Tips to Avoid Post-Meal Spikes in Your Blood Sugar


 2021-10-27

This resource on inhaled insulin was made possible with support from MannKind (makers of Afrezza (insulin human) Inhalation Powder). Beyond Type 1 maintains final editorial control of all content published on our platforms.


One of the most challenging parts of managing your diabetes is keeping your blood sugar in your goal range after a meal. For people with diabetes, trying to match the timing of your insulin with the digestion of your meal is never simple.

While there are certainly a variety of strategies that can help, it’s often hard to know which strategy to use or how to realistically apply them to real life with diabetes.

Here are 3 tips that may help you prevent a big post-meal spike in your blood sugar. Of course, patients should always consult with their medical provider before making changes to their diabetes management.

1. The mighty pre-bolus

If you’re taking fast or rapid-acting insulin via pen/syringe/pump/inhaler, the “pre-bolus” is the standard recommendation for meals that are moderate in carbohydrates, dietary fat, and protein.

A pre-bolus means you take the insulin dose for your meal approximately 5 to 15 minutes before eating because today’s fast or rapid-acting insulin takes 15 minutes to start working in your bloodstream after injection. This insulin’s action on your blood sugar also peaks at approximately 1 hour after injection.

The goal here is to time the action of your insulin with when the majority of your meal is digested and hitting your bloodstream. By giving your insulin a head start in your system, it can prevent that post-meal spike and help you stay within your goal range.

When pre-bolusing won’t help: Pre-bolusing works well for meals that are moderate in carbohydrates and low-to-moderate in fat and protein, but it can be dangerous for other types of meals. If you’re eating a high-carb/high-fat meal (like pizza, cake, Chinese food, etc.), a pre-bolus can lead to a severe low within the hour or two after eating because these meals often take many hours to digest.

Pre-bolusing is also likely unnecessary and unsafe if you’re eating a low-carb/high-fat/high-protein meal because the digestion of the fat and protein is slow and the digestion of the minimal carbohydrates will be slower, too.

Talk to your healthcare team to determine when pre-bolusing is right for you.

2. Try inhaled insulin

Inhaled insulin is one of the lesser-known strategies to improve mealtime control. Manufactured by MannKind, Afrezza inhaled insulin offers two things:

  • It starts working fast – within 12 minutes
  • It’s out of your system within 1.5 to 3 hours, depending on the dose

Important Safety Information

What is the most important information I should know about AFREZZA?AFREZZA can cause serious side effects, including:
            · Sudden lung problems (bronchospasms). Do not use AFREZZA if you have long-term (chronic) lung problems such as asthma or chronic obstructive pulmonary disease (COPD). Before starting AFREZZA, your healthcare provider will give you a breathing test to check how your lungs are working.

Please see additional Important Safety Information for Afrezza below.

Using Afrezza with your meals means you don’t need to worry about pre-bolusing, which is especially helpful if you can’t always predict when you’ll eat — like when ordering at a restaurant, or fitting mealtime into a hectic work schedule.

For people who don’t already take mealtime insulin, adding Afrezza to the biggest meal of your day can help lower your blood sugar without increasing your daily number of injections.

Using Afrezza for meals is also an alternative if you already take mealtime insulin but might also want to reduce your number of daily injections.

Using ultra-rapid acting Afrezza could be especially helpful because you can take an additional dose 1 to 2 hours after your meal if your blood sugar is still elevated, due to the short duration of effect (out of your body within 1.5 to 3 hours).

Talk to your healthcare team about adding inhaled insulin to your diabetes toolbox!

3. Go for a walk after the biggest meal of the day.

Walking after your biggest meal of the day can have a big impact on those post-meal highs, but knowing how to add it to your routine safely takes some careful thought.

If you don’t take mealtime insulin, a 15 to 30-minute walk after eating is a generally safe way to help your body burn up the carbohydrates from your meal.

If you take long-acting insulin or other medications that can cause hypoglycemia (low blood sugar), you should always carry fast-acting carbohydrates with you, like juice, glucose tabs, or jelly beans.

Talk to your healthcare team about safely adding a post-meal walk to your diabetes management regimen.

 


AFREZZA® (insulin human) Inhalation Powder is a rapid acting inhaled insulin indicated to improve glycemic control in adult patients with diabetes mellitus.

Important Safety Information

 What is the most important information I should know about AFREZZA?AFREZZA can cause serious side effects, including:

  • Sudden lung problems (bronchospasms). Do not use AFREZZA if you have long-term (chronic) lung problems such as asthma or chronic obstructive pulmonary disease (COPD). Before starting AFREZZA, your healthcare provider will give you a breathing test to check how your lungs are working.

 What is AFREZZA?

  • AFREZZA is a man-made insulin that is breathed- in through your lungs (inhaled) and is used to control high blood sugar in adults with diabetes mellitus.
  • AFREZZA is not for use in place of long-acting insulin. AFREZZA must be used with long-acting insulin in people who have type 1 diabetes mellitus.
  • AFREZZA is not for use to treat diabetic ketoacidosis.
  • It is not known if AFREZZA is safe and effective for use in people who smoke. AFREZZA is not for use in people who smoke or have recently stopped smoking (less than 6 months).
  • It is not known if AFREZZA is safe and effective in children under 18 years of age.

What should I tell my healthcare provider before using AFREZZA?
Before using AFREZZA, tell your healthcare provider about all your medical conditions, including if you:

  • Have lung problems such as asthma or COPD
  • Have or have had lung cancer
  • Are using any inhaled medications
  • Smoke or have recently stopped smoking
  • Have kidney or liver problems
  • Are pregnant, planning to become pregnant, or are breastfeeding. AFREZZA may harm your unborn or breastfeeding baby.

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins or herbal supplements.

Before you start using AFREZZA, talk to your healthcare provider about low blood sugar and how to manage it.

What should I avoid while using AFREZZA?
While using AFREZZA do not:

  • Drive or operate heavy machinery, until you know how AFREZZA affects you
  • Drink alcohol or use over-the-counter medicines that contain alcohol
  • Smoke

Do not use AFREZZA if you:

  • Have chronic lung problems such as asthma or COPD
  • Are allergic to regular human insulin or any of the ingredients in AFREZZA.

What are the possible side effects of AFREZZA?
AFREZZA may cause serious side effects that can lead to death, including:
See “What is the most important information I should know about AFREZZA?”

Low blood sugar (hypoglycemia). Signs and symptoms that may indicate low blood sugar include:

  • Dizziness or light-headedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability or mood change, hunger.

Decreased lung function. Your healthcare provider should check how your lungs are working before you start using AFREZZA, 6 months after you start using it, and yearly after that. Lung cancer. In studies of AFREZZA in people with diabetes, lung cancer occurred in a few more people who were taking AFREZZA than in people who were taking other diabetes medications. There were too few cases to know if lung cancer was related to AFREZZA. If you have lung cancer, you and your healthcare provider should decide if you should use AFREZZA.Diabetic ketoacidosis. Talk to your healthcare provider if you have an illness. Your AFREZZA dose or how often you check your blood sugar may need to be changed.Severe allergic reaction (whole body reaction). Get medical help right away if you have any of these signs or symptoms of a severe allergic reaction:

  • A rash over your whole body, trouble breathing, a fast heartbeat, or sweating.

Low potassium in your blood (hypokalemia).Heart failure. Taking certain diabetes pills called thiazolidinediones or “TZDs” with AFREZZA may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure it may get worse while you take TZDs with AFREZZA. Your healthcare provider should monitor you closely while you are taking TZDs with AFREZZA. Tell your healthcare provider if you have any new or worse symptoms of heart failure including:

  • Shortness of breath, swelling of your ankles or feet, sudden weight gain.

Get emergency medical help if you have:

  • Trouble breathing, shortness of breath, fast heartbeat, swelling of your face, tongue, or throat, sweating, extreme drowsiness, dizziness, confusion.

The most common side effects of AFREZZA include:

  • Low blood sugar (hypoglycemia), cough, sore throat

These are not all the possible side effects of AFREZZA. Call your doctor for medical advice about side effects.

Please see full Prescribing Information and Medication Guide, including BOXED WARNING on Afrezza.com.

WRITTEN BY Ginger Vieira, POSTED 10/27/21, UPDATED 08/03/22

Ginger Vieira is an author and writer living with type 1 diabetes, Celiac disease, fibromyalgia, and hypothyroidism. She’s authored a variety of books, including “When I Go Low” (for kids), “Pregnancy with Type 1 Diabetes,” and “Dealing with Diabetes Burnout.” Before joining Beyond Type 1 as Digital Content Manager, Ginger wrote for Diabetes Mine, Healthline, T1D Exchange, Diabetes Strong and more! In her free time, she is jumping rope, scootering with her daughters, or walking with her handsome fella and their dog.