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Why my post prandial spike up, low hba1c
Hey everyone,
I’ve been living with type 2 diabetes for the last 3 years and I’m honestly confused and a bit frustrated. My HbA1c is always below 6.8, which seems okay… but my post-prandial sugars are consistently high, usually above 230 mg/dL.
My fasting sugar averages around 140 mg/dL, and despite trying multiple medications over the years, the pattern hasn’t really changed.Right now I’m on:Vildagliptin 50 mg in the morning only.
I live in a South Indian household, so my diet is still very carb-heavy—rice, idli, dosa, etc. I do try to include protein, but in a combined family setup it's really hard to change the everyday meal pattern.
My parents eat the same carb-heavy meals, but their post-prandial sugars stay under 180 mg/dL, which is considered normal. Meanwhile, mine shoots up even with smaller portions.
I’m trying to understand:Why does this happen even though my HbA1c seems controlled?
Do I need Homa. IR Test and change medication?
Your HbA1c looks controlled because it represents a 3-month average, but it can sometimes “hide” high post-meal spikes if your fasting sugars are relatively okay.
What you’re experiencing is likely post-prandial glucose intolerance — meaning your body does not release enough insulin quickly after meals, especially high-carb meals. This is common in early diabetes even when HbA1c is near target.
Everyone’s metabolism is different, so even though your parents eat the same food, your insulin response and insulin sensitivity are likely lower, causing higher spikes.
Vildagliptin alone may not be enough for post-meal control.
Next Steps
• Consider adding a meal-time glucose-control medication, such as:
– Metformin (if not already on it)
– Vildagliptin + Metformin combination
– or SGLT2 inhibitor (e.g., dapagliflozin/empagliflozin) if suitable
– or Repaglinide for strong post-meal spikes.
• A CGM (Continuous Glucose Monitor) for 7–14 days can clearly show where the spikes are coming from.
• No need for HOMA-IR in routine diabetes care; it rarely changes treatment decisions.
• Try small changes like increasing protein with meals, decreasing portion size of rice/dosa, or shifting some carbs to dinner.
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