Lower Post-Meal Blood Sugars

Diabetes experts advised testing your blood sugars two hours after meals. However, most diabetics experience blood sugar spikes one hour and twenty minutes after food. So it is best to test one hour after the meal.

One study found that only 10 % of after-meal blood sugar was below 180 mg (10 mmol). It does not mean; it is not possible for you to reach healthy blood sugar.

However, be slow and in steps; first set a higher target that is easily achievable. Once achieved the set target, then lower your goal until you reach healthy blood sugar range. Be confident; you can make it with the below said tips, my advance congratulations.

Hormones & blood glucose homeostasis

1. Insulin produced by the pancreatic beta cells enables glucose from the food to move into the body cells for energy.
2. Amylin produced by the pancreatic beta cells helps slow down the release of glucose into the bloodstream from food by delaying stomach-emptying and increases satiety. Both type 1 and type 2 diabetes may have amylin deficiency.
3. Incretin is gut hormone (such as GLP-1 glucagon-like peptide 1) secreted by the intestines. It enhances the body’s ability to release insulin after eating, slow down stomach-emptying, promotes satiety, delays blood glucose release, and prevents pancreatic glucagon release.
4. Glucagon produced by pancreatic alpha cells breaks down glycogen stored in the liver and muscles into glucose and released into the bloodstream. It provides energy when there is no glucose supply from the food.

After food blood glucose rises, which instructs the intestine to release GLP-1, this in-turn increases insulin and amylin secretion. These hormones facilitate the body cells to use glucose from the food as fuel. At the same time, glucagon turn off even the reverse process that is the storage of excess glucose as glycogen takes place if the insulin level rises further.

While fasting blood glucose falls, proportionally pancreas reduces the insulin release, which in-turn switch of amylin and GLP-1 secretion, these hormones comment to store and use glucose. At the same time, a drop in insulin level turn on the release of glucagon, this breakdown stored glycogen and provide a constant flow of glucose.

After-meal, postprandial blood glucose spikes are temporary that occur after eating. Even in people who do not have diabetes, the blood glucose level rises a small amount after eating. Insulin starts doing its job to move glucose out of the bloodstream and into the cells. And Amylin keeps the food from reaching the small intestine quickly. However, in people with diabetes, this blood glucose spikes will be more significant, and it is slightly challenging to bring it back to a healthy range.

How long after food blood glucose stays high? After food, naturally, your blood glucose level goes up until insulin help the body cells to consume the glucose for energy. The blood glucose rise is a normal process of digestion; the concern is how high it goes. Blood glucose starts to rise at about 20 minutes after eating; it peaks between 1 to 2 hours and stabilizes at 2 to 4 hours after eating.

The exact timing of blood glucose spikes can vary from person to person and from meal to meal. However, on average, after-meal peaks tend to occur about one hour and 15 minutes after the start of a meal. Check before and after breakfast, lunch, and dinner. Do this several times to determine how much of a spike is taking place after each of these meals.

What should be your blood sugar levels after eating?

Here are some recommendations from the significant diabetes associations:

• The American Diabetes Association recommends keeping blood glucose below 180 mg/dl (10 mmol) one to two hours after the start of a meal.
• The European Diabetes Policy Group recommends keeping it below 165 mg/dl (9.2 mmol) at the peak.
• The American Association of Clinical Endocrinologists and the International Diabetes Federation suggest keeping it below 140 mg/dl (7.7 mmol) after eating.

In the beginning, follow after-meal goals as said below. These numbers are achievable, lead to a decent HbA1c level, and do not interfere with the daily quality of life:

• Adults who take mealtime insulin: below 180 mg/dl
• Adolescents (12–18 years): below 200 mg/dl
• School-age children (6–11 years): below 225 mg/dl
• Preschool-age and toddlers (5 or younger): below 250 mg/dl
• People with Type 2 diabetes who do not take mealtime insulin: below 140 mg/dl

Once you have achieved this target, then slowly try improving it until you reach a non-diabetic normal range of blood sugar.

A common approach to lowering after-meal blood glucose spikes is to take more insulin.

But unless blood glucose levels remain high for three to six hours after eating, taking more insulin is not going to solve the problem. Increasing mealtime insulin will most likely result in low blood glucose before the next meal.

Is Sugar Bad for You? Yes, no doubt but the total amounts of carb is more critical. So you don’t necessarily give up sugar forever, and you can enjoy it occasionally in small serving sizes.

People with diabetes when eating large amounts of simple carbs or sweets, their blood sugar spikes. And temporarily feel good (energetic) to normalize your blood sugar, your pancreas dumps insulin into the bloodstream. Your blood sugar might crash, and you feel bad (fatigue), at the same time, you gain weight like crazy. You are urged to choose simple carbs or sweets for a quick energy boost. Once again, your blood glucose spikes high and low; this vicious cycle is never-ending! This way, you may put on blood glucose roller coaster.

Know, why refined grains raises your blood glucose? Whole grain contains endosperm, bran, germ, and brush. The refining process strip off the bran, germ, and brush leave only the white-colored endosperm, which during digestion turn into glucose means sharp BS spike followed by BS crash.

When you eat whole grains, then digestion and absorption of glucose are slow and steady. Thus, more gradual blood glucose rise, followed by a nominal drop and better blood glucose homeostasis. Additionally, you can get extra nutrients for your good health.

17 Lifestyle choices to reduce BS spikes

1. Reduce carb intake - Watch, what you eat? Since food is the most important things, you can do to control your blood glucose. The wrong choice of meals with too many carbs, such as white rice and pasta can cause your blood sugar to soar. To reduce your carb intake, you should avoid sugary foods/drinks, starchy foods (such as bread, pasta, rice, beans, and potatoes), and other foods made from refined carbs. Alternatively, you can eat real foods made of whole grains, vegetables, and fruits.
2. Prefer low glycemic index foods - Glycemic Index (GI) is a measure of how much blood glucose spikes the carbohydrate in the foods produced. High GI foods produce more blood glucose spikes than medium or low GI foods. Thus as a person with diabetes, you should prefer low GI foods over high to achieve your after-meal target.
3. Take a walk after a meal - A brief (as short as 15 minutes) walk at a slow pace shortly after eating is a quick way to burn some calories, aid digestion, and reduce after-meal BS spikes. References: Journal of the American Medical Directors Association 2009 Jul; 10(6):394-7 and Diabetes Care 2013 Jun; DC_130084. Walking immediately after food can reduce post-meal blood glucose spikes in various ways. Walk after eating enhances blood flow and facilitate better absorption of insulin, faster blood glucose control. Additionally, walking divert blood flow away from the intestine, thus slow down glucose absorption. 
4. Don’t Skip Breakfast - Breakfast is the most important meal of the day, especially for people with diabetes. The study showed that on the daily breakfast was skipped, all-day spikes in blood sugar levels resulted. The researchers believed skipping breakfast can negatively affect the function of pancreatic beta cells that produce insulin.
5. Prefer smaller dinner – The digestion is better during the day than night after sunset. The study shows those who consumed a big breakfast in the morning (700 calories) and a small dinner in the evening (200 calories) had better control of their blood sugar. Those who ate a small breakfast (200 calories) and consumed a big dinner (700 calories had control of their blood sugar.
6. Eating acidic foods - Studies found acidic food slows down digestion and lowers your blood sugar spike by up to 55%. Some of the acidic foods are vinegar, tomatoes, and most other sour-tasting fruits. Drinking 1 to 2 teaspoons of apple cider vinegar immediately before meals help lower your after-food blood glucose spikes. To learn more, you can visit apple cider vinegar for diabetes.
7. Avoid Chinese Food: They are high in carb, fat, and MSG; thus, it raises blood sugar. Check your blood sugar 2 hours after eating to know who your body react to Chinese food.
8. Dried Fruits raises BS: Fruit is a healthy choice, but dried fruits such as raisins, cranberries, cherries, or dates contain more carbs.
9. Eat only 2 to 3 meals per day –
10. Sugar-Free Foods raises BS: They will raise your blood sugar levels. Why? Because of carbs from starches, it contains. Check the total carbohydrates content on the Nutrition Facts label. Also, look for the presence of sugar alcohols such as sorbitol and xylitol sweetener. It has fewer carbs than sugar (sucrose); still, they can raise your blood sugar levels.
11. Caffeine raises BS: Your blood sugar can rise after a cup of coffee, even black coffee without sugar in it. Black tea, green tea, and energy drinks containing caffeine can also raise your BS. Everyone with diabetes reacts differently for food or beverages, so keep track of your response. Ironically, other compounds in coffee may help prevent type 2 diabetes in healthy people. The study shows, type 2 diabetes who took 500 milligrams of caffeine (equivalent to four 8-ounce cups of coffee) experienced a 7.5 % increase in their average blood sugar levels. Caffeinated beverages include diet cola, coffee, and tea.
12. Artificial Sweeteners - A study published in the journal Nature. It reported about the consumption of zero-calorie artificial sweeteners. It found in diet sodas and sweeteners often added to coffee and tea. This artificial sweeteners lead to glucose intolerance, increased blood sugar levels, and potentially increase the type 2 diabetes risk.
13. Increase physical activity - Exercise enhances insulin absorption for many hours after exercise. Your body will use insulin more efficiently. In one study, just 30 minutes of slow walking reduced the average spike by 30 mg (1.7 mmol). The peaks were 45% higher when participants did not walk.
14. Manage/Lower Stress - Stress increases the release of cortisol hormone by the adrenal glands, which increases your appetite. Additionally, stress disrupts hunger hormones such as ghrelin that regulate your appetite. Anxiety-induced hunger makes you choose junk food rather than a regular healthy diet. Thus, if you are under stress, don’t eat and postpone until you are free from stress. You can lower stress by taking ten deep abdominal breathing.
15. Get enough sleep – In a study, healthy adults were asked to sleep only four hours a night for six nights. After this sleep restriction, the glucose tolerance (ability to break down glucose) on average was 40 percent lower.
16. Prevent infection - To avoid infection, wash your hands before preparing food, before eating, and after using the toilet. Always drink safe drinking water. Don't share your items such as toothbrushes, towels, handkerchiefs, razors, and nail clippers. Keep yourself clean; bath daily, brush your teeth twice daily and wash your hand whenever required.
17. Yogurt - Probiotic foods such as yogurt are load with healthy bacteria. This beneficial micro organism improves digestion and supports better blood glucose control. Always prefer homemade yogurt, because some store-bought yogurt pasteurized that kills this beneficial microbe, and also they add sugar for taste.

4 Smart ways to use insulin smartly to reduce BS spikes

1. Use Analog insulin in place of Regular insulin – Using analog insulin (Humalog, Novolog or Apidra) instead of regular insulin (Humulin R, Novolin R). Regular insulin has its peak at 2 to 3 hours, and its duration of action is up to 4 to 6 hours. The newer analog insulin has a much faster peak of at around 1 hour, and its duration of action is up to 3 to 4 hours. Analog insulin matches well with the mealtime spikes.
2. Warm up the injection site – Have you ever noticed, sitting in a hot tub for too long, bring down your blood sugar. When the skin heats up, blood vessels expand, boost circulation, and magnifies the absorption of insulin. In a study, insulin action increased on average by 30% in 51 patients in the first hour. You can warm the injection site by applying a hot pack or just rubbing the area. For people using insulin pump; Insupatch & InsuPad add a heating element with the infusion set.
3. Bolus insulin timing – Rapid-acting insulin takes 15 minutes to start working. A study shows those who take bolus insulin 15 to 30 minutes before a meal had a 4% lower A1C than those who take their bolus just before a meal. So it is better to take your insulin 15 to 30 minutes before your meal.
4. Super Bolus for insulin pump users - For people with diabetes on insulin pumps can go for “Super Bolus,” the term and technic provided by John Walsh, co-author of the book “Pumping Insulin: Everything You Need for Success with an Insulin Pump.” Super bolus is a technic to substantially reduce the basal rate for about 2 to 3 hours before eating and adding this reduced basal insulin to the normal pre-meal bolus. For example, if your basal insulin rate in the morning is one unit per hour, reduce the basal rate by 10% or 0.1 units per hour (i.e., 90 % reduction) for say 2 hours before breakfast. Then, this reduced basal insulin of 0.9 units per hour multiply by 2 hours gives 1.8 units of insulin give along with your pre-meal bolus insulin.

Does earlier bolus make a difference? Absolutely! Always best to give bolus insulin before food, but how much before? Maybe it depends on what you are going to eat and what is your pre-meal blood glucose level? Higher your pre-meal blood glucose, the earlier the bolus should be. Based on the glycemic index of the food and the pre-meal blood glucose level, bolus timing should be.

• If BS is much higher than your target, then you should give the bolus 15 to 45 minutes before a meal based on the glycemic index of the food.
• If BS is close to the target, then give the bolus at the start to 20 minutes before a meal.
• If BS is below target, then take the bolus right away to 15 minutes before eating.

Research has shown giving mealtime boluses before eating instead of after eating reduced the after-meal blood glucose spike by about 50 mg/dl or 2.8 mmol/l.

The higher the glycemic index of the food you are going to eat, then earlier should be your bolus. The glycemic index of the food is the ranking of how quickly a food causes blood glucose rise.