Posted by: Chris | 2010-04-22

Fasting Glucose

I am a type 2 diabetic and am currently on 500mg of glucovance twice daily. My readings two hours after meals and daily at about 5pm are within recomended ranges of 4.5 - 6.5. However my fasting glucose first thing in the morning is around 7.2 is this something to worry about and if so what should i be doing to bring it down?

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Our expert says:
Expert ImageCyberDoc

Hallo Chris
Don't stress about the fasting blood sugars. Ask your doctor to do a HBA1c test - if this is lower than 7%, your sugar is well enough controlled.
Dr Bets

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Our users say:
Posted by: Blindman | 2010-04-25

Hi there.

I have written to this forum concerning a similar question back in March, and have since seen my diabetologist who basically advises that sugars under 8 are Ok. but that if they go over 10, then something drastic has to be done.

I personally manage a fasting sugar between 5 and 6 due to the fact among others, that, to say the least, I have a rather wicked family history of heart disease and the circumstances of the disease would seem to indicate that most, if not all of them, could have been diabetic. Diabetes awareness has only really come into its own during the last 10 years or so and at the times when my ancestors lived, such awareness did not exist and therefore, they could not have been aware of the fact that they had diabetes then, hence the high incidence of heart disease that prevailed among them, resulting in most of them dying in their 50''s and 60''s. For better or for worse, I have determined that I am going to try and cheat myself out of this legacy.

My discussions I have had with other diabetics as peers and as a freelance diabetes educator, as well as the answer I received to my post, indicates that there cannot be said to be one norm that applies to all diabetics. I gather, without trying to sound arrogant here, that I am among a minority that can manage a fasting sugar of between 5 and 6. My determination of what might be a good fasting sugar for myself, has been determined by learning to " listen"  to my body, as well as constant monitoring over a period of time, rather than trying to predetermine at random, what would be a good fasting blood sugar for myself.

Experience has taught me that under no circumstances should I have a fasting sugar under 5, since this could spell out trouble for me in the course of the day, and again, this is a rule that applies to me and not necessarily to everyone else.

Reading between the lines of your question, I gather that you have a rather drastic drop in blood sugars during the course of the day. I gather this from the fact that you mention that you have fasting sugars of round 7.2 and that you have sugars of round 4.5 when you test after meals. Chances are that you may have experienced hypos before today, and if not, a tighter control regime would most definitely heighten the risk of hypo''s which would mean that you would have to put certain precautions in place to protect yourself. What you do about the matter, in my view, simply amounts to an exercise in choice. I have chosen the stricter approach for reasons that I have mentioned earlier in this reply. I have frequently encountered hypos, but this has not detracted me fom living a completely normal life, thanks first of all, to the very fantastic support team I have around me, which team includes fellow diabetics, two trained nursing sisters one of whom specialised in diabetic care, my dietition, my wife and my diabetologist. Something else which also contributes to the fact that I lead a normal life, is the fact that I have learnt to sense when a hypo comes on, and where appropriate, to educate others about that fact, and to take the necessary precautions to avoid, altogether, the occurrence of the hypo or at least, to take action to deal with the hypo.

In the light of what I have said earlier, I would like to advance for your consideration, some general suggestions which have worked for me.

1. See a dietition. It is probable that you have already seen a dietition, but if you have not yet done so, or if your last visit to a dietition to review your diet has been more than two years ago, this is a definite option which is worth considering.

2. Monitor your readings at particular times during the day over a period of time to try and get to understand the movement trends of your blood sugars in general. You are probably already doing this to some extent, but if you are considering a change in your management regime, I would suggest that you are fully aware of what these patterns are before implementing a regime change.

To this end, I have created a special diabetes management template in Excel format, which, when you enter a blood sugar reading, will give you the averages for the last 7 readings, the averages fo the last 14 readings, the averages for the last 30 readings, the averages for the last 60 readings, the averages for the last 90 readings, the averages for the last 120 readings, the averages for the last 150 readings and the averages for the last 180 readings. In order to track the patterns of your readings, you will also have to enter the date in the date column, and the time in the time column. Times which I record for readings, assuming the GI index as the basis, are as follows: fasting, post breakfast, post midmorning snack, post lunch. post afternoon snack and post supper. There is no post late night snack option here since the next test after this snack should be your fasting sugar.

3. If you have not already done so yet, implement an exercise regime.

4. When you eat fruits as your inbetween snacks, and if you eat apples, consider eating the apple, core, pips and all. All skins, pips and twigs, besides being good roughage, also helps to retard the absorption of sugars, even fruktose, which is a good sugar, thereby keeping sugar levels more constant and extending the time for the beneficial use of the sugars by the body.

5. Consider carefully, what you eat for supper and your late night snack, if you have a late night snack. Breakfasts and lunches should be big meals, while suppers should be lighter and late night snacks, in particular, should be low GI.

I have a square of diabetic chocolate every day and have been recording fasting sugars of over 6 recently. The chocolate I had with my late night snack, but when I moved the chocolate to lunch time, to have after my meal, my blood sugars dropped below 6 fasting, once more.

A good low GI late night snack and my personal favourite, is a tomato sandwitch on a slice of Cape Seed Loaf bread.


Reply to Blindman
Posted by: cyberdoc | 2010-04-22

Hallo Chris
Don't stress about the fasting blood sugars. Ask your doctor to do a HBA1c test - if this is lower than 7%, your sugar is well enough controlled.
Dr Bets

Reply to cyberdoc

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