Post-Meal High Blood Sugars: How to “Strike the Spike”!

Drs. E+P offer several strategies on preventing and treating the post-meal spike, including nutritional approaches, medication options, insulin timing, CGM settings, lifestyle modifications, and tips they personally use in their own diabetes management.


Additional Resources:

What Should My Blood Sugar Be after Eating a Meal?

Controlling Blood Sugars after Eating

Battle of the Blood Sugars: The Pizza Challenge

How to Eat 3 Donuts and Stay In Range

Tell us what works for you in the comments below.

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    I use both FIASP and Afrezza together. I take the FIASP pre-meal and then Afrezza if I’m heading high. Works like a charm!!

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    You guys are great!! I loved your conversation with the burger!

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    You guys are great. I have learned so much from you. Thank you, thank you. I eat oats, seeds, nuts n berries for breakfast and almost immediately my blood sugar goes through the roof. I walk after that. When you say eat low carbs, don’t I have to eat my required amount according to my carb to insulin ratio? Also I tend to go lower while eating lunch which is so annoying because I have to prick to get the accurate bs number. I am using Dexcom6 which is not always accurate.

    • First of all, oats and berries will raise your blood sugars acutely. You may think about substituting more protein and less carbohydrates in your breakfast. It is also interesting that blood sugars jump up higher after breakfast than any other meal of the day, for a lot of physiologic reasons. You don’t have to eat any amount of carbohydrates, no matter what your insulin-to-carb ratio is, you can go from zero to a ton and it really doesn’t matter. You just count your carbs and put in the correct amount of insulin for that amount of carbs. You’re not limited to eating a certain amount of carbs. I’m sure what’s happening at lunch, but it may be that you’re blousing too much for breakfast, and I would predict that if you ate fewer carbs for breakfast, you may not have those lows at lunch.

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    I have type 1 brittle diabetes. I realize this is rare and even my endo is struggling with my bs. I am a female 82 years of age and was diagnosed at 75. I am a rare case all around. i use an inPen which I find very helpful and a Libre 14 day CGM which I don’t feel is too accurate. Consequently, I rely on finger sticks for a more accurate bs. I hope you can help me with ANY suggestions you might have.

    I follow all of your posts.
    Thank you

    • Hi Barbara,
      Congratulations for making it into your 80s! You sound very up on things, so I would suggest an insulin pump that communicates with the CGM, and the Dexcom G6 is a lot more accurate. The choices for a pump could be the Omnipod 5 or Tandem’s Control IQ. I would not choose a Medtronic system at this time. I think your diabetes will be much easier when you have a system that’s modulating the basal rate according to your CGM value 24/7.

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    My mystery that I haven’t been able to solve is after I eat,my blood sugar will go down immediately and sometimes into the danger zone. It doesn’t matter if it’s pure sugar or complex carbs it just goes down before it goes up. Makes it really difficult to respond to blood sugar that’s just in a 110 range and I just want to eat something to normalize and then I have to go into panic mode. Thought’s?

    • It’s hard to answer that question without a lot more information, but the obvious thought would be that you have too much insulin on board, perhaps basal or bolus from a previous meal. Without any more information it’s hard to give you any suggestions, but I bet there’s a way to improve on it.

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    I have shifted to a protein breakfast (veggie omelet) & coffee prior to the gym in the mornings without taking any insulin, I also eat 1/2 banana just minutes prior to the gym however control IQ gives me an auto bolus and then I have to worry about going low. I set my pump in exercise mode and we have adjusted my basal and my correction factors but I still have to rely on my iced coffee to keep me from going to low. Do you have any suggestions on what else I might try?

    • This is one of the most common problems with the CIQ that I’ve seen in many of my patients. Some of my patients disconnect their pump for a certain period of time before they exercise so it doesn’t give an auto bolus, which of course will lead to delayed hypoglycemia like it does with you. There is a way to set up a special profile that you can turn to, however, it is time consuming and difficult, but it can be done. As I mentioned before, some people find it’s easier to just disconnect for a period of time.

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    I can’t tell you how many newly diagnosed diabetics I have given your website to…thank you!
    My dilemma is that I want to try Afrezza so badly since fiasp does not bring my bs down quickly enough (I am in the stratosphere for hours). Unfortunately, my endo believes Afrezza is not for DT1 since “it will cause hypos”. How can I convince her otherwise?
    Also, my insurance will only cover Medtronic cgm/pump, but you dis them causing me to freak out! What about Medtronic should I watch out for?

  8. I have been a type 2 diabetic x 22 years. Recently, I have been told I am close to becoming a type 1. Is that normal? Anyway to prevent that from happening?

    • What you’re referring to is the natural progression of type 2 diabetes. It is very common, and over time, some people with type 2 diabetes can lose their ability to secrete enough insulin to keep blood sugars normal. Going on insulin doesn’t mean you have type 1, but it does mean you are an “insulin-requiring type 2”. It’s totally normal. Typically your doctor will start you with basal (long-acting) insulin first, and eventually add in fast-acting. But one step at a time. Please visit our video vault for lectures I’ve done on type 2 diabetes and insulin:

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