Try Byetta or Symlin. Two injectable synthetic hormones, exenatide (Byetta) and pramlintide (Symlin), can substantially lower post-meal blood glucose levels. Both hormones slow stomach emptying, which keeps carbohydrates from raising the blood glucose too quickly after meals. Byetta, which is approved for use only in people with Type 2 diabetes, also blunts appetite and promotes the growth of insulin-producing cells in the pancreas. Symlin, which is approved for use in people with either Type 1 or Type 2 diabetes who take rapid-acting insulin at mealtimes, is a replacement for the hormone amylin. It helps to diminish appetite, and it additionally blunts post-meal glucagon secretion from the pancreas. (Glucagon is a hormone that raises blood glucose level by stimulating the liver to release stored glucose.)
Like much of diabetes management, medicine is only part of the story in preventing after-meal spikes: Diet and exercise can play a role as well. Here’s how:
Think lower GI. As mentioned earlier, the glycemic index is a rating of how quickly a food raises the blood glucose level. While all carbohydrates (except for fiber) convert into glucose eventually, some forms do so much faster than others.
Many starchy foods (such as breads, cereals, potatoes, and rice) have a high glycemic index; they digest easily and convert into blood glucose quickly. However, some starchy foods (such as pasta, beans, and peas) have lower glycemic index values. Foods that have dextrose in them — such as glucose tablets and gel and candies such as SweeTarts, Smarties, Spree, Runts, Nerds, and AirHeads — tend to have a very high glycemic index. Table sugar (sucrose) and fructose (fruit sugar) have moderate glycemic index values, while lactose (milk sugar) is slower to raise blood glucose.
A number of books, notably Dr. Jennie Brand-Miller’s Glucose Revolution series, contain extensive information about the glycemic index, along with lists of glycemic index values for hundreds of foods.
As a general rule, switching to lower-glycemic-index foods will help to reduce your after-meal blood glucose spikes. There are a number of characteristics that slow down the rate at which foods are digested and raise blood glucose. Here are some of them:
- Foods that contain soluble fiber (such as legumes, oats, and psyllium) are digested more slowly than low-fiber carbohydrate foods and than foods that are high in insoluble fiber that has been finely ground, such as whole wheat flour.
- High-fat foods are digested more slowly than low-fat foods.
- Solids are digested more slowly than liquids.
- Cold foods are digested more slowly than hot foods.
- Under-ripe and undercooked foods are digested more slowly than fully ripe or well-cooked foods.
- Whole foods (such as unprocessed grains, legumes, and dried beans) are digested more slowly than milled or processed foods.
Another food property that affects the rate of digestion is acidity. This is why sourdough bread has a much lower glycemic index value than regular bread. Research has shown that adding acidity to a meal in the form of vinegar (straight or consumed as part of a salad dressing or other condiment) can reduce the one-hour post-meal blood glucose rise by 50% or more.
Split your meal. The amount you eat has the greatest effect on your blood glucose level after you eat. One way to lower your blood glucose rise after meals, therefore, is to eat less. But you don’t have to starve: instead, save a portion of your meal for a “snack” one or two hours later. That way, you get all the food you need, but it doesn’t raise your blood glucose all at once.