Two hour post meal (prandial) readings

I am a diabetic educator RN and have type II diabetes—I am so frustrated —It is SO hard to get people to understand that two hour readings are ESSENTIAL to management—I went to a conference at University of South Florida and I remember the endo saying----"please get your patients to take 2 hour post meal readings and get them to understand that tissue damage happens when you are 140+ over time-----I have the hardest time getting them to change what they do because many tell me “MY DOCTOR TOLD ME TO TEST IN THE MORNING”—Did you know that people never testing a two hour are at HIGHEST risk for stroke and heart disease—DUH—no kidding—Doctors suck in knowledge and compassion regarding diabetes------It makes me nuts!!!

Thank goodness we are going for Dexcom 7 Plus training next week. Yes, I am aware of this, though we were told to aim for two hour postprandials of 160. She is a Juvenile diabetic and 12 years old, so that is a very erratic time. I can get her to 160 or140 two hours post, but then she has lots of insulin on board which will drop her further. So at the two hour mark, you “feed the insulin” and basically, you are bringing her back up again, though if you check within the hour she will be back at 140 or lower again. This necessitates feeding 8 to 10 grams of carbs each hour, until insulin on board is gone. Takes four and a half hours for insulin to leave the system; Novolog is not all that rapid. Not possible to keep track of these numbers in a Type 1 without cgms. It is also impossible to do this if she is out or at school because if she isn’t paying very strict attention, she will crash. We have to control this from our end. My main beef is endos do not even give you this target or tell you about the importance of the target. It may be very difficult to achieve, but we need to pay attention to this, as well, not ignore it. Whatever your type, the damage is still the same.

I think you are definitely “preaching to the choir” here, Lora, and we all join you in your frustration. So many of us have had doctors say, “You’re diabetic, take this medication, bye” and come to forums such as this one to get truly educated. I myself was misdiagnosed as Type II as are 15-20% of Type II’s. As a “Type II” I breezed through for a bit over a year on oral meds, not doing much else, but I did take at least one post-prandial a day and so recognized when my numbers started to rise and that I needed insulin. The rediagnosis I did on my own through research and thought and finally got it confirmed. Now that I am Type 1.5 and on insulin I am forced to take my diabetes management more seriously. I’m not saying there aren’t Type II’s who take their management seriously, I just wasn’t one of them.

I think you are in a position to educate and make changes in your patient’s lives. I’ve always gotten more information and support from RN’s than from doctors in the U.S. who are often too busy and arrogant to really help. But I absolutely agree that education is needed, for doctors as well as patients and the general public. It is shocking to me now that I realize how far behind the medical establishment is in using the knowledge available: Diagnosing Type 1.5, useful blood glucose standards (not 180!), teaching correct diabetes management and teaching good dietary management. (Retire that pyramid already!)


Thanks for the reinforcement…My frustration is getting those people who don’t read this info follow their MDs like sheep to the slaughter—Oh well–I WILL keep yelling and jumping up and down–to try to get my point across–I REALLY do jump up and down in class to make students remember me!!!

You’d be surprised the impact you make even when people seem to be ignoring you. I used to teach DUI classes. Nobody wanted to be there, most were in serious denial. They stared off into space or made sarcastic comments or politely told me it didn’t apply to them. But there were always those who came back later and said, “I thought about what you said later and it made sense, I just couldn’t admit it at the time.”

I am type one diabetitic and WAS NEVER told about post-prandial testing from any of the members of my diabetic health team. I learned about it’s value on the internet, from other diabetics, at diabetic sites like this one .Even when I got on the pump seven years ago, I was told that post-prandials were to be used for bolus and insulin sensitivity testing for the pump programming EVERY NOW AND THEN, not as an EVERYDAY OCCURRANCE. It is still sometimes hard for me to get into the habit, even when my insurance will pay for up to 10 strips a day.

Type 2’s have it hard in that many insurance companies will not pay for over 2 strips a day for them;and many doctors and medical personnel do not know the value of post-prandial testing so they do not push it. These factors are combined with what I have seen is a general aversion to testing among some type 2’s ( and some of us type 1’s who are in diabetic burnout, like I get from time to time)… I applaud you for getting the word out. But post-prandial testing is a hard sell.

God Bless

IF you haven’t already seen it, check out my page where I discuss and link to the research linking various forms of organ damage to specific blood test values. You will see an elegant study showing that neuropathy does not correlate to A1c or FBG, but does to 2 hour over 140 GTT results.

I think that in addition to patient education, what our medical system really needs is physician education. Yes, some endos realize the need for postprandial control. But many GPs, especially older ones, do not.
Maybe you could work with an endo in your area to provide some diabetes education for local GPs. If your program is successful, you could expand it to other areas.

The GPs here take care of old folks–our average age here in the Port Charlotte Florida area is 56-58.

I think we are the oldest population next to Arizona–

They discount and old folks…I will ask me boss to talk to the medical society…

Hey Lora…56-58 is not old folks!! LOL

Hi Lora…I live in Weston FL…lots of young families. My friend’s T2 husband is treated by a doc at Cleveland Clinic, S FL. He is told to take a pill once a day and take a fasting test only. World class care!

Hi Lora,

I have two, Type 2 friends who rarely test because their doctors didn’t encourage them to. One tests a couple times a month at most because he was told to test “randomly.” I mentioned to him that test strips expire so even his random testing is useless. The other, diagnosed about 6 years ago, also tests sporadically. Neither take their D seriously & it seems to be due to how blase their doctors are. It’s the take-these-pills & see you in six months attitude. Their A1cs are pretty high, but they’re told that they’re doing great.

Not wanting to be a doom & gloom merchant, I’ve diplomatically attempted to get them to take their health seriously. But, what’s a friend’s advice compared to a doctor’s instructions?

Type 2 is so sadly prevalent that you’d think education would be at the forefront. I’m wondering if this is having the opposite effect–so commonplace that doctors have a lax approach of “oh, just another Type 2.”

Glad there are educators like you to jump up & down!

There HAS to be an ADA approved class around…Does your friends’ husband ASK for education…If not no one comes forth–The MD isn’t interested in the wellness of his patient


Sure–I hear—"Oh I only take pills…People think that if they do not take insulin they are OK.

65-90% of diabetics are type ll…I have been certified as an educator or 18 years…and I am not thrilled with the progress related to understanding about diabetes among patients.

I have suggested that, but he is not interested. When he was diagnosed, he was assigned to a 1 hour class. (This was in another state.) His wife went along. They seemed to take away nothing. I have tried to turn her on to more healthful options for him…nuts as opposed to pretzels…but he is in some kinda serious denial and refuses to cut back on carbs. They don’t really seem to know about carb counting at all. She prepared a frozen entree with about 65 grams per spoonful for me because she assumed it would have less carbs than a sandwich. I had just gotten my pump, so I walked her through my routine of carb counting and dosing. She didn’t seem to have ever looked at the nutritional info on a food package. This is an educated, smart mature person, mind you. After we went through the dosing, she brought out fruit. She was surprised that I had to take insulin for fruit! The bigger problem is that she could try to influence him, but she feels she is not being a “good wife” if she doesnt buy the ice cream and cookies and chips and prepare the foods he requests…and he requests potatoes and pizza. I don’t know how to argue with that! That concept is so bizarre to me on a few levels!

Before I was diagnosed, I volunteered at the foot center at a hospital. It primarily dealt with diabetics and their foot wounds that would not heal. I knew nothing about diabetes but did have an idea that these people had to be careful with carbs. There was a dear sweet older couple that I always looked forward to seeing. The wife was complaining one day that her husband’s constant need to snack drove her crazy. The poor gentleman was about 300 lbs and confined to a wheel chair. He said that his favorite snack was potato chips. I asked if he didn’t need to balance the carbs with some protein. His reply was that the chips were flavored with real cheese. He was so proud. I related that story to the doc on duty and I overheard him ask the nurse if they had any nutritional info to pass out. I could just see this older couple studying a brochure and changing all their bad habits. NOT!

I do have another friend with a T2 husband…they are both extremly conscientious, have educated themselves, probably thanks to a great educator like yourself (I have been lucky with that, as well.)

You go, girl!

Exactly–take pills, pills must be working, I can eat whatever I want, doc says I’m fine. It’s nothing.

Want to cry & scream.

I have only been diagnosed diabetic since May 9, 2009. My blood sugar at the time of diagnosis was at 276 and, with the help of a friend who has been diabetic for over 50 years, I brought it down to generally around 100 to 115. In the last 2 weeks I noticed a pattern with my blood sugar. It seems that it will want to spike very early in the morning. Generally it will hit around 120 to 125, but has gone as high as 136 to 140 but then it comes down to around 100 to 110 within 2 hours. I have even noticed that after a meal, it has only spiked to say, 115. My good friend told me that it may just be my liver cycling and dumping Glycogen into the blood stream. He said that I cannot control that and not to be too worried about that as long as it does come down quickly. I am not on insulin, just pills. What do you say?

Hi Steve,

It does sound like dawn phenonmenon & there’s lot of info here on this topic for you to search. The way to get a better idea about this is to test right before bed to see how much your BG is going up overnight. Nothing much you can do without insulin to control this & some Type 2s do take basal (slow acting) before bed to prevent the overnight spikes.

A couple of things you can try. Don’t eat dinner (or snacks) for 4-5 hours before bed. In case this isn’t dawn phenonmenon, eating to close to sleep can cause morning highs because you’re still digesting & not active. Eat breakfast as soon as you can after waking to prevent your liver from dumping more glycogen. Realize this sounds odd, but it works.

You want to aim for as normal BG as possible. Morning fasting should be under 100. If you can’t control this, worth speaking to your endo about basal insulin before bed.

I have actually tested my blood before going to bed. It has been anywhere from say 100 to 105, The strange thing is that if I find myself getting up around 6:00 AM…that is when it spikes to those high levels. I have even tested after eating and NO KIDDING…my levels fell instead of rising. It would go from 125, for example and go down to 108. Later in the day, it would fall to 95. I am on a low carb diet (Atkins) and it has been working down with the occasional spikes.

I believe you about eating lowering BG. I’d wake up to high numbers & not want to eat fearing I’d be off the charts, but found that eating right away helps. Exercise also sends me high in the morning.

Everything you’ve said points to dawn phenonmenon, as your friend suggested. Some basal insulin before bed would take care of this.