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Question
Posted by: diabetic personality | 2010/03/17

Concern about high fasting sugar.

Hi there.

I am a compliant diabetic and monitor my blood sugars with the aid of a program which I wrote myself. My pseudonym therefore, is by way of a joke at the expense of the " typical diabetic personality" .

Besides hypos which I have had lately and for which I am now receiving treatment, I am on the whole satisfied with the kinds of blood sugar readings I am getting.

However, I have a small matter of concern which I cannot deal with till I get a doctor''s appointment in more than a month''s time, and thought I would ask your oppinion about the matter. In short, my concern relates to unacceptably high fasting sugars.

One of the things that I religiously do, is to take a fasting blood sugar test every morning. I take random sugar tests at other times during the day as well, albeit that the sugars for those periods are necessarily less frequent than my fasting sugars, firstly, because I am on the whole satisfied with the results of these random tests, and secondly, if I had to do tests 6 times a day, each test co-inciding with my six meals which are each smaller meals, based on a GI diet modified for diabetics, I would single-handedly balance the budget of the company who supplied me with my glucometer. While arguably, I might be charritably disposed, this is a luxury I could ill afford.

Besides the random tests that I perform over a period of time, I will also do tests if I feel that at a particular time, I am experiencing an extraordinary circumstance which could negatively impact in some way on my blood sugars, or if I suspect that I might be having a hypo. In the latter case I test because often, the symptoms of my hypos and low blood pressure, which I also have from time to time and which is also presently also being dealt with by altering my BP medication, are similar. I usually test for both as I don''t want to just presume I have a hypo when in fact, I might actually be having low blood pressure.

When I was diagnosed with diabetes, I was 40 years old, but at present, I am going on 52. Although I have at times not always been compliant with good diabetes management in general and diet in particular, the good Lord has kept me so healthy that it is an absolute sin. However, as I indicated earlier, I am now compliant and have been for some time, with the result that on the whole, my sugars have stabilised nicely.

In the earlier days of my monitoring, I recorded fasting sugars on a regular basis between 5 and 6 Mmol/l. Sometimes I recorded readings of less than 5, but I found from experience that when this happens, I must, medication aside, also be prepared for the fact that I may have a hypo during the day.

Not only were my fasting sugars between 5 and 6, but in the earlier days, I even managed an HB1C3 count of roundabout 6. My latest HB1C3 which was taken on 26 October, last year, admittedly before I started being compliant again, though, was 6.4 which is significantly higher, for an HB1C3, than the averages I have managed in the past.

I find that although on the whole, I still have fasting sugars of between 5 and 6, and the odd one below 5, I am having an increased number of fasting sugars over 6, some of them being as high as 6.8, without there being any real reason for it. These sugars I regard as unacceptably high for fasting sugars by my standard. In fact, my 30 day average for a fasting sugar sits at 6.3 which I regard as totally unacceptable, although I must say, I don''t view the average reading as critical at this stage.

In view of the fact that my wife is on a special diet herself, although not for diabetes, we consulted the same dietition. We could not see the dietition at the diabetic clinic together, since she is not diabetic, and could therefore, not qualify to use the dietition from the clinic, so, for the sake of economic common sense, I settled for us seeing a dietition whom we could both see. The only problem that this entails, and I have a thing about it, is that our dietition and my diabetologist do not necessarily sing from the same song sheet and this can at times, be extremely frustrating, to the point that you want to tear your hair out. I have no complaint about the dietition. In fact she is very good, but it is just frustrating to try and mary two diets in such a way that neither person becomes too compromised as far as their diet is concerned.

The kind of tip I would give to every diabetic who might read this post, is not to be too quick to shop independently for a dietition, but if you are seeing a diabetologist and if you are on your own, or if you have a partner who is diabetic or who is healthy and does not necessarily have to go onto a special diet, to give serious consideration to using the dietition that your diabetologist recommends. I have yet to hear of a healthy person who died just because they went onto the diabetic diet. Using the dietition whom your diabetologist recommends, if possible, will just make life a lot easier for both of you.

Coming back to my question, the dietition advised me to consider dropping the late night snack which I have before going to bed. This snack usually takes on the form of a tomato sandwitch made from low GI bread and a square of diabetic chocolate, which I believe, does have a high fat content, both of which I enjoy greatly. It has been suggested to me to move the square of diabetic chocolate from the late night snack, back to after supper, or even after lunch. I have even received advice from a number of people to take an extra carbohydrate at breakfast or the midmorning snack, while others have even suggested that I stop the medication altogether!!! Needless to say, many of these advisers, and notably the ones with the most drastic advice, are not medically qualified, hence the fact that I have rather taken their advice with a bag of salt, rather than just a pinch of salt.

In the light of the fact that I am presently writing exams at the time of this letter, however, I have rather reluctantly decided that by way of a safeguard, to take the one extra carbohydrate as suggested by one person who is medically qualified, and whose views I also respect, although she is not a doctor, so as to limit the risk of contracting a hypo while I am writing. However, once the exams are over, I will remove the one carb and see what the effect of my new medicinal regime would be on the hypos.

However, I must point out that I don''t want to tamper with too many things until I see the diabetologist next, as altering things, especially if they are not critical, could just make diagnosis and treatment that much more complicated. It would involve me having to remember every little detail so that I can apprise him of all of the facts and if there are lots of alterations to regime, this could easily lead to one little detail, and invariably it will be an important one, to be forgotten.

I have already, out of absolute necessity, had to adjust my medication and more adjustments now, would simply be more undesirable than the remnant of the problems I am still facing, hence the fact that I am prepared to wait for my diabetologist''s final verdict on the matter.

Furthermore, enjoyment aside, if I am already recording a significant number of fasting sugars under 6, I argue that dropping the late night snack, could also increase the number of fasting sugars under 5 that I may record, and as a consequence, could actually in effect undo the treatment that I am currently receiving to control the instances of hypoglycaemia I have recently experienced, in that I will possibly again increase the instances of hypoglycaemia, possibly back to the same levels as I have been experiencing until now.

The questions I want to ask are the following:

1. What would my risk be of having more instances of fasting sugars that are too low, should I drop the late night snack?

2. Is a fasting sugar average of 6.3 still a good fasting sugar, and if not, what is a good fasting sugar? Should my fasting sugars be lower than they are according to the average?

3. To what extent, if any, does aging impact on fasting sugars?

4. Would aging from the 40''s to the 50''s have that same kind of impact?

Thanking you sincerely.

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Our expert says:
Expert ImageCyberDoc

Hallo Blindman
1. It is better to take a late night snack to prevent hypoglycemia
2. I am not too worried about the fasting sugar of 6.3, you don't have to do anything drastic until you see your diabetologist
3. Aging won't affect your fasting blood sugar
Your HbA1C is a better indication of whether your diabetes is causing damage to your eyes, kidneys etc than the morning fasting blood sugar. I wish more patients would take their self care as seriously as you do - would prevent such a lot of unnecessary problems!
Dr Bets

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1
Our users say:
Posted by: cyberdoc | 2010/03/18

Hallo Blindman
1. It is better to take a late night snack to prevent hypoglycemia
2. I am not too worried about the fasting sugar of 6.3, you don't have to do anything drastic until you see your diabetologist
3. Aging won't affect your fasting blood sugar
Your HbA1C is a better indication of whether your diabetes is causing damage to your eyes, kidneys etc than the morning fasting blood sugar. I wish more patients would take their self care as seriously as you do - would prevent such a lot of unnecessary problems!
Dr Bets

Reply to cyberdoc

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