I have been reading a lot, and see over and over that the FBS number is the last to move, but don’t understand why that is. In three months, I have lowered my A1C from 6.7 to 6.1, yet my FBS is still in the 110-120 range. It is very discouraging. I am not on any medication.
This is about the degradation of fasting blood sugar as your diabetes progresses. Once you have diabetes then all bets are off. You can have constantly elevated blood sugars with diabetes for a variety of reasons, you can have improper signaling, an overactive/insulin resistant liver and even your hyperthalmus can get out of whack regulating your blood sugars.
As to the progression of diabetes, often it goes like this:
- You lose the ability to produce enough insulin to regulate blood sugar (either from insulin resistance or insulin deficiency)
- You can’t store enough insulin in your islet cells (Phase I response) to handle meals, your blood sugar after meal degrades
- You then can produce enough insulin to deal with meals at all (Phase II response) at all and your blood sugar after meals is not only high but the high lasts for hours
- Then when it get’s really bad you can’t even produce enough insulin to keep your fasting blood sugar in check even if you don’t eat anything
In most cases you will get modest rise in A1c and have a normal fasting blood sugar when you get to (2), but when you get to three your A1c will be like over 6.5% and your fasting blood sugar will be high.
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I’m 15 years in, and still have the most trouble with my FBS number. You’re doing great with your A1C!
The FBS is a problematic little bugger for so many of us, and it is affected by so many things. For many of us there is the problem of Dawn Phenomenon (DP). If, for example, you were to wake up and check your BG in the middle of the night you might find that your BG is lower than you went to bed and lower than it is when you actually wake up. As part of the get ready to face the day wake-cycle our livers dump glucose to “help” us.
For many of us that number can further be tinkered with by how we slept. If I sleep badly, that number is higher. I suspect that has to do with the higher cortisol levels from the stress of insomnia (which in my case is often complicated by/caused by fibromyalgia pain keeping me from getting comfortable enough to sleep).
People find various ways of trying to deal with DP. Some try red wine at night. Some try a small protein snack before bed, or if they wake during the middle of the night. For me, I’m on insulin so if I wake up somewhere before I actually want to get out of bed I take a couple of units of Novolog before trying to go back to sleep as, if I don’t get up and eat my BGs can rise up to 50 points between waking up at 6:30 and going “oh HECK no!” and waking up again at 9am and actually getting out of bed.
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My A1c has varied between 5.3 and 5.8 during the last 4 years. During that time my FBS gradually rose from 101 to as high as 125 over the last 4 years–even though my diet and lifestyle have been very healthy and anti-diabetic, and all my other numbers improved. A month ago, I decided to eat more often, and my Fasting Blood Sugar is now often 105 instead of the upper teens or early 20s. Just sharing this because I changed nothing else! Just started to eat more often (and actually I am eating more food, too–I used to stay hungry more in an attempt to lose weight–which didn’t work). So, keep trying things, listening to your body, and maybe you will find a way to bring it down. But regardless, focus less on that number and more on the A1c, trigs, c-reactive protein, fasting insulin level, and what your blood sugar numbers are 2 hours after you eat a meal. Those numbers matter much, much more according to the limited number of studies that exist that actually look at which numbers show correlations to disease. You are doing GREAT!!!
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Interesting! I’ve read too that often the liver dumps glucose in the early morning because someone didn’t eat a large enough dinner or enough calories to sustain them over night. When I was pregnant I had some high fasting blood sugars, though all the other readings were normal. I tried eating some ice cream just before bed (fairly low GI), and that seemed to lead to lower numbers in the morning.
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Thank you for this information, Brian. I saw a different doctor today - my husband’s union has a Wellness Clinic. She encouraged me to try Metformin. I had been resisting because I have this stubborn idea that I need to fix this without medication. She said it was very safe and effective. Do you have thoughts on this?
Some people find that trying to manage their diabetes without medication is very important. I think that diet and exercise are the first part of a good treatment plan, but medication can really support that. In my view you have done great already. You could probably drop your A1c a bit more simply by keeping up with what you have been doing. But taking a medication is perfectly fine, particularly if it means you don’t drive yourself crazy on the whole diet and exercise thing.
And yes, metformin is safe and effective. It is the oldest and best understood oral diabetes medication. In patients that have an A1c of about 8% it has been found to reduce A1cs by 1%. It has been found to be at least as effective as alternate medications such as TZDs, DPP-4 and even sulfonylureas. While you are unlikely to see a 1% A1c drop you should reasonably expect to see some improvement.
And metformin is safe, the biggest drawback is that it can cause gastric distress. This can be reduced by asking for metformin ER which is an Extended Release version. And best of all metformin can be very inexpensive. You can get a 90 day prescription of metformin 1000mg (max is 2500 mg) for $10 at Walmart.
Oddly, I actually found I had more gastric troubles with the ER version than the regular. Just another one of those “everybody’s different” things!
Things I’ve found that do help:
• Taking it with food and NOT on an empty stomach. Probiotic foods such as yogurt and kefir were particularly helpful for me when I first started, or increased my dose.
• Taking it at evenly spaced times. This was hard for me due to the sleep disturbances caused by my fibromyalgia for awhile, but I learned that if my doses of the non-ER got too close together (say less than 8 hours instead of closer to at least 10 or 12), I’d have some gastric issues.
• Time. The initial gastric effects, if even experienced, generally subside after a couple of weeks as your body gets used to the medication and dose.
As Brian mentioned, Metformin is very safe. In addition to it being safe, it may have some added health benefits. Some studies are being done investigating the possibility that Metformin may have some cancer preventing properties: http://www.cancer.gov/about-cancer/causes-prevention/research/metformin
Honestly, the diet and exercise are not what’s driving me crazy. Not getting my FBS below 100 is really making me insane, so maybe metformin is the way to go.
Thank you again, for all of your feedback. This website is a gift.
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A way to check whether going too low at night is making your FBS go high: Make a few extra tests at middles of the time you’d normally sleep.
I’m not understanding why one would want or need to make their fasting blood sugar go higher than usual to check what their BG is doing during the night. Why not just check it during the night without making the fasting BG higher before hand? I’m not meaning to be critical or adversarial; I guess I just don’t understand your post…
There’s no need to make it go high for these extra tests. Instead, check it during the night without making the fasting BG higher before hand, to see if going low during the night is the CAUSE of FBS going higher than expected in the morning.
I have always had fasting in teens, with good readings during the day. To make am’s lower I need more medication thus making me have lows during the day. I no long worry about it as long as my A1C is good. Nancy
Thanks, Nancy. I’ve started Metformin, so will see if that helps. I think I would rather get them lower, even if it means taking Metformin, just because I’ll obsess about it otherwise. Are you on insulin, or just metformin? Do I need to worry about lows with Metformin?
I am on metformin and insulin. Metformin is well long term used medication,cheap too. Yes I did watch for lows when I exercised.i think you need to look at all your numbers and A1C to determine how things look,not just one number. Having too many lows is not good you need a balance. Nancy
Metformin by itself doesn’t generally cause hypoglycemic episodes, though it’s possible to experience them in the case of exercise or whatnot. If you take insulin in addition to Metformin, generally you tend to need a bit less insulin after starting Metformin because it reduces insulin resistance.
If you go too long without eating you run a slightly higher risk of having a low when on Metformin, I believe, due to the way it works by affecting how the liver stores and releases glucose when our blood sugar starts to dip. Drinking, which already impairs the liver’s ability to release glucose when our blood sugar starts to dip, may of course be further impaired when on Metformin so use of alcohol should be limited.
I am taking one 500mg metforming pill a day to start. I have taken it for five days, with no stomach issues. I am taking it after my evening meal, just before bedtime, thinking that would help with my FBS. Do you think that is the appropriate time to take it? Should I consider cutting it in half and taking half in the morning, also? I am taking the Extended Release, but I’ve read it only provides 5-6 hours of benefit.
In the short-term, Metformin XR “peaks” about 4-8 hours after taking it, so taking it at bedtime is best for your morning blood sugar to help prevent liver dumping in the morning.
In the long-term, Metformin takes awhile (a couple of weeks) to really build up to its best performance level. Typically you should see slowly improving results as the days go on. For now I wouldn’t change your dosing or your dosing schedule.
Your doctor has started you on a very low dose to minimize side effects. At your next visit your doctor may increase the dosage, if it’s needed, by adding a second pill in the morning once your stomach has gotten used to the current dosage.
Yes, the same thing has happened to me! Ironically, I was avoiding food after 7pm because I thought it was better to eat less… Thanks for your comment.
You should not split or crush Extended Release (ER). If you do that it won’t work as ER. ER claims to release over 24 hours but it may not. If you need to take two pills throughout the day a better thing would be to ask you doctor to prescribe 500 mg twice a day. And actually most advice I have seen suggests that a single 500 mg dose is to small to have any effect and is only used to get you accustomed to taking metformin.
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