13 Ways to Lower After-Meal Blood Sugars
By David Edelman - 3 Comments

Learning to lower your post-meal blood sugars is a proven way to feel better and reduce your risk of diabetes complications, explained Gary Scheiner in last week’s “Strike the Spike” program at the American Association of Diabetes Educators (AADE) conference in Philadelphia. As AADE’s Educator of the Year, founder of Integrated Diabetes and long-time type 1, he knows what he is talking about.
Today, we will review the strategies that he shared in that program. These fall into two broad categories: slowing down your food and speeding up your insulin. Although it wasn’t mentioned, a thirteenth strategy is of course to eat fewer total carbohydrates during a meal.
How Big Is Your Spike?

Most people are taught to test their blood sugars two hours after meals. However, this probably doesn’t tell you how high your blood sugars go. When you eat a meal, most people experience their highest blood sugar one hour and twenty minutes after they eat. So Scheiner recommends testing one hour after the end of the meal.

What should your goals be? Here are some recommendations from the major diabetes associations:

American Diabetes Association – under 180 mg (10 mmol) at 1 to 2 hours after the meal
American Association of Clinical Endocrinologists – under 140 mg (7.7 mmol) at peak
European Diabetes Policy Group – under 165 (9.2 mmol) at peak

In practice, these targets are not very realistic. For those with type 1 diabetes, one study found that only 10% of post-meal blood sugars were below 180 mg (10 mmol). So in practice, Gary talked about the importance of individual targets. For example, he has found that a realistic target for children is striving for a rise under 100 points (5.5 mmol). Talk to your doctor about an appropriate goal for your age and health.
Slow Down Your Digestion

Strategy #1 – Lower the Glycemic Index of your meals. Glycemic Index (GI) is a measure of how much a food spikes your blood sugars during the first two hours after you eat. It is rated on a 100 point scale, with 1 as the lowest and 100 as the highest (eating pure glucose). Here are some examples from Wikipedia:

Low GI Foods – under 55: beans (white, black, pink, kidney, lentil, soy, almond, peanut, walnut, chickpea); small seeds (sunflower, flax, pumpkin, poppy, sesame); most whole intact grains (durum/spelt/kamut wheat, millet, oat, rye, rice, barley); most vegetables, most sweet fruits (peaches, strawberries, mangos); tagatose; fructose
Medium GI Foods – 56–69: not intact whole wheat or enriched wheat, pita bread, basmati rice, unpeeled boiled potato, grape juice, raisins, prunes, pumpernickel bread, cranberry juice[citation needed], regular ice cream, sucrose, banana
High GI Foods – 70 and above: white bread, most white rice, corn flakes, extruded breakfast cereals, glucose, maltose, maltodextrins, potato, pretzels, parsnip, bagels

You’ll note that fruits are lower on the Glycemic Index. You need to be careful to look at quantities. For example, sweet fruits may spike you more slowly than pretzels, but may also be more dense with carbohydrates. It is also important to look at total carbohydrates.

Strategy #2 – Split the meal. ”There is now rule that you must eat your whole meal at one time,” Scheiner noted. If you have a sandwich, you can eat half, wait thirty minutes, then eat the other half. This is simple and foolproof way to slow down digestion.

Strategy #3 – Increase post-meal physical activity. When you’re active, blood goes away from your stomach and to your muscles, slowing down digestion. To be effective, you should get moving with 30 minutes of your meal.

Strategy #4 – Eat acidic foods. Studies have found that acidic food slows down digestion and lowers your blood sugar spike by up to 55%. Acidic foods include vinegar, tomatoes, and most other fruits.

Strategy #5 – Change the order of your foods. Within your individual meals, eat your veggies before your starches (e.g. potatoes). Also, make lunch the higher carb meal and strive for less carbs during breakfast and dinner.

Strategy #6 – Consider appropriate medications. Medications including DPP-4s and GLP-1s can slow digestion. In particular, Scheiner describes Amylin as “a hammer” that was very effective. This injected hormone, which like insulin is produced in the pancreas, slows your digestion, suppresses after-meal glucagon secretion (which can raise sugars), and makes you feel fuller. If you take Amylin, it’s important to watch out for low blood sugars and side effects including nausea.
Speed Up Your Insulin

Strategy #7 – Switch from regular to analog insulins. Switch from regular insulin (Humulin R, Novolin R) to analog insulin (Humalog, Novolog or Apidra). Regular insulins have a peak at 2 to 3 hours and last for 4 to 6 hours. The newer analog insulins have a much faster peak of around 1 hour and last 3 t o 4 hours. This makes it easier to match them to mealtime spikes.

Strategy #8 – Choose the right insulin. Pumps and multiple daily injections are much better than NPH. NPH has long peaks and can’t really over mealtime spikes.

Strategy #9 – Take insulin 15 to 30 minutes before the meal. Rapid acting insulin is only rapid compared to regular injected insulin. “They shouldn’t even be allowed to call it rapid,” said Scheiner. “They should have to call it ‘rapider than regular’.” Even rapid insulin takes 15 minutes to start doing anything. In one study, those who bolused insulin 15 to 30 minutes before a meal had a .4% lower A1c than those that bolused at the start of a meal.

Strategy #10 – Warm the injection site. Warming the injection site speeds up the absorption of insulin. If you’re taking a shower anyway, take the insulin first. You can also warm the site by rubbing it or, as Scheiner half-joked, “having someone you love rub it for you”. You can also use exercise to warm up the injection site. For those using insulin pumps, he mentioned two products under development. The Insupatch adds a heating element to the infusion set. The other, Hylenex, is injected into the pump infusion site and loosens up fat tissue under the skin. In studies, it causes the insulin to absorb about twice as quickly.

Strategy #11 – Consider Sulfonylureas substitutes. Talk to your doctor about Maglitindes, including Nateglinide, Repaglinide and Mitiglinide. These drugs are rapid-acting and increase the amount of insulin produced by the pancreas. They are taken at mealtime and leave the bloodstream quickly. It’s important to watch out for low sugars when taking this class of medications.

Strategy #12 – Increase post-meal activity. Exercise not only increases blood flow to your muscles, but it also causes them to absorb insulin better. For many hours after you are active, your body will use insulin more efficiently. In one study, just 30 minutes of very slow walking reduced the average spike by 30 mg (1.7 mmol). The peaks were 45% higher when participants did not walk. Gary shared a wide variety of activities to consider:

Walking pets. You have to do it, so do it after a meal.
Household chores
Planned exercise
Shopping
Gardening
Casual stroll
Dancing
Bowling
Mini golf
Skating
Romance