Blood sugar higher than expected with intermittent fasting

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GeoffWithT2D

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Type 2
I’m new to the forum, so Hello everyone!

I have T2D which is well controlled with 500mg of Metformin morning and evening. HbA1c is around 35. Normally, my fasting glucose is around 5.4 in the morning.

I started intermittent fasting a few weeks ago, mainly to lose some weight. I have noticed that my fasting blood sugar has gone up a bit. This morning it was 5.9, for example. I have had several raised readings like that. Is that anything to worry about?

Also, I like to go for walks, and I will often walk a few miles in the morning before having anything to eat. To avoid getting hypos I delay taking my morning Metformin until I’m ready to eat something. Is that a problem, perhaps? Should I be cutting the tablet in half and taking a smaller dose?

Thanks for any advice!
 
A HbA1C of 35 is well below diabetic range. Prediabetic is 42-48 with anything above being diabetic.

Normal levels are from 4 to 7 so a reading of 5.9 is perfectly normal. What are some other of your readings?

Metformin shouldn’t cause hypos as that isn’t how it works
 
Thanks Lily.

My HbA1c would be much higher without the Metformin, I expect, but I was diagnosed with T2D 20 years ago, and I have been on Metformin ever since.

If I go walking on an empty stomach, I can do so pretty much all day without eating anything, just as long as I haven’t taken any Metformin first. The other day I picked two or three wild blackberries, as they looked delicious, but even that was enough to get my insulin flowing, and I started to get a bit low.

I’m surprised that you say Metformin doesn’t work like that. Perhaps I was wrong to use the term hypo. My blood sugar can fall to say 3.5, and I start to sweat a bit and feel a bit weaker and generally not very well. I will usually have to stop for a few minutes and take some glucose. Does that clarify things?

Typically, after a meal, my glucose gets up to around 10. If I notice it getting any higher than 11, I tend to go for a walk round the block to bring it down.
 
3.5 is hypo

Metformin works by reducing the amount of glucose the liver releases into the body which in turn should help with insulin resistance. It shouldn’t cause hypos.

How many carbs do you roughly eat a day?
 
Although in theory Metformin should not cause hypos some do report they experience them.
 
I don’t really measure my carbs. Say 3 slices of bread. Some alcohol 2 or 3 days a week. But, there’s carbs in everything, even vegetables.
 
grovesy said:
Although in theory Metformin should not cause hypos some do report they experience them.
Click to expand...
Thanks, Grovesy. I’m definitely not making it up! 🙂

Perhaps, when I am out walking, I need the energy being released from my liver, as the fat burning is not keeping up with the rate I am using energy? I really know remarkably little about how all this works.
 
Sounds like you are making observations based on your own experience, and finding a system that works for you @GeoffWithT2D

But yes, typically Metformin is not considered likely to increase the risk of hypos, and works ‘in the background’ having built up over a number of doses to reduce insulin resistance and reduce the amount of glucose trickled out by the liver. It isn’t generally seen to be a meal-specific medication that acts on the next intake of food. But you know your own experiences and reaction to things better than I do.

If you are experiencing low glucose events, and have a low HbA1c, it might be worth asking your Dr about reducing your dose, and seeing what effect that has on your HbA1c?

Alternatively I suppose you could take a small snack for walks (perhaps 10-15g of carbs). But that might begin to feel like an unnecessary faff?
 
Metformin in itself shouldn't cause hypos.
But, everyone uses blood glucose when they are exercising.
The liver releases glycogen to replace it, and Metformin changes the way this happens, so it is possible, like any athlete who "hits the wall" to run low.
That is why many "carb load" beforehand.
I don't low carb, or the intermittent fast, but personally I'd just try taking my Metformin after exercise.
In theory this shouldn't make a lot of difference, as Metformin accumulates, it's not an instant hit, but it's worth trying as an initial step.
 
My BG drops into the 3s after a walk/run and I feel a bit odd - vision goes strange. Quickly recovers when I stop and goes back to normal levels. It’s all very natural.
 
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