Q: I have had diabetes for about six years. I want to know why I’m starving and so tired 10 or 15 minutes after I eat. I feel like I’m hungry all the time! Six months ago, this wasn’t a problem. I try to eat healthy, but the hunger pangs are miserable. My doctor says my A1C is good and has no explanation for the fatigue and hunger. Can you help me?
A: That has to be frustrating for you, but there may be an explanation and a solution. The fatigue you feel soon after eating could be caused by postprandial hyperglycemia, or a “spike” in blood sugar soon after eating. It is common for the blood sugar to rise modestly after meals and then return back toward normal within an hour or two. But if it climbs very high, even if it eventually returns to normal, it can leave you feeling a bit washed out. Checking your blood sugar with a fingerstick 30–60 minutes after eating will tell you if this is happening, as will a continuous glucose monitor.
Readings above 180–200 mg/dl after eating can cause the type of symptoms you describe. This can be fixed by choosing slowly-digesting foods such as fresh vegetables, whole fruit, legumes, and dairy products. If you take insulin at mealtimes, taking it earlier can help, as can engaging in some light-to-moderate physical activity soon after eating.
Interestingly, the post-meal hunger you’re experiencing also can be caused by blood sugar spikes. However, it also could be due to a lack of a hormone called “amylin.” This hormone normally is produced along with insulin at mealtimes, but it is produced in insufficient amounts in many people with diabetes. Amylin helps curb hunger and slows digestion so that you feel fuller after eating. It also blocks the production of glucagon by the pancreas, which helps lower post-meal blood sugars. Several medications — including pramlintide, GLP-1s, and DPP-4 inhibitors — can replace or mimic amylin, so ask your doctor if one of these might work for you.
Another tactic you might consider is consuming more fiber in your meals. Fiber not only slows down digestion (which prevents the after-meal blood sugar spikes), but also creates a sense of fullness. A registered dietitian can work with you to build more fiber into your daily meal plan.
Have a question about diabetes? Send it to Gary Scheiner MS, CDE, at email@example.com.
Want to learn more about preventing after-meal hyperglycemia? Read “Strike the Spike II.”