[Physiopathology of postprandial hyperglycemia]

Several factors are determinant for postprandial blood glucose. Knowing and analysing these factors will help to optimize diabetes management. First, meal introduces the concept of food glycemic index. Blood glucose peak following a meal is modulated by gut hormones incretin effect, essentially GIP and GLP1. At the hepatic level, 30% of absorbed glucose is extracted by the liver which reduces its endogenous production in parallel. A reduction in hepatic glucose production blockade--through an excess in glucagon or free fatty acids in portal flow--will result in postprandial hyperglycemia. Finally, insulin secretion pattern is less influent than the hepatic insulin resistant state itself in determining this hyperglycemia.