Every diabetic is familiar with fastingblood glucose tests.
You don't eat for at least eight hours, you check your blood sugar, and by
that, you establish what your baseline glucose is.
This was at least the traditional idea of blood sugar testing.
But given that most of us spend a lot of the day -- maybe even most of the day
-- having eaten something within the last few hours, can we really call the
glucose levels we have after eating "abnormal"? In fact, isn't it more
abnormal to go eight hours during the day without eating or drinking
with diabetes can seem like a full-time job -- trying to keep up with
everything you need to do for proper diabetes care.
"Diabetes is a very time-consuming disease to manage well," says
Karmeen Kulkarni, MS, RD, CDE, and former president of health care and
education for the American Diabetes Association. "The medication, the food, the physical activity -- you add life
in general to that whole picture and it ends up being quite
In short, this is the idea behind postprandial -- or after-meal
-- glucose testing. Since we spend so much time in a postprandial state, the
argument goes, it's important to monitor blood glucose levels during that time,
too. While it may make intuitive sense, postprandial testing is one of the most
hotly debated subjects in diabetes care. Is it an important new way of testing
blood glucose that will reshape diabetes treatment, or is it merely a
distraction from what's really important?
Setting the Limits
Paul Jellinger, MD, past president of the American Association
of Clinical Endocrinologists (AACE), is a firm believer in the importance of
postprandial testing. In 2001, when Jellinger was president of AACE, the
organization issued a consensus paper on diabetes treatment that discussed
"What we came up with was a number of new guidelines for
postprandial testing," Jellinger tells WebMD. "We made a recommendation
that a person's postprandial blood sugar, taken two hours after eating, should
not exceed 140 mg/dL."
How did they arrive at that limit? Given the ways in which we
all eat, postprandial testing would seem inherently imprecise; for instance,
the glucose level of someone who just ate a salad for lunch might be pretty
different from someone who just finished a Thanksgiving dinner. To resolve this
issue, the AACE set a cutoff based on a comparison of the typical glucose
levels of diabetic and non-diabetic people after eating.
"We know that in a normal person without diabetes, it's
very rare for his or her blood sugar to exceed 140 mg/dL two hours after a
meal," says Jellinger. "It can happen, but not often."
However, Jellinger is quick to concede that the cutoff number
has been contentious. Just because people without diabetes don't usually reach
a blood-glucose level of more than 140 mg/dL does not necessarily mean that
anything above that particular number increases the risks of diabetic
"I think postprandial testing is very important," says
Om Ganda, MD, director of the lipid clinic at the Joslin Diabetes Center and
associate clinical professor at Harvard Medical School. "In order to
control diabetes well, you need to control the blood sugars 24 hours a day, and
not just when you're fasting. People can have a pretty normal fasting blood
sugar but still have a high postprandial level."
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Your level is currently
If the level is below 70 and you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.
People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.
Congratulations on taking steps to manage your health.
However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.
Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.
Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.
One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.
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