Morning blood readings

[mrgrumpy]

I am at a loss to know what to do next. My last Hba1c reading was 7.2. Up in 6 months from 6.5. I am very diet conscious and avoid carbs as much as possible.

My morning meter readings are increasing and average anything from 7 to11. My HCP advices a slice of toast before bed. (Yes really).

I am on Metformin ( 4 x 500 gm ) and Gliclazide (2 x 40 gm) per day. . I did get by Hba1c down to 5.5 and of course my HCP slashed my meds.
Any suggestions as to what to do next would be appreciated.

 

[Leadinglights]

I am at a loss to know what to do next. My last Hba1c reading was 7.2. Up in 6 months from 6.5. I am very diet conscious and avoid carbs as much as possible.

My morning meter readings are increasing and average anything from 7 to11. My HCP advices a slice of toast before bed. (Yes really).

I am on Metformin ( 4 x 500 gm ) and Gliclazide (2 x 40 gm) per day. . I did get by Hba1c down to 5.5 and of course my HCP slashed my meds.
Any suggestions as to what to do next would be appreciated.

Being on gliclazide you do have to be a bit careful about going too low on carbs but approx how many grams of carb do you have per meal/day.
Toast before bed doesn't seem the best plan, you could try cheese or nuts instead or some yoghurt.

 

[rebrascora]

Hi and welcome.

Can you give us an idea of the sort of things you typically eat and drink for breakfast lunch and evening meal, so we have a bit more of an idea how low carb you actually are and whether there is wriggle room for a bit more dietary change. Taking Gliclazide, you do need to be cautious, but if you lower your carbs a bit more and see now improvement in your levels then I would suspect that the Gliclazide is not working.

Can you tell us a bit about your original diagnosis? How that came about? ie Found via a routine blood test or were you symptomatic and if so, which symptoms? Do you have much/any weight to lose? Are you able to do gentle exercise like walking?

 

[trophywench]

Being on gliclazide you do have to be a bit careful about going too low on carbs but approx how many grams of carb do you have per meal/day.
Toast before bed doesn't seem the best plan, you could try cheese or nuts instead or some yoghurt.

Sorry @Leadinglights - what on earth made you say that 'toast before bed' thing? Someone may have said they did that, but not mrgrumpy!

 

[rebrascora]

Sorry @Leadinglights - what on earth made you say that 'toast before bed' thing? Someone may have said they did that, but not mrgrumpy!

Jenny, it is in mrgrumpy's first post.... middle paragraph!
He was advised by his HCP to have a slice of toast before bed.

 

[mrgrumpy]

Hi and welcome.

Can you give us an idea of the sort of things you typically eat and drink for breakfast lunch and evening meal, so we have a bit more of an idea how low carb you actually are and whether there is wriggle room for a bit more dietary change. Taking Gliclazide, you do need to be cautious, but if you lower your carbs a bit more and see now improvement in your levels then I would suspect that the Gliclazide is not working.

Can you tell us a bit about your original diagnosis? How that came about? ie Found via a routine blood test or were you symptomatic and if so, which symptoms? Do you have much/any weight to lose? Are you able to do gentle exercise like walking?

Hi rebrascora,
My breakfast is one slice of toast (carbs 16.7) followed by either a single Shredded wheat (carbs 15) or Natural yogurt, fruit and sliced almonds. Lunch is usually eggs or cheese,Evening meal chicken or fish with above ground veg. I avoid root veg due to the higher carb content.
I was originally diagnosed 15 plus years ago. No symptoms. I do walk for exercise.
My wife died of Diabetic related complications, so I am very aware of this disease, but my HCP do not appear to understand the low card regime.

 

[rebrascora]

Thanks for that info.

Do you have anything with the eggs or cheese at lunchtime (bread/ryvita/pasta or perhaps salad) and what do you drink throughout the day?

My initial thoughts are that you could perhaps reduce your carb intake at breakfast. Mornings are when we are often more insulin resistant so it is better to have a low carb breakfast and perhaps have a few more on a lunchtime or evening. Whilst 35ish grams of carbs isn't huge it looks to be about your biggest intake of carbs for the day when your levels are already high and your body struggling so you might cope with those carbs better on an evening perhaps in the form of some root vegetables or lunchtime, especially if you are able to go for a walk afterwards.

I would suggest a slice of lower carb bread (Warburtons do a "No added sugar" wholemeal loaf which is just over 9g carbs a slice if I remember rightly but let''s say 10g), and that with a couple of scrambled/poached eggs and maybe some mushrooms or a 2 egg omelette would more than half your morning carb intake but still leave what should be plenty of glucose in your blood for the Gliclazide to work on without too much risk of dropping you low.

Then maybe have another slice at lunchtime with a low carb soup (ie not containing potatoes or lentils) and then maybe a carrot and/or a baby potato or two with your evening meal. Personally I think a carrot or beetroot is better for you than a slice of bread so I would choose that over eating bread or shredded wheat. In fact I often open a jar of pickled beetroot and eat two or 3 on an evening on their own as a snack and there is negligible impact on my BG. Pickled veg in general seem to be better for my BG than fresh and lots of extra flavour. I sometimes have sliced pickled gherkins with my scrambled eggs with cheese and it gives it a real zing, or a little piccalilli or pickled beets with my cooked ham or corned beef. It can make meals a lot more interesting and can be quick and easy if you haven't got a lot of time to prepare and cook veggies.
Anyway, just some thoughts.

 

[Brambleberry]

I was reading about increase BG on a morning. It is called the Dawn Phenomenon. Overnight as we sleep and are effectively fasting the liver converts glycogen back into glucose and that is why the BG can be higher in the morning. I think that may be why you were advised to have toast before bed.If I am understanding the theory correctly your body has something to work on slowly as you sleep it is less likely to do that ? I am newly diagnosed and still in the trial and error stages. Perhaps someone more experienced than me might be able to enlighten us.

 

[trophywench]

Ooops, sorry! - dunno how but I entirely missed the whole middle bit of the OP.

 

[Brambleberry]

Just read about how to beat dawn phenomenon and it says avoid carbs at bed time. So much conflicting advice out there!!

 

[rebrascora]

Just read about how to beat dawn phenomenon and it says avoid carbs at bed time. So much conflicting advice out there!!

I think the conflicting advice is partly because we are all different and partly because the NHS dietary advice is still hung up on eating carbs.

Even the slowest acting carbs will be gone from my system in about 3 hours unless I have a big meal with lots of fat and then that slows the carbs down, but then my levels will be high all night.
Sometimes some nuts or a chunk of cheese at night (and a little glass of red might help 😉 too) can help to settle the liver but often it is just a question of not worrying about the waking BG level and just focusing on reducing the post meal spikes as much as possible and usually the waking BG will then gradually come down itself, because the overall strain on the system is reduced, but it can take weeks or months for it to slowly come down into range.... but better slowly than quickly which can put pressure on the delicate blood vessels in your eyes and feet and kidneys.

 

[harbottle]

I was reading about increase BG on a morning. It is called the Dawn Phenomenon. Overnight as we sleep and are effectively fasting the liver converts glycogen back into glucose and that is why the BG can be higher in the morning. I think that may be why you were advised to have toast before bed.If I am understanding the theory correctly your body has something to work on slowly as you sleep it is less likely to do that ? I am newly diagnosed and still in the trial and error stages. Perhaps someone more experienced than me might be able to enlighten us.

It probably uses Glycogenolysis (From glycogen) and gluceneogensis (Making it from fats and protein) to keep the body topped up and this is triggered by various hormones.

It been observed that DP also happens to people on low carb diets, but no one really knows why.

I've seen a website that talk about the pancreas stopping responding to rises in BG on a low carb diet, but the paper they reference is just theory - it talks about how the brain in mice only starts responding to higher blood sugar levels and disabling neurons resets it. So maybe low carb diet effectively gets the brain to change the 'set point'?

Brain control of blood glucose levels: implications for the pathogenesis of type 2 diabetes - Diabetologia

Despite a rapidly growing literature, the role played by the brain in both normal glucose homeostasis and in type 2 diabetes pathogenesis remains poorly understood. In this review, we introduce a framework for understanding the brain’s essential role in these processes based on evidence that the...

link.springer.com

Herein, we introduce a model in which normal glucose homeostasis hinges on intact brain sensing of the circulating glucose level (Fig. 1) and propose that dysfunction of this sensing process can be acquired in association with obesity and plays a central role in type 2 diabetes pathogenesis (Fig. 2). This model is supported in part by evidence that the brain has the capacity to restore the defended level of blood glucose to normal in animal models of type 2 diabetes [51, 52], implying that a defect fundamental to the pathogenesis of hyperglycaemia must reside in the brain and is targeted by peptides such as FGF1.

There's also an idea that low carb diet encourages fat burning so muscles start to become more insulin resistant as they are getting energy from ketones.

 

[grovesy]

I don't eat after 18.00 but still get dawn phenomena. In fact my rise starts from around 6.00.

 

[Ricky43]

If I am hungry before bed I eat 1 teaspoon of peanut butter - much better than a slice of toast!! Re bread I am now enjoying a thin slice of Dillons Keto bread at lunchtime. Expensive but tasty.

 

[harbottle]

If I am hungry before bed I eat 1 teaspoon of peanut butter - much better than a slice of toast!! Re bread I am now enjoying a thin slice of Dillons Keto bread at lunchtime. Expensive but tasty.

I’ve had to stop buying peanut butter as I like it so much I couldn’t stop eating it!

 

[hazey59]

As a recently diagnosed Type 2 I was really glad to find this discussion on morning fasting readings as I didn't understand why mine are going up from when i first started finger prick testing in July. Despite having a new three monthly HbA1c result of 40mmol/m which puts me in the normal range, my morning fasting readings have recently been 6.7 and 6.9 - i understand fasting non diabetic levels should be 3.9 to 5.5 so my readings are still in the diabetic range. However i fast during the day, drinking things like green tea. and my levels at 5pm will commonly be in the 4's so something seems to be working. I also can have 4s and 5s after a low carb evening meal going up to 7.5 if i have carbs such as rice or pitta bread with a kebab (usually have a treat once a week with chips etc one evening). I am not on medication but want to understand what is happening in my body. I read that higher BG readings on waking show that the pancreas is not sensitive enough to the glucose poured out by the liver. I have read the short version of Roy Taylor's book but am still confused.

 

[harbottle]

Here's a paper looking at the current knowledge of DP:

Thirty Years of Research on the Dawn Phenomenon: Lessons to Optimize Blood Glucose Control in Diabetes

www.ncbi.nlm.nih.gov

An evening dose of insulin for T2s appeared to prevent it.

 

[Ricky43]

Here's a paper looking at the current knowledge of DP:

Thirty Years of Research on the Dawn Phenomenon: Lessons to Optimize Blood Glucose Control in Diabetes

www.ncbi.nlm.nih.gov

An evening dose of insulin for T2s appeared to prevent it.

I tried an evening dose of Metformin and it didn't seem make any dfference to me. Maybe I didn't try it long enough. It is more important to me for my BS to reduce enough after my breakfast to be in the 5's by 4 - 5 hours so I can eat my lunch at the same normal time as everyone else not half way into the afternoon!! I just take 1 x500mg metformin with my breakfast. Before my evening meal my BS is always in the 5's and sometimes 4.9.

 

[hazey59]

Here's a paper looking at the current knowledge of DP:

Thirty Years of Research on the Dawn Phenomenon: Lessons to Optimize Blood Glucose Control in Diabetes

www.ncbi.nlm.nih.gov

An evening dose of insulin for T2s appeared to prevent it.

@harbottle, thank you, the article was very interesting and seems to state the dawn phenomenon needs to be taken seriously particularly if it is increasing.

 

[Ricky43]

Ah it's an evening dose of Insulin that is required so no chance for us lot on only Metformin then!!!!