Do you generally just check your blood glucose when you wake (fasting) and before meals? Research shows that it may be time to add a few post-meal checks to your monitoring routine. If you take insulin several times a day or use an insulin pump, this means more checks each day. If you have type 2 diabetes, but don’t take insulin, this may mean fewer before meal checks and more after meal checks. Read on to learn why and how.

Research Reveals Importance of After Meal Checks

More research is revealing that both how high blood glucose rises (magnitude of the rise – also called glucose variability) and how long blood glucose is elevated (duration of the rise) are associated with increased cardiovascular disease, and eye and kidney disease. The rise of blood glucose after meals is mainly due to the amount of carbohydrate you eat and how well your blood glucose lowering medications cover the rise.

The Bullseye

At present there’s varied opinion from leading diabetes organizations about the optimal post meal bullseye. Do some checks to see your results. Then use the strategies for control (below) to more closely hit your bullseye.

Strategies for Post Meal Control:

• Take rapid acting insulin about 10 to 15 minutes before you eat to allow it time to start acting (if your blood glucose is within your pre-meal target). This helps your insulin stay ahead of the rise of blood glucose from carbohydrate that starts raising blood glucose quickly.
• Take rapid acting insulin about 10 to 15 minutes before you eat to allow it time to start acting (if your blood glucose is within your pre-meal target). This helps your insulin stay ahead of the rise of blood glucose from carbohydrate that starts raising blood glucose quickly.
• Use your correction factor (the number of mg/dl 1 u of insulin will lower your blood glucose) to correct a high blood glucose if it is between 140 mg/dl and 180 mg/dl before a meal. Then hold off eating for about 15 to 30 minutes until your blood glucose begins to drop.
• Take a closer look at what and how much carbohydrate you eat. Take enough insulin to cover the carbohydrate. Accurate carbohydrate counting can improve the accuracy of your medication dosing and after eating glucose results.
• Keep in mind that foods which contain carbohydrate raise blood glucose at varied paces. Legumes (dried peas and beans like chickpeas, black beans, split peas, and lentils), food that contain whole grains or a lot of fiber, pasta and pizza can cause a slower rise.
• Learn what different foods and meals do to your blood glucose. Build your personal food and glycemic impact history. Use your history to make decisions about medication dosing in the future.
• Check your blood glucose about two hours after you eat to get a sense of how high it goes. Do keep in mind, however, that this result depend on what you eat, the time you took your medication and many other factors.
• Be careful not to over treat a high blood glucose two hours after eating. You still have about two hours of insulin action left on the rapid acting insulin because it takes about two hours to reach its peak effect. It takes about four hours until its action is complete. (Action time is shorter or longer for some people.)
• Check your blood glucose at one hour, three, four and five hours after you eat on occasion. You learn each and every time you do a check.
• Check your blood glucose about two hours after you eat your biggest meal if you have type 2 diabetes. This tells you both about your food choices and amounts of food as well as the effectiveness of your medication doses. Discuss these results with your healthcare provider.

Find the combination of food and blood glucose lowering medications that work best to control your after meal blood glucose levels. Keep in mind that after meal checks are important to prevent diabetes complications. Maintain good records and share these with your healthcare providers. Have your observations ready and engage in dialog about ways to optimize your control.

Hope Warshaw, MMSc, RD, CDE has been a dietitian and diabetes educator for more than 25 years and regularly counsels people with diabetes. Hope is also a freelance writer and the author of several bestselling books published by the American Diabetes Association including: Complete Guide to Carb Counting and Guide to Healthy Restaurant Eating.

Learn more at www.hopewarshaw.com