I’m a 60-year-old male and have had type 1 since 1979. I am physically fit, have normal weight, and have no diabetes complications. I have an A1c target of about 6%, use Novolin in a pump, and have a basal rate that holds my blood sugar steady without eating. When I have a pre-meal blood sugar of about 100 mg/dl [5.6 mmol/L], and eat a “standard good meal” followed by normal activity, not exercise, when might I normally expect that the postprandial blood sugar returns to near the pre-meal levels?

As you know, persons without type 1 diabetes have their blood sugar go up within five minutes of eating and stay up for some time after the meal. With therapy for diabetes, the target is to keep the glucose level from remaining high for longer periods of time. When we have our patients intensively control their glucose levels, the two-hour goal is often stated to be under 120 mg/dl [6.7 mmol/L]. You would anticipate that the usual pre-meal glucose of 100 mg/dl [5.6 mmol/L] to which you refer would probably occur within another 30 minutes or so. Interestingly, in women with gestational diabetes, there was an improved A1c when the target blood sugar was achieved after meals, compared to a target blood sugar before the meal. This would suggest more potency for A1c lowering with an aggressive post-meal blood sugar target.

JTL