Glucose Testing: After Meals?
Should diabetics test their blood sugars after eating, too? The debate continues.
Detecting and Treating Postprandial Hyperglycemia
While the significance of postprandial testing and the
standards for doing it haven't been firmly established, proponents like
Goldstein and Ganda ask their patients to keep a log of blood sugars before and
after a certain meal each day for a few weeks before a doctor's visit; that
way, they can see whether there are any worrying spikes in the glucose levels
above 140 mg/dL.
Treatment for postprandial hyperglycemia can include behavioral
techniques such as exercise and weight loss, and medication. One ongoing study,
the European Study to Prevent Non-Insulin Dependent Diabetes (STOP-NIDDM),
seems to show that treatment of people with IGT -- based on postprandial blood
sugars -- with the drug acarbose (Precose or Prandase) helped prevent the onset
of type 2 diabetes and reduced the risks of cardiovascular problems. In his
practice, Goldstein has had success using sulfonylureas and fast-acting
insulins in reducing postprandial blood sugar levels.
And while the general significance of postprandial
hyperglycemia is debated, there is some consensus that it is important for
certain groups of people. In 2001, a panel chaired by Nathan released an ADA
position paper on postprandial testing. One of the few issues that was agreed
upon was the benefit of postprandial testing in pregnant women who develop
gestational diabetes. Women whose postprandial glucose is monitored and reduced
have fewer complications during pregnancy and their risks of having a cesarean
delivery are reduced.
Nathan, who is dubious of the general uses of postprandial
testing, believes it may have other advantages.
"The importance of postprandial glycemia is greater in the
pre-diabetic state, where it can be a more sensitive indicator of abnormal
metabolism," he tells WebMD. This may be especially true for the elderly,
who may exhibit postprandial hyperglycemia that isn't detected by fasting
Deciding What To Do
Obviously, there isn't any scientific consensus on whether
postprandial glucose testing is an important part of general diabetes care.
While proponents like Jellinger concede that we don't yet have absolute proof
of the importance of postprandial hyperglycemia, he believes that the
epidemiological studies are evidence enough. "I don't think that we're
doing our patients any favors if we wait for a study that may never
happen," he says.
However, critics like Goldstein argue that given the impending
and potentially catastrophic epidemic of type 2 diabetes, "the last thing
we need to put all of our energy into is postprandial hyperglycemia," he
says. "We should be working on the bread and butter things."
So what should you do? The best advice is to talk to your
doctor and see whether he or she suggests postprandial testing in your
particular case. While treatment focused specifically on your postprandial
glucose levels may not be necessary, it might be useful to know what they
"The study of postprandial glucose testing is just in its
infancy," says Fran Kaufman, President of the American Diabetes
Association. Whether it will emerge as a significant tool of diabetes control
just isn't clear yet.