Postprandial glucose management of people with insulin-treated diabetes
6 affiliations
- 1Division of Endocrinology, Metabolism & Lipid Research, Washington University, St Louis, MO, United States
- 2Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, United States
- 3Department of Medicine, Division of Endocrinology, Diabetes and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- 4Department of Pediatrics, University of California, San Francisco, San Franciso, CA, United States
- 5Department of Medicine, Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- 6International Diabetes Center, Minneapolis, MN, United States
Abstract
Diabetes is a highly prevalent, chronic condition requiring complex treatment strategies and close monitoring. Achievement of optimal glucose management reduces vascular complications of diabetes and the long-term burden of the disease. Attenuation of postprandial rise in glucose is a critical component of overall glycemic management and often the most difficult for people with insulin-treated diabetes to achieve. While postprandial glucose (PPG) elevations are a consequence of insufficient endogenous insulin secretion or exogenous insulin dose to cover ingested carbohydrates, a mismatch between the absorption of nutrients and peak insulin concentration is also a key factor in managing PPG. Type 2 diabetes is characterized by loss of first-phase insulin secretion, resulting in elevations in PPG and prolongation of hyperglycemia after eating. In type 1 diabetes and other forms of insulin-requiring diabetes, insulin administration must match carbohydrate and other nutrient intake in both quantity and timing. Continuous glucose monitoring (CGM) has provided insights into glucose patterns and the effectiveness of diabetes therapies in managing glucose levels at all times of the day. When CGM is used with an automated insulin delivery pump or connected insulin pen, prandial insulin dosing can be analyzed for more effective coaching and education. Based on the 2026 American Diabetes Association Standards of Care guidelines, delivery devices and method of insulin administration should be assessed regularly and individualized based on the needs of each person, considering options such as automated insulin delivery, inhaled insulin, or multiple daily injections. This manuscript reviews the causes and contributors of postprandial hyperglycemia and strategies for its management. In particular, use of lifestyle management, insulin dose adjustments, timing of premeal insulin doses, and insulin kinetics will be reviewed for precision management of postprandial hyperglycemia.
Related
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- Distinct insulin sensitivity profiles revealed by clustering based on continuous glucose monitoring data in people living with type 1 diabetes
- The Lost Glucose Sink: Association of Sarcopenia Risk with Disproportionate Postprandial Glycemic Excursions in Older Adults with Type 2 Diabetes Mellitus
- Cost‐effectiveness analysis comparing advanced hybrid closed‐loop automated insulin delivery with multiple daily insulin injections and continuous glucose monitoring in adults with type 1 diabetes in Japan
BibTeX
@article{mcgill2026postprandial,
title = {{Postprandial glucose management of people with insulin-treated diabetes}},
author = {Janet B. McGill and Irl B. Hirsch and Carol J. Levy and Eda Cengiz and Grazia Aleppo and Anders L. Carlson},
journal = {Frontiers in Endocrinology},
year = {2026},
month = oct,
doi = {10.3389/fendo.2026.1947837},
url = {https://doi.org/10.3389/fendo.2026.1947837},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Postprandial glucose management of people with insulin-treated diabetes
AU - Janet B. McGill
AU - Irl B. Hirsch
AU - Carol J. Levy
AU - Eda Cengiz
AU - Grazia Aleppo
AU - Anders L. Carlson
PY - 2026
DA - 2026/10/23
JO - Frontiers in Endocrinology
DO - 10.3389/fendo.2026.1947837
UR - https://doi.org/10.3389/fendo.2026.1947837
AB - Diabetes is a highly prevalent, chronic condition requiring complex treatment strategies and close monitoring. Achievement of optimal glucose management reduces vascular complications of diabetes and the long-term burden of the disease. Attenuation of postprandial rise in glucose is a critical component of overall glycemic management and often the most difficult for people with insulin-treated diabetes to achieve. While postprandial glucose (PPG) elevations are a consequence of insufficient endogenous insulin secretion or exogenous insulin dose to cover ingested carbohydrates, a mismatch between the absorption of nutrients and peak insulin concentration is also a key factor in managing PPG. Type 2 diabetes is characterized by loss of first-phase insulin secretion, resulting in elevations in PPG and prolongation of hyperglycemia after eating. In type 1 diabetes and other forms of insulin-requiring diabetes, insulin administration must match carbohydrate and other nutrient intake in both quantity and timing. Continuous glucose monitoring (CGM) has provided insights into glucose patterns and the effectiveness of diabetes therapies in managing glucose levels at all times of the day. When CGM is used with an automated insulin delivery pump or connected insulin pen, prandial insulin dosing can be analyzed for more effective coaching and education. Based on the 2026 American Diabetes Association Standards of Care guidelines, delivery devices and method of insulin administration should be assessed regularly and individualized based on the needs of each person, considering options such as automated insulin delivery, inhaled insulin, or multiple daily injections. This manuscript reviews the causes and contributors of postprandial hyperglycemia and strategies for its management. In particular, use of lifestyle management, insulin dose adjustments, timing of premeal insulin doses, and insulin kinetics will be reviewed for precision management of postprandial hyperglycemia.
SN - 1664-2392
ER -