Can't figure out why my blood sugar levels don't go down

[MihaiM]

Hello everyone

I am confused about the numbers and hopefully some of you know what’s happening to me. So I have been diagnosed a month ago with diabetes type 2 with H1bc of 6.5 % 48 mmol. The diabetic nurse told me to go on a low carb diet and lose weight and hopefully reverse it. I have gone on a diet and I lost 5 kilos in one month. I bought a CGM also to constantly see my blood sugar levels. I’m confused because every day there is the same pattern. I wake up at 6 am with blood sugar around 5.8 mmol, during the night it stays constantly around 5.8, just saw a small spike at 5 30 am of 6.2mmol. So I eat breakfast before going to work at 6 30 am. When I wake up its around 5.8 mmol. After 1 hour it spikes at 7.3. After two hours its around 6.3-6.5. Then it stays like that all morning around 6-6.5 mmol until 2 30 pm when it starts to go down finally in the range of 5.2 mmol. I dont eat anything until 2.30 pm. So I dont undestand, why doesnt the blood sugar goes below 6 until 2 30 pm? After I have lunch it goes to 5.5 after around 2-3 hours also same with dinner. Would it be better to skip breakfast every morning to have blood sugar in the range between 5 and 6 mmol? Also, is there a way to have blood sugar lower than 5.8 while I sleep?

 

[Docb]

Hi @MihaiM and welcome to the forum.

Getting a proper perspective on the numbers can take a bit of time. The thing that people tend not to tell you is that blood chemistry is quite complicated. Although food intake can be a big factor, there is lots of other stuff going on. In particular the body will generate glucose if it thinks you are going too low. Also, although the monitors are remarkable, the readings they give are not as precise as implied by giving a number after the decimal point.

A quick scan of your numbers suggest to me that you ought to be into sub diagnosis territory at your next blood test. Nothing above 8 and generally hovering between 5 and 7 looks good to me so in your position I would keep doing the same as you are and change very little. Certainly would not think of skipping breakfast.

Congratulations on the weight loss, you must be doing something right to achieve that in a month. Do you have much more weight to lose? If so, then it might be that your bathroom scales could be a simpler, and easier to interpret, way of monitoring your progress.

 

[Proud to be erratic]

Yes, great advice from @Docb.

Your diagnosis at 48mmol/L, just puts you into T2 territory and your Nurse rightly has judged you don't need any medication, just that you need to make some modest lifestyle changes to help nudge you back down from that diagnosis.

Your present numbers are fine and the weight loss is terrific. The biggest precautionary observations I would make is to sustain your weight loss and learn from your expensive CGM experience what foods/meals you should avoid for the future. Don't let your weight loss regress into a "yo-yo" experience.

The other thing you can do to help yourself is to increase your exercise / activity levels; this doesn't necessarily mean rush out and join a gym club (of course you can do that if you think that would help motivate yourself). But do take every opportunity to walk a little more, park further away from your place of work or get off a bus one stop sooner; walk upstairs rather than take a lift or escalator. After meals make more of a routine to be active for 10+ minutes, do small active tasks after mealtimes, such as cleaning, clearing, fetching or carrying; such post meal activity can do wonders for stimulating your metabolism to not only speed up the digestion of food, but improve your natural insulin resistance and get your natural insulin better placed to clear glucose arising from that digestion into individual body cells and thus organs and muscles.

 

[MihaiM]

Hi @MihaiM and welcome to the forum.

Getting a proper perspective on the numbers can take a bit of time. The thing that people tend not to tell you is that blood chemistry is quite complicated. Although food intake can be a big factor, there is lots of other stuff going on. In particular the body will generate glucose if it thinks you are going too low. Also, although the monitors are remarkable, the readings they give are not as precise as implied by giving a number after the decimal point.

A quick scan of your numbers suggest to me that you ought to be into sub diagnosis territory at your next blood test. Nothing above 8 and generally hovering between 5 and 7 looks good to me so in your position I would keep doing the same as you are and change very little. Certainly would not think of skipping breakfast.

Congratulations on the weight loss, you must be doing something right to achieve that in a month. Do you have much more weight to lose? If so, then it might be that your bathroom scales could be a simpler, and easier to interpret, way of monitoring your progress.

Thank you for the great response. I’m 180 cm in height, so ideally I should be around 80 kilos. I had a terrible eating habit before and was drinking alot of beer. Cut all the beer and sugar. When I was diagnosed I had 110 kg. Now I have 105 kg. So I would still need 25 kilos to lose I guess? So skipping breakfast would not help with weight loss and to have lower blood sugar levels in the morning?

 

[MihaiM]

Yes, great advice from @Docb.

Your diagnosis at 48mmol/L, just puts you into T2 territory and your Nurse rightly has judged you don't need any medication, just that you need to make some modest lifestyle changes to help nudge you back down from that diagnosis.

Your present numbers are fine and the weight loss is terrific. The biggest precautionary observations I would make is to sustain your weight loss and learn from your expensive CGM experience what foods/meals you should avoid for the future. Don't let your weight loss regress into a "yo-yo" experience.

The other thing you can do to help yourself is to increase your exercise / activity levels; this doesn't necessarily mean rush out and join a gym club (of course you can do that if you think that would help motivate yourself). But do take every opportunity to walk a little more, park further away from your place of work or get off a bus one stop sooner; walk upstairs rather than take a lift or escalator. After meals make more of a routine to be active for 10+ minutes, do small active tasks after mealtimes, such as cleaning, clearing, fetching or carrying; such post meal activity can do wonders for stimulating your metabolism to not only speed up the digestion of food, but improve your natural insulin resistance and get your natural insulin better placed to clear glucose arising from that digestion into individual body cells and thus organs and muscles.

Thank you for the advice. So best would be to exercise before a meal on empty stomach to burn fat and also after a meal also?

 

[JimmyBlue]

So skipping breakfast would not help with weight loss and to have lower blood sugar levels in the morning?

Hi @MihaiM I don't think that helps as much as you may think. A good breakfast sets you up for the day. I eat greek yoghurt, chopped almonds and a small portion of fruit each morning which goes a long way to filling me up. If I need a snack I eat more almonds but pecans, walnuts, hazelnuts, etc. are all options as they are very low carb but provide fibre and protein.

As @Docb said you are only slightly above the prediabetic level at 48 so a little more exercise and perhaps smaller portions of potatoes, pasta, rice and bread would help improve the average level. However, your results are way below were some people (me for example) are and I would love to find my BG not going above 7.5.

The other point is that you should be measuring 2 hours after the meal as that is the post postprandial point that most doctors and diabetes nurses work to. This is a link to a chart from Tayside NHS showing the targets for BG.

NHS Tayside

Website of NHS Tayside

www.nhstayside.scot.nhs.uk

 

[Docb]

So skipping breakfast would not help with weight loss and to have lower blood sugar levels in the morning?

It might, but it might leave you a bit hungry and grumpy mid morning and temp you to a "snack".

In your position I would be watching my bathroom scales and keep doing what I am doing whilst the weight is drifting down. At some point your weight might level off and that would be the time to think again if you have not reached your target. My only other thought is not to get too obsessive about things. Be content with things moving in the right direction, keep a weather eye on things to make sure it continues, and don't neglect the rest of your life - especially that bit that does not involve beer and sugar!

 

[MihaiM]

Thank you for your answers. What about this liver dumping glucose? After I have been finally with 5.3 mmol at 2:30, at 3:10 after 40 minutes I was again 6.0 mmol, is it liver dumping glucose? If so why does it keep dumping glucose all day?

 

[Drummer]

Thank you for your answers. What about this liver dumping glucose? After I have been finally with 5.3 mmol at 2:30, at 3:10 after 40 minutes I was again 6.0 mmol, is it liver dumping glucose? If so why does it keep dumping glucose all day?

Has someone told you that you need to keep your blood glucose levels so low?
If you consider that 8mmol/l is considered just fine after eating, you have no reason to worry about your results, plus you are barely into the diabetic range - just by one number - so although diabetes is not something to ignore your concerns are a bit baffling.

 

[rebrascora]

BG goes up and down all day and night in response to something like 42 factors, some of which we have control over but most we don't. Things like food, exercise, medication, stress, illness, ambient temperature, how much activity (thinking) your brain is doing etc... The body is constantly adjusting the insulin and glucose from the liver and from food to balance things within a set range but not a specific number, so people who are not diabetic also find their BG levels wander up and down and spike a bit after food and drop a bit after exercise and can even drop to hypo levels after very extensive exercise like running a marathon.

The liver is trickling out glucose throughout the day and night as a sort of back up battery or store to keep levels topped up when muscles and brain power are taking them down, especially when there is no food being eaten. I believe generally eating switches off that liver function until no more glucose is being released by the food and then it resumes, but by far the largest surge is in the morning before breakfast and is believed to stem back to prehistoric times when we needed that energy to go out and hunt or forage for the first meal of the day and needed that glucose to fuel us otherwise we would be too weak to be successful at the hunt and we would rapidly die out. It doesn't take nearly as much energy to get out of bed and walk into the kitchen and open the fridge, as it does to hunt down a wooly mammoth, kill and butcher it before you can have breakfast.

Do keep in mind that 6mmols is a perfectly good number for your BG to wander up to and completely normal, so try not to get hung up on these very minor undulations. Balancing glucose and insulin is a very, very complex task as those of us who are insulin dependent know only too well, so the fact that the body can adjust it constantly to be within a few mmols most of the time is pretty impressive I can assure you.

 

[Docb]

Thank you for your answers. What about this liver dumping glucose? After I have been finally with 5.3 mmol at 2:30, at 3:10 after 40 minutes I was again 6.0 mmol, is it liver dumping glucose? If so why does it keep dumping glucose all day?

You are reading too much into your readings. I once did ten tests in a row of all my fingers and thumbs and what I found was that I got a spread of readings. My conclusion was that when you look at the reading on a meter it is best to round it to the nearest whole number and then assume that it could easily be one unit higher or lower. So your readings are 5 and 6. Each could easily have been one unit higher or lower which means that you should not read anything into the difference you have seen. You need differences of 2 or 3 whole units before you can begin to think you are seeing a difference in blood glucose.

The hand held monitors are brilliant bits of kit and it is a wonder that they give a reading anywhere near your actual blood glucose but like all bits of measuring kit there is an error on the result and that needs to be remembered.

 

[helli]

I assume you are testing your BG with a finger prick.
This is great and what many of us have been doing with decades. However, it only gives us a single moment in time reading; you don't know what is happening between finger pricks. So just because it was 5.3 at 2:30 and 6.0 at 3:10 doesn't necessarily mean your BG was constantly rising. As @rebrascora mentioned, stress maybe one of the things that raises BG. Some people get stressed by pricking their finger (especially if the blood is not flowing as well as they would like, for example which could raise their BG.
You may benefit from checking out the Libre free trial to see what is happening between pricks.

The other thing to remember (which I think @Docb just touched on) is that home testing kits need to comply with a standard to be within 15% of the "real" BG and only 95% of the time. This means that a reading of 6.0 could be anything between 5.1 and 6.9. Or, occasionally, a bogus reading.
And this accuracy is good enough to calculate the dose of a potentially lethal medication, insulin, for those of us with Type 1.

 

[Proud to be erratic]

Thank you for the advice. So best would be to exercise before a meal on empty stomach to burn fat and also after a meal also?

Certainly the more exercise you can fit in to a working day, the better it would be. But if you are time short, then some modest exercise, or being active, after eating does seem to be a great metabolic stimulant. However, there are no "absolute" rules with this D malarkey. What works for me (or anyone else) might not work for you. We learn these things individually, by trial and learning.

Overall, you are only just into the D zone; you are doing really well, after your initial willingness to take note of the warning message you got a month ago. Make simple enduring lifestyle changes that are easy for you to sustain into the foreseeable future, even after you've got a future potential "all clear", such as an HbA1c below 42. Then enjoy life from age 31 to 100 just aware that there are thresholds best not crossed!

 

[harbottle]

Not sure it's anything to worry about.

Mine does the same, and my hba1c has been normal for 3 years. Flat all night, goes up a little when I get to work, and then drops in the early afternoon.

From what I've read about the circadian rhythm it might be possible due to hormones to be slightly higher at some points in the day. Cortisol is released after waking and getting active, which causes insulin resistance, and the amount of insulin released by the pancreas can change during the course of the day as well. There's also the possibility the pancreas doesn't have the same sensitivity to glucose all day, and at some points may not respond as quickly.

When I first got my hba1c down to normal levels, I was paranoid about it and used to go out for a walk if I saw it over 6.0. However, even after a walk it would go back up to, say, 6.2 after a while.

I'd just rely on the hba1c test and not try to get hung up on the daily 'ebb and flow' of blood sugar. Keeping it at the levels you're seeing will hopefully give good results next time.

 

[everydayupsanddowns]

Thank you for your answers. What about this liver dumping glucose? After I have been finally with 5.3 mmol at 2:30, at 3:10 after 40 minutes I was again 6.0 mmol, is it liver dumping glucose? If so why does it keep dumping glucose all day?

I wouldn’t worry too much about the difference from 5.3 to 6.0mmol/L @MihaiM

When I have a dump of glucose it’s much more significant than that - more like a rise of 4-6mmol/L so, say, from 5.0 to 9.5mmol/L

You’ve been doing really well so far, and you’ve made great progress in the short time since your diagnosis. I think you should just keep doing what you are doing 🙂