I have pre-diabetes, although I think I am well on my way to official diagnosis. I exercise, eat well, and have always been a healthy weight. However, I had hypoglycemia growing up (runs in the family), then gestational diabetes 3 times, and have had higher than normal blood sugars ever since. I’ve always been fine on fasting BG, but after meals I tend to spike too high unless I am careful about what I eat. I’ve been on metformin for about a year and a half. Lately things are different, though. For one thing, my fastings have crept up and are usually over 100 and sometimes over 110 (last blood work done in April my fasting was 85). Just as background info - I tested negative for anti-bodies, so I don’t have Type1/LADA.
What I don’t understand, however, is now my sugars are rising after I eat breakfast. For example, this morning my fasting number was 110. I ate breakfast and at one hour my number was 104. I then worked out during the morning and 4 hours after I ate breakfast I was ready to eat lunch and my before lunch number was 123. My body still makes insulin and I had eaten nothing from breakfast until that point. My after breakfast number was fine, so it wasn’t what I ate. Is this something I should do something about? Any suggestions?
That occurred to me, but it has happened for several days in a row. I wonder if the exercise does something, but it still seems to happen without an actual workout (although I tend to be pretty active most mornings).
That is a good question. I do drink a lot when I eat breakfast, but then I don’t usually drink much until I eat lunch. I can try and drink in between and see if that makes a difference.
I eat different things when it happens, but I believe the day I gave the example for I ate a small piece of toast (11g of carbs) with butter and 4 slices of cheddar cheese along with a 16oz glass of decaf black tea.
I do sleep well at night. Some nights I don’t get enough sleep and others I get plenty, but I generally conk out quickly and sleep soundly.
I take 1000 mg per day - 500 mg at breakfast and another at dinner. I am guessing/hoping my doctor increases my dosage after I get my blood work back.
i’m prediabetic and take 1000 mg of metformin too. sometimes i would get a rise later on in blood sugar, but i was told it was food that digested slowly and so the glucose was released into my blood stream later. but i don’t think you would get that rise from butter and cheese…do you wash your hands before doing a blood test? you might have some food residue on your finger that would affect the results.
I do wash my hands before I test, every time. Plus, I didn’t touch any food between the first after breakfast reading and the next. Whenever I get a reading that I feel can’t be right I will rewash my hands and retest to double-check. It is possible that I touched a surface with food and then didn’t do a good job washing my hands, but I would expect that to be an occasional thing, not a regular issue.
I ride horses. The exercise includes getting the horse (sometimes from fields that are a good walk away), grooming, tacking, walking up to the ring (which is a good walk away), riding for between 30 minutes and 1 hour (English style - walk/trot/canter with occasional small jumps), walking back down to the barn, untacking, grooming again, and putting the horse away (sometime just into a stall and sometimes walking back out to the field). There is certainly some anaerobic exercise involved, but most of it is aerobic. I think it compares best to interval training - low level exercise most of the time with bursts of high intensity.
Just to update - I repeated the same situation I described above today: fasting BG of 108, 1 hour after breakfast (small piece of toast with 4 slices of cheddar cheese and 16oz decaf black tea) BG of 91, almost 4 hours after breakfast BG of 123. I went riding again between testing my BG after breakfast and then just now before lunch. I made sure I had clean hands for all testings.
I should mention that I get very frustrated because my BG responses to fasting and food are completely unstable. The same meal will produce wildly different results on consecutive days (for example, the same breakfast two days in a row produced 1 hour numbers of 88 and 149). I am just lumping this latest pattern into that category of weirdness. What I am mostly curious about, though, is whether I should try and avoid going too long between eating or to eat more before exercise to avoid my BG from drifting up in this way. It is totally new and very confusing!!!
I have to caution you, blood sugars are not some predictable thing. And when you have diabetes things become even more unpredictable. Many of us find that eating the same thing generates very different results at different times. All kinds of things affect the results; how well you slept, how much stress you are under, your activity level, what you did and ate yesterday, etc. And the mornings are often even more difficult for many of us since our bodies naturally raise our blood sugars in a process called Dawn Phenomenon (DP) (I call it Darn Phenomenon). This can cause a blood sugar rise upon awakening. I have a wicked case of DP and while I mostly control it with insulin these days I always found that eating a good meal first thing in the morning really helped. If I skipped my breakfast my blood sugars would be terrible. And unfortunately exercise in the morning for many of us can result in high blood sugars as well. One well know diabetes expert (Dr. B) advises that we just avoid exercising in the morning. I don’t think you have to do that, but that should help you understand what is happening.
And at least for now, I would suggest that having a blood sugar after exercise of 123 mg/dl is not a cause for concern. Many of us get a blood sugar rise from exercise and as long as you return to a good fasting blood sugar an hour or two afterwards that is not a cause for concern. And while you might not be happy with the blood sugar surge from a meal, as long as your blood sugar returns down to less than 140 mg/dl 2 hours after your meal you shouldn’t fret over things. Don’t get too alarmed with your blood sugar variations, you are comparing it against a unrealistic ideal. You actually don’t know how your blood sugars were before and I’m sure you would be shocked at how things vary in a non-diabetic person.
Thanks for the feedback and reassurance. I actually have a pretty good idea of how much my blood sugars have varied over the years as I have been checking on and off for about 20 years now (a very long, thankfully slow, road to diabetes). I know that I am still safely in the prediabetic range (mostly). I just get very frustrated by having behaved well over all these years and even when doing what makes sense, the results keep slowly getting worse over time. I am up to 4 doctors assuring me that no matter what I do I will eventually end up diabetic (and one more recently that I will end up insulin dependent, eventually). And, the 123 number is about 1.5 hours after I finished exercising.
I am an engineer by training and the complete lack of logic in the system hurts my brain! I keep checking because it is the best way to keep the road long and slow. I just wish I could understand why or even WHAT is going on!
you had gestational diabetes and you say you have been checking on and off for 20 years. are you in perimenopause/menopause? hormones changing at this time are said to disrupt blood sugar control. somehow estrogen is involved, but I am fuzzy on the science.
also, i wonder if playing around with the timing of metformin would help a little. i take mine in the late afternoon (500) and right before bed at 9:30 pm (500). some people like to take 1000mg all at once and not split it.
someone who knows more can chime in on this, but isn’t it true that insulin deficiency results in an increase in glycogenolysis (endogenous production of glucose from glycogen; see http://diabetes.diabetesjournals.org/content/51/11/3151.full)? maybe your insulin is not being produced at a steady rate. it dips low, especially without a meal to stimulate its secretion. when insulin dips low, the body thinks that it is in dire need of glucose and will produce it endogenously. is my understanding correct? even if you don’t have the antibodies for type 1, it is thought that there are other types of diabetes which involve problems with insulin production. i have the risk allele for the TCF7L2 gene,which is associated with insulin insufficiency, but not due to autoimmune attack.
“Finally, TCF7L2 polymorphisms have been associated with impaired insulin secretion, glucose production, and glucose tolerance via direct effects on pancreatic islet beta cells.[13, 14] Indeed, dysregulation of glucose metabolism, decreased processing of proinsulin, and elevated levels of gastric inhibitory peptide and glycated hemoglobin (HbA1c) can be observed in normoglycemic individuals with TCF7L2 polymorphisms before the onset of type 2 diabetes.[15, 16]”
“…almost 4 hours after breakfast BG of 123…” if my above hypothesis is correct, if you eat a little snack of not too many carbs(!!!), say 2 or 3 hours after breakfast, your 4 hour number should be lower than 123. the little snack will stimulate some insulin, so your body will not have to produce any glucose endogenously since it will sense insulin levels are not dangerously low. how little the snack should be, i’m not sure. but it can’t really hurt to try. it just might be a little tedious. if after the little snack your bg at the 4 hour mark is even higher than 123, i would be wondering if you ran out of stored insulin. maybe you used up a lot of it dealing with the glucose in the bread you had at breakfast. then i would try a second experiment of eating a lower carb breakfast with everything you ate before but leaving out the bread, do everything else the same, and then see where you are at the 4 hour mark.
There is logic in diabetes and BGs, the problem is that there are too many variables, most of which we aren’t aware of. Anything your body does, every hormone released (or not released), will effect your numbers. There is rhyme and reason to it, but it’s just as complicated as the human body, so don’t hurt yourself trying to figure it out!
Also, yes, you have “behaved”, you’ve done what you should, but diabetes (all types) is mean son of a gun. I read that statement from you and immediately thought, yep, I behaved, too, I behaved for the first 10 months of my life before being dx’d type 1. Do not beat yourself up.
A few things to keep in mind, fat slows digestion. So if you eat something like butter and cheese, your food may stay with you a while longer. This is also a possibility with high carb meals. It just takes your body longer to digest them.
Any kind of lady-time messes with BGs. I know many, many a female diabetic who needs a lot more insulin during their periods. Menopause will also screw with things, though I have not gone through that yet so I don’t fully have a grasp on it.
Thank you for all those ideas and thoughts! I always take one metformin in the morning and one at night and never thought to try mixing up the timing. I will start with that and see what happens. I’ve also never heard of the TCF7L2 gene, but it sounds very interesting.
Fortunately (or unfortunately?), I am not knowingly in or near perimenopause/menopause. I am only 41. The first case of gestational diabetes was only about 14 years ago. Twenty years ago I was dealing with hypoglycemia and checking my blood sugar because of reactive lows. Different problem, but same basic treatment for me (diet/exercise).
I will try to eat a low carb snack 2 to 3 hours after breakfast and see if that makes a difference. I have trouble eating whenever I would like given my lifestyle, but I can sometimes be on-the-ball enough to prepare something I can take with me. I will try it when I can and if it helps I will find a way to continue. Just out of curiosity, I did the same meal and tested about 4 hours after without doing the riding. Same old pattern - fasting 117, one hour after meal 85, almost 4 hours after meal 127. So it doesn’t seem to be the exercise (although I did go sailing which is some work, but not nearly the same as horseback riding).
By the way, the reason the one doctor said she thought I would one day need insulin was because my fasting c-peptide has been very low. I think this could be relevant for your hypothesis. Thanks so much!
Thank you for the encouragement. My husband tells me the same thing - it is not my fault. Glad to hear you behaved for the first 10 months of your life! My oldest son gave us some really tough times during that period!
I have noticed changes in my BG based on female cycle, but in my case it is the opposite. Out of the blue my numbers will be terrific and it seems like I can eat anything and have perfect numbers. It only lasts for about 2 days a month. If I could just predict WHICH two days…
I will try testing at 2 hours after my meal and see what is happening. Typically 2 hours after I eat I am not in a position to test (one of the reasons I go by 1 hour numbers), but on the days that I can I will test both times and see if that helps my understanding.
And yet, at some level the human body amazes me, because for those who are sugar-normal, the body figures all this stuff out completely in the background, which I think is just some incredible engineering (built over a really long time).
