Blunting post-meal glucose surges in people with diabetes

Abstract

Worldwide, the morbidity and mortality associated with non-communicable diseases have been climbing steadily - with costs aggressively keeping pace. This letter highlights a decidedly low-cost way to address the challenges posed by diabetes. High levels of postprandial blood glucose are disproportionately linked to much of the microvascular damage which, in the end, leads to macrovascular complications and organ failures. Systematically controlling post-meal glucose surges is a critical element of overall glycemic management in diabetes. Diet, exercise and medications form a triad of variables that individuals engaged in diabetes self-management may manipulate to achieve their targeted glucose levels. As a rule, diabetes patients in developing countries as well as those living in the pockets of poverty in the western world cannot afford special diets, medications, glucometers and supplies, lab tests and office visits. Exercise is the one option that is readily accessible to all. Decades of research in laboratory settings, viewed holistically, have established that light to moderate aerobic exercise for up to 60 min starting 30 min after the first bite into a meal can blunt the ensuing glucose surge effectively. Moderate resistance exercise, moderate endurance exercise or a combination of the two, practiced post-meal has also been found to improve many cardio-metabolic markers: Glucose, high density lipoprotein, triglycerides, and markers of oxidative stress. On the other hand, pre-breakfast exercise and high-intensity exercise in general have been decidedly counterproductive.

Keywords: Pre-meal exercise; Post-meal exercise; Exercise timing; Exercise intensity; Glucose surge; Insulin resistance

Core tip: A critical part of diabetes self-management is the systematic blunting of the post-meal glucose surge. The reason for this is that the glucose surge is closely linked to the vascular complications of diabetes and eventual organ damage. Decades of studies have shown that a moderate intensity exercise - aerobic, resistance or combined - starting 30-40 min after the start of the meal can efficiently blunt the glucose peak. Post-meal studies starting at other times have also shown improvements in other metabolic markers including high density lipoprotein, triglycerides and markers of oxidative stress. Promoting post-meal exercise can make a big difference in the daily lives of diabetes patients worldwide.