So, I was initially diagnosed as T2, then Type?, then uncontrolled Type 2, then possibly LADA or early Type1b. As I’m sure some of you remember from my posts earlier this fall. Anyhow, within a couple months after diagnosis in May I got my overall BG down, then my A1c down to 5.1, and my fasting BG (with the help of metformin) were reliably in the 80s, sometimes the 70s.
Over the last two months, my doctor ramped my Metformin ER up to 2,000mg per day (up from 500mg on diagnosis) in order to help with spikes from working out and dawn phenomenon. I eat very low carb (less than 30g net carbs per day, less than 10% total calories from all carbs), and I exercise a lot. I was told to keep an eye on my fasting BG and my numbers in general in case they started to creep up.
Well, in the last six weeks my 14 day average fasting BG has crept up from 84 mg/dL to 93 mg/dL, and for the first time since late May, I’m seeing fasting numbers over 100 mg/dL. I’ve lost a ton of weight (not all intentionally), I’m taking more Metformin ER, I’m eating less carbs, and I’m exercising more… While my overall 90 day average BG (from meter) is resting right on 90 mg/dL, my fasting is often the highest of the day.
Am I being paranoid in thinking it’s weird my fasting numbers are going up instead of sitting still or gradually going down with increased treatment intensity?
Anyhow, just curious if anyone has any words of wisdom on such a (slight) pattern, or if I’m just being ultra-paranoid
Regardless of what type of diabetes you have it is pretty much a foregone conclusion that metformin isn’t going to keep your fasting levels in check for all eternity. You’re still very much within optimal ranges. If you consistently start seeing uncontrolled fasting numbers… like 150+ and you’re not doing anything yourself that’s contributing to them, then it’s time to start worrying about changing things up. Right now you’re doing great.
Oh, and yes you’re being paranoid. And you’re freaking out over a statistically insignificant trend you’re seeing within the accuracy limits of one batch of test strips to the next;)
Instead of micro analyzing a point to point pattern you might find it more useful to determine what your goal range is for fasting, and then analyze how frequently you’re waking within that range one month vs the next… a longer term bigger picture perspective… and be realistic with your goal ranges-- anything under 100 is pretty much spectacular if you’re doing it consistently
That’s pretty sound from a statistical standpoint. Since my goal range for fasting is 80-95 mg/dL, that would put T-60 days to T-30 days as 0 out of range, and T-30 days to T-0 days as 42% out of range. Might be a small jump (between average of 85 and 90 something), but it is a jump.
I totally get that my current range is fantastic for the vast majority of diabetics, whether on insulin therapy or not. And I am prone to being more than a bit paranoid about my numbers. I’m young and have a 3 month old son, and have seen various members of my family lose limbs, eyesight, and life to this disease, even after being relatively well-controlled.
Thanks for the reality check!
If people could indefinitely keep by ranges of 80-95 it wouldn’t even be a real disease. Be realistic when you realize that it may not always remain that tightly controllable, but you can still be very tightly controlled without ranges that tight (realize that’s substantially lower variability than most non-diabetics)
I’ve heard of very few of the horrible complications occurring within tightly controlled diabetes… at the ranges you’re keeping you have “less diabetes” than average Joe America.
You know, I really hope you’re right. My husband and I have discussed whether in 5-10 years our son may actually have better blood sugar control than us, and whether in future even non-diabetics will be taking something to regulate their BG to a tighter range. Of course, all this assumes that the dramatic reduction in complications we see when dropping numbers from, say, a 7 to a 6 A1C translates all the way down to the lower range of BGs. That still remains to be seen, but I sure hope it’s the case, because it means our son has a much better shot at being healthy and complication-free than diabetics even 20 years ago.
When I was pregnant I had high fasting BGs even though the overall picture was of non-diabetic BGs. I was told to eat something like ice-cream or with a little more carbs before bed, with the logic that dawn phenomenon could result from BGs dipping too low overnight, stimulating liver production as you wake up. It seemed to work okay for me (a non-diabetic person). Or you could try what someone else on this forum suggested, a glass of scotch, neat, before bed! Apparently alcohol also suppresses liver glucose production.
I think that it’s just important for everyone to understand that it’s just another body process just like blood pressure that varies quite a bit from time to time in everyone-- and that it’s not an unhealthy thing as long as those fluctuations are appropriate and properly controlled— so, no, I don’t think there’d be any justification for non diabetics to take meds to control their perfectly normally regulated blood sugars. I think Bernstein was way off when he tried to proclaim to the world that all non diabetics have a bg of 83 all the time regardless of circumstance
I agree. This conclusion was based on one anecdotal, very non-scientific “study” (I cringe even using that word to describe it) using home glucose meters, which weren’t/aren’t even all that accurate. It drives me crazy when people proclaim this as truth. Blood pressure, body temperature, heart rate, other substances in the blood all vary slightly over time. It makes no sense that blood glucose would be any different.
I think I saw a CGM based paper that also found a mean BG of around 89. Not sure if this is the one you’re talking about?
Interestingly, my husband wore my son’s expired transmitter (using xdrip you can wear the G5 transmitter till it dies, but only with Android phones). His average BG corresponded to an A1C of 4.9, but when he did a lab-based test a month or two ago, his A1C was 5.6. I think we also have to be wary about extrapolating between A1C and CGM in the lower range. A bunch of provocative research hints that in the non-diabetic range, A1C is not a very reliable marker of average BG because red blood cells tend to hang around longer.