Increase in AM and normal after Evening meal

I am pre-diabetic and started with Hypoglycemia issues in 2007- before the impaired fasting glucose diagnosis in March. My fasting readings have increased from 97-107 to 106-117 the past two weeks. The strange thing is that other than two post-meal readings 140 or higher in the evening, my Blood glucose readings have been consistently between 110-133. Why would my fasting readings increase when my post meal readings in the evening have been fine? I’m not waking up during the night with symptoms of dropping low so I don’t think it would be from my liver. It seems kind of strange to me, but maybe two weeks is too soon to be a pattern? Any input would be appreciated.

Hi Bjm,

There could be a number of reasons. When your fasting bg is getting higher that is usually a sign that your diabetes is progressing I think because beta cells are running out of steam or being killed off to the point they can't produce enough insulin to regulate bg levels without food intake being involved. The liver will automatically start producing glycogen when we wake up and get going, which our alpha cells signal with glucagon production and if you don't have enough "basal" insulin to counteract that the fasting level will go higher. My bg raises at least 20-30 points when I get up and take a shower etc. if I do that before bolus and eating.

I think a lot of people still have good phase two insulin response for quite a while with meals. I think when things start to go out of wack there is irregularity in numbers as your body struggles sometimes successfully to continue to manage things. I also had hypoglycemia for years before my D diagnosis.

Have you had antibody testing and c peptide testing? If not I would definitely do that.

Thanks so much for the advice! My family doctor is kind of old fashioned and just goes by fasting and A1C for a diagnosis. I was told by a few endos I contacted that I need a doctor referral and I doubt he will give me one until I am diagnosed as fully diabetic. He is having me wait for 6 months to be checked again. In the meantime, I am trying to get all the info I can on what to eat and how it effects me, I am testing frequently ( fasting and in the evening) to determine what foods cause the rise and also the number of carbs, which I rarely go over 60 per meal and I don't snack in between. I plan on taking my food logs to the doctor who will appreciate the information. I am only 5 ft. tall and weigh 110, so I don't need to lose weight. It's frustrating to me that all of a sudden my fasting readings are rising when my post meal are within range. Prior to this, my post meal were higher and the morning readings reflected that, which made sense. I'm currently not on meds and would like it to stay that way, which is I am trying to get the fasting within normal range too. Thanks again for your help, but I;m not sure what to do or should I just wait the 6 months?

I think what meee is suggesting is that you get testing to determine if you are Type 1 or Type 2, not just for diagnosis. Since you are thin, there is a possibility you are Type 1 and waiting isn't a good idea. If you see continued rise I would demand a referral to an endo if you need to have one.

Hi bjm,

You're welcome :)

Zoe is right about what I was saying: I'm thinking you could be adult onset type 1, even more so now with your description and if you get the c peptide and antibody testing done that can help to determine that. I wouldn't wait. I would ask for this testing now or preferably for a referral to an endo, but your gp can do the testing too. If your doc won't do that, go to someone who will. Diabetes isn't something to mess around with or wait and see what happens because the consequences can be severe. Do you have a family history at all? It sounds like you are fluctuating like I said which is what happened to me also for at least two years before I crashed to dka.

6 months before dka I had a non fasting test of 106. But if I had had proper testing when there were signs of high bg it would have saved me a crisis. I went to several doctors with symptoms for a few years.

The more testing you do the better. And although 60g may not seem like a lot per meal it's actually quite high for someone who is pre D whatever type. I would try to lower that a lot and eliminate the foods that spike you a lot. If your fasting and after meal bg continues to rise you won't be able to manage this without some medication probably. You can do your own glucose tolerance test by testing a fasting bg in the morning, drinking 80g of carbs: ie: juice and then testing every half hour for 3-4 hours.

I moved my appointment up from September to June 27th and that will be 3 months instead of 6. I did have a c-peptide and insulin done (fasting) back in 2007 because of the hypoglycemia. The c-peptide was 1.5 and the insulin was 3–they were both in normal range, but that may have changed now. I tried having a snack–a few peanut butter crackers before bed to avoid the liver dump and wound up with the highest fasting to date-123. I think I know what may be happening…even though my post meal readings are below 140 at 2 hrs I think they are rising at 3 hours. Last night I had whole wheat spaghetti and turkey meatballs which totaled 55 carbs. I was 123 at 2hours and 145 at 3 hours. This morning I had a 118 fasting. It is interesting to hear what happened to you and hope you are doing better. I am glad you got treatment. To answer the other question, I do have a strong family history…My mother and father have diabetes (type 2, though mom is uncontrolled with meds and was on insulin in the hopsital). My maternal grandma has type 2 and her mother died at a young age with type 1.

That's good you moved your appointment up. I think it's time for another c peptide(fasting and non fasting) and antibody testing- just check out melitta's blog for more info on adult onset of type 1. These are the tests to get for antibodies:

glutamic acid decarboxylase autoantibodies (GAD), islet cell cytoplasmic autoantibodies (ICA), insulinoma-associated 2 autoantibodies (IA-2), and zinc transporter 8 autoantibodies (ZnT8).

Make sure you get ALL of these done because the most common one for type 1 adults to be positive for is GAD, however some aren't and are positive for one or more of the others.

You have a strong history of D so it could be either, but I'm guessing adult type 1.

I will message you :)

ps. I would try eliminating wheat and gluten, I have pretty much eliminated that and it has helped me. For instance I can eat jam & berries but if I have one slice of toast I will spike 9 times out of 10 no matter what I dose for it.

I consider anyone with a "prediabetes" diagnosis as having diabetes. It's just an early stage. I think that term invites patients and their doctors alike to take a relaxed wait and see attitude. As others have said, a correct diagnosis is important. Whether you're T1D or T2D, there are many things you can do at this stage that can give many benefits to your body.

You have shown an unusual degree of interest and readiness to take action. I would find a doctor that's willing to be more curious and proactive in his/her response to your symptoms.There are things you can do now that can bestow long-term benefits to you.

Carbs in the diet drive blood glucose (BG) levels in people with diabetes (PWD). While the level of carbs consumed with acceptable post meal BGs will differ from person to person, eating 60 grams of carbs will cause BG trouble for most PWD.

Have you considered cutting your carbs down to say 30 grams at meals and see what your meter measures? I suspect that the results may be dramatic enough to get your attention. Good luck!

Thanks for the advice and you are right...if I am close to 60 or over, my blood sugar is over too. The only time it doesn't go up with that level of carbs is if I eat fat with the carbs. I prefer not to do that since my cholesterol use to be elevated before I started taking fish oil and thyroid meds.Right now I am what I've heard stated "eating to my meter" so I can determine what works for me. If I lower the carbs significantly and my readings don't improve or continue to get worse, I will ask for a referral for more definitive tests. Thanks for the input:)