Insulin treatment of post-prandial hyperglycemia

With evidence that elevated post-prandial glucose (PPG) is a major risk factor for cardiovascular disease, there is increasing emphasis on primary treatment of PPG in diabetes. The carbohydrate content of a meal is the principal contribution to PPG, so efforts to reduce carbohydrate ingestion are an important dietary approach to management. Although all oral hypoglycemics reduce PPG, newer agents including disaccharidase inhibitors and meglitinides act more selectively to lower PPG. GLP-1 agonists and pramlintide act primarily on post-meal glucose. DPP-IV inhibitors are oral agents that raise GLP-1 levels. Unquestionably, exogenous insulin is the most potent agent to lower PPG levels. Long-acting basal insulin has Much less effect on PPG than rapid-acting insulin taken at the time of a meal. Inhaled insulin is no more effective than injectable insulin but is much more acceptable to most patients and may thus lead to administration of insulin earlier in the course of type II diabetes.