Meals and hypoglycemia in people with diabetes

Strict glycemic control is important to minimize diabetes-related microvascular complications. A link has been suggested between postprandial glucose and increased cardiovascular risk, and guidelines from the American Association of Clinical Endocrinologists (AACE), American Diabetes Association (ADA) and International Diabetes Federation (IDF) now include targets for postprandial glucose levels. This treatment review presents recently published data on factors that contribute to post-meal glucose levels and hypoglycemia in people with diabetes, including methods to estimate meal-time insulin dose, meal composition, the second-meal phenomenon, and the benefits of diabetes structured education programs such as the Dose Adjustment for Normal Eating (DAFNE) and the Tayside insulin management (TIM) course.