal Highs

Solving the spiking glucose puzzle.

Theresa Garnero By Theresa Garnero, APRN, BC-ADM, MSN, CDE

Is deciphering your logbook more frustrating than figuring out a Sudoku puzzle? Sudo-what?

In case you haven't seen one in your local newspaper, Sudoku is a game where you fill in a grid of nine rows and columns with the numbers 1 through 9, using each only once. It requires logic and identifying patterns of numbers — and their relationship to each other — in order to solve the puzzle. Sudoku gives you a few clues and you fill in the rest.

Sound familiar? Blood glucose pattern management is similar, only with more variables that can leave you perplexed as to the reason why glucose levels spike. Can you spot some clues to this reader's concern about spiking glucose values after meals?

My glucose testing shows values from 370 to 478 after eating. My exercise program has been walking. I want to go back to the gym, but I'm concerned about going less than 50 (hypoglycemia). I need to get over an infection caused by a haircut cut. I am watching what I eat, but the spiking could be the results of not exercising and aging (I'm 61). My doctor had me double my medication and still no reduction in the glucose level. Please advise.

Let's try to crack this glucose code. What we know about this glucose riddle is significant: values more than 400, an infection, effects of aging, and increased medication. What we don't know is equally important: fasting and pre-meal values, what type of medication, when did the reader ever have a low, and years with diabetes. Let's discuss each of these areas.

After meal highs
The reader's first comment was about spiking glucose values after meals. And rightly so. Values above 250 can be dangerous. This may be more of a baseline than a post-meal reading issue. Without the pre-meal reading, we have nothing with which to compare.

If glucose values raise 50-80 points from before the meal to two hours after the meal, then the meal was OK (carbohydrate content of the food was tolerated/processed by the body and/or medications). If the reader started out at a 300 and two hours later was a 350, both are clearly above target, but the meal was not the problem. Given the information, my focus would be to look closer at pre-meal patterns. Plus, it never hurts to check out food choices with a dietitian.

Exercise program
Before hitting the gym, make sure you are not in danger of skyrocketing those glucose values any higher. Discuss your continued high readings with your healthcare provider and come up with an exercise plan that will keep you safe and out of the emergency room.

Going for a 30-minute walk is an effective exercise strategy for people with diabetes, and it's free!

Somewhere along the line, the reader has either witnessed or experienced hypoglycemia (a reading of less than 70). The chances of bottoming out from the 400s to 50s are slim, unless the reader is taking insulin or one of the pills that stimulate insulin production. Having a 15-30 gram carbohydrate snack prior to 30-60 minutes of exercise can minimize hypoglycemia risk. The key is to test your glucose before exercise and know when the medicines are working at their strongest. Carry quick-acting glucose when you exercise (glucose tablets or a small box of raisins, for example).

Infection and other factors
Having high glucose values is the perfect environment for bacteria to have a party at your expense. Just a little cut can become a major issue. The reader reported having an ongoing infection from a cut received while getting a haircut. Are antibiotics involved? Sometimes diabetes medications need to be adjusted during periods of infection, since infection causes the glucose levels to rise even further.

What about pain, stress, and cortisone use? All of them can play a significant factor in glucose control.

Affects of aging and medication
Diabetes is a chronic disease that typically worsens with age. Luckily, complications are not inevitable! Continue to test blood sugars regularly and realize that medications often need to be added or increased. I always say, you can eat like a saint and exercise like we all should (just like my dietitian colleagues), but if you are not on the right type and amount of medicine, diabetes management is most difficult.

Keep in mind that glucose values more than 250 are considered toxic to the insulin-producing cells of the pancreas. Pills for diabetes are much less effective when glucose values are consistently high. Insulin may be needed to get glucose values down into the target range (pre-meals: 70-120; 2 hours after meals: less than 150-180) and reduce your risk of complications.

Unlike the Sudoku brainteaser in the newspaper which allows you to check your answers, we can't flip to the back of our logbooks to find the solution to spiking glucose values. If you are baffled, staring into the maze of unexplained glucose values, you can take the opportunity in getting help to figure it out.

Read Theresa's bio here.

Read more of Theresa Garnero's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

Last Modified Date: January 28, 2013

All content on is created and reviewed in compliance with our editorial policy.

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by Brenda Bell
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...
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