Most people with diabetes frequently test their fasting and 2-hour postprandial blood glucose levels, and often wonder whether fasting blood glucose or 2-hour postprandial blood glucose is more important. In fact, both are important, but for type 2 diabetics, postprandial blood glucose plays a more important role in preventing diabetic macrovascular and microvascular comorbidities. Cardiovascular complications are the most common and costly diseases of type 2 diabetes.
For patients with diabetes, it is important to routinely monitor fasting blood glucose, 2-hour postprandial blood glucose and glycated hemoglobin, and all blood glucose values should be maintained at good levels over time. Good glycemic control can prevent not only diabetic macroangiopathy, such as angina pectoris, myocardial infarction and stroke, but also diabetic microangiopathy, such as diabetic nephropathy and diabetic retinopathy. Therefore, as long as they can control their diet well, exercise appropriately, take their medication on time and review regularly, diabetic patients can control their blood sugar very effectively and prevent and delay the occurrence and development of comorbidities.
What is postprandial blood glucose?
Postprandial blood glucose usually refers to the blood glucose 2 hours after a meal. Compared to fasting blood glucose, postprandial blood glucose is a more effective predictor of progression from decreasing glucose tolerance to diabetes. In normal individuals, an increase in blood glucose after a meal rapidly stimulates insulin secretion, inhibits hepatic glucose output, increases glucose utilization by peripheral tissues (muscle and fat), and turns glucose into glycogen and fat for storage in muscle tissue. At the same time, the secretion of some blood glucose-raising hormones, such as glucagon, adrenaline, glucocorticoid and growth hormone, is inhibited so that hepatic glycogen breakdown and hepatic glucose output are reduced. Both of them work to gradually restore blood glucose to the postprandial level after eating, thus keeping blood glucose in the range of 4.4mmol/L to 7.8mmol/L. After the onset of diabetes, due to the diminished function of pancreatic B cells, less and less insulin is secreted, which cannot utilize the excessive sugar in the blood after meal into the tissue cells, presenting postprandial hyperglycemia.
What are the common causes of postprandial hyperglycemia?
1, postprandial hyperglycemia is related to diabetes itself. Patients with urinary disease often have significantly higher postprandial blood sugar due to impaired insulin secretion in the early phase and delayed insulin peak, and if the patient is combined with serious insulin resistance, the postprandial hyperglycemia will last for a long time.
2. High postprandial blood glucose is related to the patient’s neglect of postprandial blood glucose. Most diabetic patients often only pay attention to fasting blood sugar when monitoring blood sugar, and rarely monitor postprandial blood sugar. This leads to the fact that once the doctor asks to check the postprandial blood sugar, he often finds that his blood sugar is alarmingly high and the glycated hemoglobin is also obviously elevated.
3. Postprandial hyperglycemia is also related to the patient’s diet. This is not only related to the secretion of more hormones to fight against insulin in the morning and the production of large amount of glucose by the liver, but also may be related to the quality, quantity and cooking method of the patient’s breakfast. Some patients like to eat thin rice for breakfast, because thin rice is heated for a long time, starch is easily dissolved in water, and can be widely contacted with digestive juices and easily absorbed after eating. In addition, thin rice is semi-fluid, and the emptying time of the stomach is shorter after eating, so it is easier to raise postprandial blood sugar by eating thin rice for breakfast than eating dry rice.
4, after high blood sugar and patients with improper medication related. A part of type 2 diabetic patients, with obvious obesity and insulin resistance, but have been using long-acting insulin promoters such as euglycemia and other drugs, such drugs due to the long onset of action, can not well improve the early phase of diabetes insulin secretion, reduce insulin resistance, so it is often difficult to control postprandial blood sugar. In addition, when some patients use insulin, they mainly use medium- and long-acting insulin instead of combining with short-acting or ultra-short-acting insulin with fast onset, so post-prandial blood sugar is also easy to be high.
How to control postprandial hyperglycemia?
1. Strictly control the diet. Pay attention to the quality, quantity and cooking method of each meal, insist on eating dry rice as the main breakfast, if you are not used to eating dry rice for breakfast, you can choose “ten grain rice” porridge, that is, brown rice, black glutinous rice, millet, buckwheat, gravy, oats, lotus seeds, cereals and red barley and other portions of the mixture, if you want to taste better, add longan, raisins, etc.. Use this coarse grains cooked porridge, can have a sense of satiety, intestinal absorption time is long, can maintain the stability of blood sugar.
2, adhere to the appropriate exercise after meals. Proper exercise after meals can consume body heat and assist in reducing postprandial hyperglycemia. It is generally recommended to start exercising half an hour after meals, and you can choose aerobic forms of exercise, such as jogging, brisk walking, etc. The intensity of exercise should not be too great, and the time is mastered in 30-45 minutes. It is recommended not to do intense anaerobic exercise, the latter can stimulate sympathetic excitation, but will raise blood sugar.
3. Pay attention to the monitoring of post-prandial blood sugar. After being diagnosed with type 2 diabetes, you should not only check fasting blood sugar and urine sugar regularly, but also monitor postprandial blood sugar without fear of trouble. For patients with type 2 diabetes, blood glucose should be checked daily when the disease is unstable, at least once a week when the disease is stable, fasting and 2h after meal blood glucose, and at least once a month all day fasting, 2h after three meals, and bedtime blood glucose. Therefore, when considering how well your diabetes is controlled, we should pay full attention to the overall control of blood glucose, rather than one-sidedly focusing on fasting blood glucose, or one-sidedly recognizing that fasting blood glucose is well controlled.
4. Use drugs that can improve the first-phase insulin secretion. Such as non-sulfonylurea insulin secretagogues such as Reglanet, Naglinide, fast-acting insulin analogues such as NovoRel and other drugs, these drugs can effectively improve the early phase insulin secretion, and have the dual effect of dose-dependent and blood glucose concentration-dependent when promoting insulin secretion. The newly developed glucagon-like peptide-1 (GLP-1) can also significantly improve glycemic control in type 2 diabetes due to its effect of significantly improving first-phase insulin secretion and inhibiting glucagon release. In addition, among many antidiabetic drugs, α-glucosidase inhibitors are also a good drug for controlling postprandial hyperglycemia due to delaying postprandial carbohydrate absorption by competitively inhibiting α-glucosidase on the small intestinal villi.