The Importance of After-Meal Testing
Settling the debate about post-meal "BS"
As a person who has lived with diabetes for 35 years and as a physician specializing in taking care of people with diabetes for over 20, it has always made perfect sense to me to try and mimic what happens to the post-meal blood sugar (BS) levels in people without diabetes. Why would it be “OK” or “not bad” if a person with any type of diabetes has BS values commonly above 250 to 300 mg/dL for several hours at a time after every meal?
In the post-meal state 12 hours a day
It has been demonstrated that most people with diabetes are in the post-meal state (i.e., the amount of time BS values are above what they would be if a person were in the fasting state) for up to 12 hours a day. The recommended fasting BS goal for people with diabetes is 110 mg/dL. Therefore, if post-meal BS values are excessively high for several hours after each meal, there is a heck of a lot of hyperglycemia during the day. Well, hours turn into days, days to weeks, and weeks to months. If blood sugars remain high over several months, your A1C will also rise. In addition to just a high A1C value over time, wide swings in BS values (also known as “glycemic variability”) are also thought to be a potential cause of diabetic complications.
Controlling post-meal BS is important in pregnancy
When it comes to controlling the post-meal BS in pregnant women with gestational diabetes, there is no argument at all—even by those so-called “diabetes experts.” In terms of the baby’s health and reducing the rate of the mother’s need for a cesarean section, it has been clearly proven that adjusting insulin therapy according to the results of post-meal BS values improves outcomes at delivery.
A very good friend of mine is one of those “diabetes experts” reluctant to say that post-meal BS is important. He once told me that it was probably not abnormal for “normal” people like himself (he does not have diabetes) to have high BS values after large meals, so why get concerned about it at all? Well, while we were in Paris attending a diabetes meeting, I offered to test his blood sugar after he ate appetizers, a large steak, soup, salad, lots of bread, a heavy-carbohydrate-laden dessert and several beers.
It was only 110mg/dL. Need I say more?
Perfect study has not been done yet
I will be the first to admit that the perfect cause-and-effect study linking complications with elevated post-meal BS levels in men and women (who are not pregnant) has not been published yet. I guarantee you—and my good buddy—that if he had diabetes he would be actively controlling his own post-meal BS values.
This is why I think the debate over the importance of the post-meal BS is full of bull!