• What is Postprandial Glucose

    A postprandial glucose test is a blood glucose test that determines the amount of glucose, in the plasma after a meal. The diagnosis is typically restricted to postprandial hyperglycemia due to lack of strong evidence of co-relation with a diagnosis of diabetes.

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    Dr. Amish Parikh, MD, FRCPC, Endocrinologist, discusses how to control post prandial glucose levels with meal time insulin.
    Dr. Amish Parikh, MD, FRCPC, Endocrinologist, discusses how to control post prandial glucose levels with meal time insulin.
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    Dr. Jean-Francois Yale, MD, CSPQ, FRCPC, Endocrinologist, discusses how to control post prandial glucose levels with fast acting meal time insulin.
    Dr. Jean-Francois Yale, MD, CSPQ, FRCPC, Endocrinologist, discusses how to control post prandial glucose levels with fast acting meal time insulin.
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    Richard Bebb, MD, ABIM, FRCPC, discusses Long-Term Benefits of Glucose Testing.
    Richard Bebb, MD, ABIM, FRCPC, discusses Long-Term Benefits of Glucose Testing.
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    “What is CGM and how does it work?” : Dexcom G6 Continuous Glucose Monitoring (CGM) System
    “What is CGM and how does it work?” : Dexcom G6 Continuous Glucose Monitoring (CGM) System
  • Controlling Post Prandial Glucose With Meal Time Insulin

    PPG is postprandial glucose, it’s a measurement of what the blood sugars are after a meal. Typically after you eat, the body makes insulin, and that helps to control the sugars after the food has been digested. In people that have diabetes, oftentimes the insulin made is not enough, and the blood sugars can go high after a meal, which is also called postprandial hyperglycemia.

                             

    PPG can influence the A1C levels. The A1C is a measurement of the average blood sugar for the past three months or so. For people that have diabetes, we usually target an A1C of less than or equal to seven percent.

    High postprandial sugars can make you feel unwell, such as being tired, and over time, if the blood sugars are high on a consistent basis, this can lead to diabetes-related complications such as problems with your eyes, heart attack, and problems with your kidneys.

    Mealtime insulin is designed to help control the blood sugars after you eat. They try to mimic the body’s natural response to sugar surges. They last anywhere from 40 to 120 minutes. However, they do not completely match the body’s natural response to insulin, and therefore there is still a chance postprandial hyperglycemia can occur.

    If patients take their insulin as prescribed, before they eat, they have the best chance of keeping their sugars under good control and avoid postprandial hyperglycemia. If insulin is missed, then the blood sugars after meals can go very high.

    Mealtime insulin helps to control sugars after meals, and should ideally be taken 30 to two minutes before a meal, depending on the type of insulin. Some insulins now, however, allow you take them 20 minutes after a meal, and still achieve good postprandial sugar control. In summary, postprandial hyperglycemia can influence A1C levels.

    If you would like more information about this topic, feel free to speak to your family doctor, your diabetes team, such as the nurse practitioner or dietitian, or your endocrinologist. Often seeing a Endocrinologist or  local family physician  in conjunction with a registered dietitian and athletic therapist is a great option to take control of this condition. Smart Food Now and exercise is also optominal for overall health.    

    Presenter: Dr. Amish Parikh, Endocrinologist, Toronto, ON

    Local Practitioners: Endocrinologist

  • Post prandial blood glucose is a measure of your blood glucose after you have eaten.  In healthy individuals when a meal is consumed, insulin that is produced by the pancreas keeps glucose levels within a normal range.  In Diabetes, the pancreas does not make enough insulin to process mealtime sugars.  This means that glucose in the blood goes above the normal range, which is also called post prandial hyperglycemia

    Post prandial hyperglycemia can contribute to a persons overall blood glucose control.  One marker of overall control is the A1C blood test.  The A1C test shows an average blood glucose level over a span of a few months.  It’s used to screen and monitor a patients overall blood glucose control.  For most patients, the target for A1C is greater or equal to 7%.  Post prandial hyperglycemia can impact a patients A1C level.

    Having high post prandial glucose levels can make a person feel unwell and experience symptoms such as tiredness and feeling thirsty on a daily basis.  If they are high over time, this can put a person at risk of developing diabetes complications such as worsening eye sight, heart attacks, and kidney disease.

    High post prandial glucose levels are managed with Bolus or ‘meal time’ insulins.  These insulins are formulated to try and replicate the body’s natural physiological response to mealtime sugar surges.  They are designed to have a rapid onset and last anywhere from 40 to 120 minutes.  If patients take their meal time insulin exactly as prescribed, they have the best chance of being protected from post prandial hyperglycemia.  If they do not take their meal time insulin as prescribed, the body will have a harder time bringing down post-meal sugar spikes.  Depending on the insulin, mealtime insulins should ideally be taken 2 to 30 minutes prior to a meal. Some insulins now even allow the patient to take the insulin up to 20 minutes after the meal and still achieve good post prandial glucose control.  

    Presenter: Dr. Jean-François Yale, Endocrinologist, Montreal, QC

    Now Health Network Local Practitioners: Endocrinologist

  • Understanding Meal Time Insulin and Post Prandial Glucose Control

    Postprandial means after a meal. So postprandial glucose is really the elevation of glucose after we’ve eaten. When we eat we digest the food, it goes in the blood, and the first thing we have to do is to store it in our cells and that’s done because insulin goes with the food to tell the cells “store the food.”

    So normally after we eat the glucose goes up for an hour or two and then slowly comes back to where it’s normal because of the action of insulin. In some cases, when people have diabetes, and it’s not very well controlled, the glucose rises after the meal but can stay higher for a longer period of time, and we call that postprandial hyperglycemia, where the insulin action was not sufficient, and we ended up with high glucose levels eating.

    The A1C levels represent the average glucose level of someone over a period of about two to four months – that’s what we use to assess if the diabetes is well controlled or not, and we’re usually aiming for levels under seven percent.

    The A1C is affected by the glucose levels throughout the day, so it includes the effects of fasting glucose, but also the glucose levels after eating, the postprandial glucose levels. So if either or both of these are high, that makes the A1C be higher, and when the A1C is higher that increases the risk of complications of diabetes, whether it be complication in the eyes, the kidneys, the feet, the heart etc. We really aim to control the A1C to normal levels to prevent long-term complications of diabetes.

    When we eat the glucose rises, and therefore the insulin levels have to rise with the meal, in order to tell the body to store the food, so it’s important to coordinate the insulin rise with the food that’s entering the system.

    In people that are treated with insulin, that is done by giving rapid-acting insulin, which tries to reproduce this action of our normal insulin that’s usually secreted by ourselves. So this rise in insulin that occurs after a meal, if it’s a rapid-acting insulin, helps to control the glucose levels.

    If the insulin is slower, because there are some older insulins that are slower, then of course they’re not able to reproduce this and we end up having high glucose levels after meals. So more and more we’re developing some insulins for the mealtime that are faster and faster. So they reproduce better and better the normal response of the body, so that if the insulin rises in time with the food, then there’s no postprandial hyperglycemia.

    The best timing for mealtime insulin depends on the kind of insulin that’s being used. With the slightly older insulins that are used a little bit less often now, it was very important to give it up to 30 minutes before the meal, because it took some time to get to the blood, so in order to reproduce the normal response of the body, it had to be taken sometime before, which complicates things because then people don’t always know 30 minutes before what they’ll end up eating.

    So the newer insulins tend to be faster acting, so they can be given closer to the meal. They can be given within 15 minutes and even right at the beginning of the meal, in order to still be able to better control glucose levels.

    And finally the most recent ones, the ones that just came out, can even be given after the meal, right after the meal, and it will still be able to control postprandial glucose, because they go in the blood so rapidly. So the best timing depends on which kind of insulin is being used, and it’s important to respect that, because if you don’t take it at the right time, you can end up having very high glucose levels.

    So in summary, postprandial hyperglycemia, or glucose levels that are too high after meals, is a contributor to high A1Cs, and therefore can lead to complications in the long term. So it’s important to take the appropriate action to control postprandial hyperglycemia.

    If you need more information or are interested in this topic, you can consult your family physician, your diabetes educator or your endocrinologist, who will be able to give you some strategies to help you better control postprandial hyperglycemia.

    Presenter: Dr. Jean-François Yale, Endocrinologist, Montreal, QC

    Local Practitioners: Endocrinologist

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