Work

Postprandial glucose management of people with insulin-treated diabetes

Year: 2026

Type: review

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.

Source: Frontiers in Endocrinology

DOI: 10.3389/fendo.2026.1947837

Authors: Janet B. McGill, Irl B. Hirsch, Carol J. Levy, Eda Cengiz, Grazia Aleppo, Anders L. Carlson