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1	Strike The Spike! Strategies for Combatting After-Meal Highs Gary Scheiner MS, CDE
2	Overview Definitions Risks Detection Management
3	After-Meal Peaks Defined ADA Goal: <180 mg/dl 1-2 hrs after start of meal DCCT Goals: <180 mg/dl 2 hrs after meal European Diabetes Policy Group: <165 (to prevent complications) International Diabetes Federation: < 140 mg/dl 2 hrs after meal
4	After-Meal Goals for Children Under 5 Years: <250 @ 1 hr. post-meal (<120 pt. Rise) 5-11 Years: <225 @ 1 hr. post-meal (<100 pt. Rise) 12 Years + < 200 @ 1 hr. post-meal (<80 pt. Rise)
5	After-Meal Peaks: Reality for children
6	After-Meal Peaks: Reality in Children
7	After-Meal Highs: Immediate Problems Tiredness Difficulty Concentrating Impaired Athletic Performance Decreased desire to move Mood Shifts Enhanced Hunger
8	Long-Term Problems
9	Long-Term Problems (contd)
10	Long-Term Problems (contd)
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13	Measurement of After-Meal Peaks SMBG Capillary (finger) test After completion of meal Check BG 1 Hr PP (or) every 15, 20 or 30 min until 2 consecutive BG drops occur No addl. Food/insulin until test is completed
14	Meter Test Example
15	Meter Test Example Time pp BG Value Premeal 135 :20 155 :40 168 1:00 214 1:20 222 1:40 175 2:00 141
16	Measurement of After-Meal Peaks CGMS (Medtronic) Worn for 72 hrs (or more), then data is downloaded Meals should be entered as “events” while wearing Calculates 1 & 3-hr post-meal averages
17	Measurement of After-Meal Peaks Real-Time Continuous Glucose Monitors Allow tracking of post-meal trends Produce BG estimates every 5 minutes
18	CGMS Case Study
19	CGMS Case Study
20	CGMS Case Studies
21	After-Meal Spike Reduction Lifestyle Approaches Medicinal Approaches
22	Glycemic Index All carbs (except fiber) convert to blood glucose eventually G.I. Reflects the magnitude of blood glucose rise for the first 2 hours following ingestion G.I. Number is % or rise relative to pure glucose (100% of glucose is in bloodstream within 2 hours)
23	Glycemic Index (contd.) Example: Spaghetti GI = 37 Only 37% of spaghetti’s carbs turn into blood glucose in the first 2 hours. The rest will convert to blood glucose over the next several hours.
24	Glycemic Index (contd)
25	Glycemic Index (contd) Use of Glycemic Index Lower GI foods digest & convert to glucose more slowly High-fiber slower than low Hi-fat slower than low Solids slower than liquids Cold foods slower than hot Type of sugar/starch affects GI
26	Glycemic Index (contd.)
27	Examples: Use of GI
28	Choice of Bolus Insulin
29	Timing of Bolus Insulin
30	Timing of Bolus Insulin
31	Does Timing Matter?
32	Does Timing Matter? Bolus w/meal Bolus pre-meal
33	Choice of Insulin Program
34	Injectible Symlin (Amylin Pharmaceuticals)
35	Injectible Symlin (Amylin Pharmaceuticals)
36	Pre-Meal Hypoglycemia
37	Physical Activity Intervention
38	Examples: After-Meal/Snack Activity Shooting Hoops Dancing Bowling Mini Golf Skating Walking Pets Household Chores Planned Exercise Yard Work Gym Class???
39	Examples: After-Meal/Snack Activity
40	Summary
41	For More Information: Gary Scheiner MS, CDE Integrated Diabetes Services 877-735-3648 (877-SELF-MGT) Website: www.integrateddiabetes.com E-mail: gary@integrateddiabetes.com