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New eating and insulin-dosing strategies designed to control postprandial glucose spikes


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3 minutes

Satish K. Garg, MD
Satish K. Garg, MD

Technology advances have confirmed long-standing suspicions that postprandial glucose spikes can be important contributors to poor diabetes control.

“The new technologies we have today—continuous glucose monitors, hybrid closed loop systems—have confirmed the importance of controlling glucose levels after meals to improve overall glucose control and possibly reduce long-term complications,” said Satish K. Garg, MD, Professor of Medicine and Pediatrics at the University of Colorado Denver.

Dr. Garg will review the latest evidence about postprandial glucose levels during the symposium Postprandial Glucose Spikes—Eating and Insulin Dosing Strategies. The two-hour session will begin at 4:30 p.m. CT Sunday, June 5, in Room 343 at the convention center. The session’s four speakers will discuss practical strategies to improve eating habits and optimize the growing number of insulin-dosing options to improve glucose control, increase time in range, reduce A1C, and lower the risk of long-term complications from poor glucose control.

A1C levels correlate closely with both microvascular and macrovascular complications, Dr. Garg noted, and lower A1C is associated with fewer complications in both type 1 and type 2 diabetes. Any change in nutrition, lifestyle, insulin dosing, or other factors that reduce glucose spikes contributes to lowering A1C.

“A1C is one marker for diabetes management and postprandial glucose spikes contribute to the A1C,” said Holly Willis, PhD, RDN, CDCES, diabetes research investigator at the International Diabetes Center. “From my perspective as a nutritionist, lowering those postprandial glucose spikes starts with what and how much you are eating.”

Holly Willis, PhD, RDN, CDCES
Holly Willis, PhD, RDN, CDCES

The traditional approach for managing postprandial glucose focuses on macronutrients like carbohydrates, fats, and proteins, Dr. Willis said. Decades of research has been devoted to counting carbs and adjusting prandial insulin dosing to account for the estimated glucose spike. More recently, ADA nutrition guidelines and recommendations have focused on insulin-dosing strategies to account for the impact of proteins and fats on postprandial spikes, Dr. Willis said.

“You can also achieve quite nice glucose management by following an overall healthier eating pattern,” she said. “The messaging about how to dose insulin for high-fat, high-protein meals is important. But, in a sense, it misses the big picture, which could benefit from focusing on ways to help people improve the quality of their overall diet. I’d like to see more conversations and approaches that think more about the actual foods people eat and a little less about the grams of this or that.”

There’s no perfect eating pattern that every person living with diabetes should follow, Dr. Willis said. But there are nutritional pillars that should guide any eating pattern—eating more whole foods, more non-starchy vegetables, limiting refined grains and added sugars, reducing processed and packaged foods. Any of these will improve almost any eating pattern.

“Postprandial glucose is an issue for everyone with diabetes,” Dr. Willis said. “This symposium will look at new approaches to insulin dosing and nutrition. You are going to come away with insights you can use in your clinic tomorrow.”

Also during the session, Jeremy Pettus, MD, University of California, San Diego, will review insulin options to optimize postprandial glucose levels, and Nicole Patience, MS, RDN, LDN, CDCES, CEDRD, Joslin Diabetes Center, will review several case studies that highlight the importance of postprandial glucose control.