Challenges in Flattening the Post-Meal Spike

January 12, 2022

People often say that managing diabetes is so difficult because you can eat the same thing every day, take the same dose of insulin, and have different blood sugars each day. This can be so frustrating and make people feel like they are failing at their diabetes. But getting the bolus for meals right depends on many things, including counting the carbohydrates accurately, timing the bolus properly given the glycemic index or fat and protein content, and ensuring that the insulin gets into the body properly, to name a few.

What the Research Shows

High post-meal glucose levels affect Time in Range (TIR), HbA1c, and, over the long term, increases the risk of complications. It’s also incredibly common for the post-prandial (post-meal) blood sugar spike to be a challenge for people with diabetes. It turns out that even in a 2021 study where you control the meals, there is still more variability within a person than between people when you look at the glucose levels after meals.1

Let’s break down this study. There were thirty participants in the study who met the inclusion criteria:

  • Age 8-15 years
  • Type 1 diabetes for more than a year
  • HbA1c 9%
  • Using a CGM (continuous glucose monitor)

Before the study began, participants completed a two-week “run-in period,” during which the study doctors reviewed their glucose data and adjusted their current insulin regimen to reduce the variables that could affect the study. Then, the participants were given a consistent breakfast for six days. After the six days, they had a 14-day “free-living period,” meaning they returned to their usual routine. This allowed the researchers to look at the CGM data for the controlled portion compared to the normal portion.

The researchers were surprised when the results showed that the variability was greater within the individual participants as opposed to between the different participants. Other studies showed variability both within and between participants in adults, while this was the first study to look at pediatrics.1,2 The researchers hope this will help healthcare professionals with education strategies and, above all, help them feel empathy for the families they see with diabetes.

Strategies for Reducing Spikes

One of the best ways to reduce post-meal spikes is taking insulin ahead of the meal. This is not always recommended if you have meals that are low in carbohydrates or very high in fat. This is not necessarily recommended for infants and toddlers; as always, check with your own diabetes team. The best way to figure out how to nail a bolus is to eat the same foods repeatedly to determine what doses and timing work best for you for the foods. Utilizing one of the available AID systems can also be helpful in reducing spikes since the systems work to bring you to your target glucose level all the time.

Here are some additional tips about reducing post-meal spikes from #DiabetesHacks

  • If you cannot Pre-Bolus ahead of meals, you can take some of the insulin up front and the rest after the meal. You can also eat the non-starchy vegetables first, then the protein, and then the carbohydrates to allow time for the insulin to start working.
  • You can use a mix of insulin types to meet your needs best.
    • For example, if you are on multiple daily injections (MDI), you can use inhaled insulin for meals or snacks when you’re away from home instead of an injection.
    • Some people also have a prescription for inhaled insulin to use for post-meal high blood sugars, even if they use an insulin pump.
  • If you are of legal drinking age, combining a glass of wine or one beer with a high-fat meal (such as pizza) can help balance the delayed rise in glucose, similar to an extended bolus for fat and protein.

Hopefully, this also helps you have self-compassion or compassion for your loved one with diabetes when the after-meal glucose levels are out of range. This can help you build resilience and remind yourself that you can only control so many variables, and some of it is just luck.

  1. Substantial Intra-Individual Variability in Post-Prandial Time to Peak in Controlled and Free-Living Conditions in Children with Type 1 Diabetes
  2. Interindividual and Intraindividual Variations in Postprandial Glycemia Peak Time Complicate Precise Recommendations for Self-Monitoring of Glucose in Persons with Type 1 Diabetes Mellitus

Written and clinically reviewed by Marissa Town, RN, BSN, CDCES

Last Updated: March 26, 2024