Diabetes Self-Management Blog

Many people (and their doctors) use A1C and fasting blood glucose levels to gauge their diabetes control. But those numbers only tell half the story. To prevent organ damage, we also have to keep glucose from spiking after meals. How can we do that?

Do You Spike?
If you just check your blood glucose levels in the morning and maybe at bedtime, you will miss these spikes. Say your numbers at those times usually run about 125 mg/dl. If your blood sugar levels were like that all day, your A1C would be about 6.0%. But maybe when the doctor tests your A1C, it might be closer to 7.6%. You know then you are spiking after meals high enough to raise your average sugar to 170, which means spiking well over 200. You can find a good calculator for converting A1C to average glucose here.

Glucose levels above 140 can lead to inflammation of blood vessels and organs. The higher the spike goes and the longer it lasts, the more damage there is likely to be. With any type of diabetes, we want to get those spikes down, and it takes a lot of monitoring and experimenting to get it right.

Gary Scheiner, MS, CDE, who has Type 1, wrote here that for Type 1s, it’s about managing your insulin so that it peaks when blood glucose is peaking and drops off when glucose levels do. You can only do that with fast-acting insulin injections or a pump. But even then, you have to know how much a given meal is likely to raise your sugar to know how much to give and when to give it. Scheiner recommends testing about an hour after completing a meal or snack. That’s when sugar levels tend to be highest.

Jenny Ruhl at Diabetes Update says different people and different foods spike differently. So to find the very highest spike, you might have to try different times. “Meals heavy in fat digest more slowly than those that are made up mostly of starches and sugars,” she says. “Large meals of any composition may produce a slightly delayed spike.” High protein meals may spike even later. It will take some experimenting to find out.

It’s also valuable to learn how fast blood sugar levels come back down, and how low. So you might want to check again an hour after the peak. Ruhl says that, “When you take a second reading is up to you and depends on how many strips you have and what [you already know] about how your blood sugar works. Most of us will find it informative to [check] an hour after the peak occurs to see how fast our blood sugar is dropping from its peak.”

For many people, after-breakfast spikes go the highest. It may be that insulin resistance is worse in the mornings because you haven’t been moving around much.

Shrinking the Spike
You can do many things to reduce after-meal (also called “postprandial”) spikes. Most important is eating fewer, less-refined carbs. More vegetables, more fiber, so that glucose gets into the blood more slowly. Including some protein at each meal also slows the rise in glucose. (This includes breakfast!) If you’re Type 2, your natural insulin might be able to keep up with this slower drip of glucose into the blood.

You can also check the glycemic index (GI) of your foods. Low-GI foods put glucose in your system more slowly, reducing spikes. This page has a good glycemic index chart.

Gary Scheiner recommends mild physical activity after eating to reduce insulin resistance and get glucose into cells. “The key is to avoid sitting for extended periods after eating,” he says. He also gives many tips on working with insulin boluses and basal rates here.

There are reliable natural ways to reduce spikes. One of the best is vinegar (apple cider, rice, or wine). Take a couple of teaspoons as part of a dressing or drink or in a capsule before or near the beginning of a meal. Dozens of readers commented here that vinegar had lowered their blood sugar levels.

Cinnamon also has been found to reduce glucose spiking. A study in The Journal of Clinical Nutrition found that, “Inclusion of cinnamon in the diet lowers the postprandial glucose response, a change that is at least partially explained by a delayed gastric emptying rate.”

One study found that mulberry leaf reduced spikes by 44%, probably by slowing carbohydrate absorption, (like the starch-blocker drug acarbose (brand name Precose.) Other studies show that mulberry reduces insulin resistance. Most of these studies come from Korea and Japan. Here mulberry leaf extract is marketed as the main ingredient in Glucocil, a popular supplement. Glucocil is a little pricey (though not compared with brand name prescription drugs), but straight mulberry leaf extract is available for less than $10 a month.

So it seems not too hard to reduce postprandial spikes, and well worth the effort. How has that gone for you?

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Comments
  1. These postings were really very useful. I was certainly glad to hear that “apple cider” vinegar before meals is a good idea because my mom has been preaching that for years and I thought it just an old wise-tale.

    Posted by Cecelia |
  2. Now, I will turn everyone green, a simple cheat fix is to add oil and fry the potatoes and rice.

    Boiled only - rice and mashed potatoes really spike the sugar.

    Fry the stuff ( I hear socks curling up on some folkes ankles) and voila with proper portion control and peak is smoothed over.

    Posted by jim snell |
  3. Even better than Jim suggestion is to avoid those 2 at all times.

    Posted by calgarydiabetic |
  4. Be that as it may; I am always running my system at Doctor’s orders to keep BG going sub 100 and not trigger liver glucose add cycle which my liver is bad behaved.

    Yes, going low glycemic and let liver to fill in bottom is the proper stratagy as long as one’s system is working properly and the liver fifo add does not shoot 20 per cent above nominal.

    So.. some carbs are usually helpful in meeting my doctor’s goals.

    People consistently work with a one set solves sll without understanding the underlying facts/issues.

    Posted by jim snell |
  5. Jim
    Since I am fairly new at this can you please explain your comment “liver fifo add does not shoot 20 per cent above nominal”

    Posted by Teresa |
  6. My apologies; in plain English -American:

    Ones liver has a storage buffer where excess glucose is stored. Its role is couplke fold as follows:

    a) When intestine/gut no longer providing glucose from digestion, liver provides a low level feed that helps set the operating point of ones body and if every thing good, this will be maintained at 80 to 100 nominal.

    b) In this consition when gut/intestine not providing glucose and if BG goes sub 70, brain/liver will catch this fact and feed even more glucose in. When it does, liver is supposed to observe insulin level and cut off this larger addition once BG gets to 20 percent above nominal of 100.

    For some of us folks, we have livers mis behaving and adding too much glucose under these conditions. Sometimes - most this excess glucose only creates a slightly larger BG level.

    In my case I watch my liver crank on hard and watch BG shoot to 511 - max on caveman machine and then as liver finally stops adding, BG will slide back to 278 to 311 as heart pumps the stuff (crap-glucose) around the body diluting it down.

    My Doctor decided and I agree it is better for me to stop that monkeyshines by stopping BG from going sub 100 and triggering the legitamate liver activity.

    It is interesting to note that metformin also stops this nonsense and doses at 10:00 and 12:00am midnight of 500 mg doses stop the dawn effect from doing same thing.

    Before this theatrics, my a1c was 13.3 and could not lose an ounce. Aftar controlling liver on metformin and BG bottom and control - a1c dropped to 6.9 and than 6.4 and I could finally lose weight on 1200 calorie diet and 2 miles walking.

    Why is my liver misbehaving - I do not know but you can read up on the researched data on how metformin actually works to slow down excess liver glucose ralease at Salk Institute, John Hopkins CHildrens as well as work done by University of Pittsburg on hormones and action in liver causing excess glucose release.

    Posted by jim snell |
  7. I am currently testing a cgm device on myself. I am not diabetic, but have been AMAZED to see the blood sugar peaks and valleys being recorded on the cgm…and that is with a fully functioning pancreas and no liver issues.

    Posted by Jackie Kelley RN MS CDE |
  8. I have found that a lot of the things they say here works. I was taught to add protein to my breakfast of oats with almond milk. and a grapefruit I used to grind peanuts and use 2 tbs with the cereal or use a Tbs. of peanut butter. I am now on a diet that doesn’t recommend using any nuts but almonds or hazlenuts, so I use a tbs. of almond butter! My blood sugar never gets above the normal limits with this. Also this diet reccomends using fresh lemon juice and it also helps with any spike you might incure!I drink lemon water with my dinner and lunch and it seems to work. In the evening I have a fruit shake that is full of carbs but add some whey protein powder and that flattens the line! Dan

    Posted by Dan Kashefska |
  9. cinnamon did not work for me. Vinegar does. I also eat at least 20 grams of protein with each meal. Since I am a vegetarian, this requires planning. Protein keeps me full so I eat less overall. A vegetarian diet is usually high in fiber which in itself helps.

    Posted by Linda |
  10. my 7 year old son has tyoe 1 diabetes and it is not a 1 size fits all, it is very difficult to keep his blood/glucose/sugars under control. we do with insulin at 6 shots per day, even then we have to keep an eye out for ketones, he has had diabetes for 3 years and 3 months, gets checked 12 to 15 times per day to catch everything incuding insulin going bad or not working to full strength. A1c is 7.1 - it is a lot of work for parents to let a child grow up the right way as a child through stages and to manage diabetes. he has not been to the hospital for any emergency pertaining to diabetes, but a lot of sleepless nights to this on a parents side. Remeber one size is not for everyone. different foods and drinks for one may not work for another, then you also have allergies amongst other restrictions and a lot of other experimenting with items. need to find the cause or causes for type 1 diabets and take them out of the environment, diabetes is more like a virus today than disease it once was considered. Diabetes the Parent Side International.

    Posted by Diabetes the Parent Side International |
  11. Several ways to stop spikes or that I found lowers sugars so be careful if you will follow the below and adjust your insulin.

    1. Simply don’t eat till your next meal and just drink water.
    2. Eat just a bite or two, ok three, of something rich or starchy but that’s all if you can’t help it.
    3. Eat something not starchy like vegetables almost all you want.
    4. Eat only a simple soup dish.

    All these will keep your sugar in check, if you use your normal insulin and it can go below average so be careful.

    Posted by Bimbam |
  12. The article and individual suggestions are all great. Thanks for all of it. I’m a spiker and know it…….

    Posted by Sonya Googins |
  13. articles by david spano are full of important information!!! they are well written and easy to understand…thus, can put the information to good use……many thanks..renee touriel ^.^

    Posted by renee touriel |
  14. My mom is a type 2 diabetic. She is going through chemo and radiation right now. We are struggling with her blood sugar. The problem is just before dinner her levels are spiking to 400. They run about 130-140 for her checks before and after breakfast and lunch. We are confused.
    Thanks Leslie

    Posted by Leslie |
  15. Leslie, your mother’s numbers are strange. Perhaps it has something to do with the chemo she is on, or some other new medicine? I would definitely ask her doctors to pay attention to this. Temporary continuous glucose monitoring, or more frequent monitoring might point to an explanation, but that may be too much trouble with everything else she is going through.

    Posted by David Spero RN |
  16. I have been a type 1 diabetic since 1981. I have had few side effects and tried to keep my A1C less than 7. After returning from Iraq in 2003 my A1C was 7.6 mostly due to the conditions I had to work under with the UN.

    I spent 5 years in Algeria under similar conditions got malaria, dysentery and dengue fever. The insulin I carried lasted 2 years without refrigeration as it is a very stable molecule.

    I had a major heart attack in 2008 and had a 100% and 70% blockage of the descending left artery (the widowmaker) my collateral flow made it possible for me to drive myself to the emergency without trouble and received three stents.

    Recently however I had a bottle of Humalog go cloudy. I think I may have injected a little blood accidentally reusing a needle. I have reused my needles for 30 years without trouble of any kind. I hope to encourage people not to live in fear of diabetes.

    One fact is that I am an athlete and run a mile in 4:40 at age 59. I have been physically fit all of my life and cannot say enough for the benefits of exercise. I still deadlift 640 lb as well as do mixed method martial arts.

    Posted by Harry Gatley |
  17. Sorry Bimbam, but this is the worst information I’ve seen posted on how to manage/reduce spikes. Obviously, if you don’t eat anything, you won’t spike. This is a very malnourishing diet. Which would you rather have, broken leg or arm? Diabetes or an F-up endocrine system. So many things wrong with your advice.

    Posted by Rayca |
  18. Type 2 diabetic.. tested my BS this am after a breakfast of 2 slices of cinnamon toast, and a cup of coffee with non-dairy creamer came back at 374! I’ve never had a BS that high-scared the heck out of me. Tested for Ketones which came back negative. Took 2 500 mg Metformin and waited. One hour later it came down to 274 and continued to drop. I had a scrambled egg for lunch. 6pm its 127. That was a huge scare for me. I have recently moved my 87 year Mom in with me and care for her. Do you think this could be stress related?

    Posted by Ann |
  19. My cure for my own diabetes in 2005 was half a teaspoonful of cinnamon and half a teaspoonful of fenugreek with breakfast. My GP still does not believe it. I also drink apple cider vinegar with warm water immediately after meals. I have also cut back quite savagely on the amount of dairy I use.

    Posted by Vasco Stevenson |

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Blood Glucose Monitoring
Blood Glucose Monitoring: Minimize the Pain, Maximize the Gain (08/15/14)
Potential A1C Test Alternative; Glucose Meter Recall (01/21/14)
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Why Do Test Strips Cost So Much? (09/24/13)

 

 

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