Newbie advice for blood glucose levels pls

[Mediumsmiffy]

Hello everyone, thanks in advance for any help/ support

I was diagnosed as type 2 on 19 May hba1c was 53 not on any meds. Next Dr blood test is 28 July.

Starting weight on diagnosis was 184.64 current weight is 169.41.

Bought a Accu check instant yesterday - first reading at 15:21pm before food was 6.9 then at 20:26pm 2 hours after food it was 7.5 but this morning at 06:47am it was 8.9.

I don’t understand how it has gone up? I know this is only the first day of testing but please may I ask for some advice, I am so confused and anxious. What should I be aiming for in my results? How can I get my morning levels lower.

 

[Felinia]

Hello and welcome. It's what is known as the Dawn Phenomenon.

The dawn phenomenon is a natural occurrence where the body releases hormones that increase blood sugar levels,usually between 4am - 8am. These hormones signal the liver to release stored glucose, providing energy for the day ahead. In people with diabetes, particularly type 2, the pancreas may not produce enough insulin to counteract this surge, resulting in elevated blood sugar levels.

In type 2 diabetes, the body either doesn't produce enough insulin or the cells become resistant to insulin. This means that even with the natural rise in counter-regulatory hormones, the body can't effectively utilize the glucose, leading to the dawn phenomenon.

One of the common symptoms of the dawn phenomenon is high morning blood sugar. Others can include:
Increased thirst, Increased hunger, Frequent urination, Headaches, Blurred vision, Fatigue or feeling tired, and Irritability.

One of the suggested ways to manage the dawn phenomenon is to eat earlier in the evening, and with less carbs.

Hope this reassures you.

 

[harbottle]

Sounds like Dawn Phenomenon. The body produces hormones in the morning that trigger glucose release from the liver and also make us more insulin resistant. People with diabetes struggle to deal with this so levels goes up.

If your liver has a lot of glycogen stored up, it can make the levels rise higher, hence why a low carb meal in the evening can help control it.

The liver can also make glucose from amino acids and fats, but this is a slow process. Unfortunately, in people with T2D this process produces excess glucose which can also contribute to morning rises, but not as sharp as a release from glycogen.

Check your levels before 3am and see what they are. As this is about the point at which the hormones kick in.

 

[Leadinglights]

You are very early in your journey (horrible expression) so you might expect morning readings to be the last to come down because of your liver being super helpful in releasing glucose, some people find testing in bed will make a bit of difference.
Your meal tests look good so if you can maintain that you are on a good track. The aim is 4-7 mmol/l fasting / morning and before meals and no more than 8-8.5 2 hours post meal or no more than a 2-3mmol/l increase from before to 2 hours after.
What you have been doing seems to be working for you but you may find this link will also give you some ideas, https://lowcarbfreshwell.com/

 

[everydayupsanddowns]

Starting weight on diagnosis was 184.64 current weight is 169.41.

Bought a Accu check instant yesterday - first reading at 15:21pm before food was 6.9 then at 20:26pm 2 hours after food it was 7.5 but this morning at 06:47am it was 8.9.

Well done on your weight loss @Mediumsmiffy

Sorry to hear about your diagnosis, but great to hear you have a BG meter to help you refine your menu.

For those who have a substantial early-hours liver dump / Dawn Phenomenon, the waking reading can be a bit stubborn, and is often the last to come down. For others, DP doesn’t really kick-in until they get our of bed, which can make breakfast time extra-tricky.

Ideally you’d want to aim to keep the meal-rises at 2hrs after eating, to be no more than 2-3mmol/L higher than your ‘before’ reading (so the meal you ate today looks like it suited you well). And ultimately you are wanting to aim for:

4-7mmol/L before meals and
No higher than 8.5mmol/L by 2hrs after.

Keep working on your weight loss, and aiming at those small meal rises, and hopefully your waking readings will come into line soon.

 

[PerSpinasAdAstra]

As others have stated - Dawn Phenomenon which is a slow rise beginning in early morning which many report ends after breakfast and Foot to Floor phenomenon which begins after getting out of bed and becoming 'wide awake' and is relatively short-lived. Both likely caused by the daily cycle of hormones. I experience minimal Dawn Phenomenon so long as I don't go too long without eating breakfast but if I test very soon after getting out of bed I see a Foot to Floor 'spike' which I can see to some extent on the graph almost every day when wearing a CGM. I typically wait at least 15 minutes before testing in the morning, once I've been fully awake for a while, to try to minimize variations in my morning readings due to Foot to Floor.

Other possible causes of high levels in the morning are a poor night's sleep, stress and anxiety, and other variables like illness. Hormones again. I often see quite big variations which correlate with how well and how long I slept the night before.

It's worth bearing in mind though that even the highest-quality finger stick meters will produce a bad reading now and then, and the Accu-Check Instant is a mid-range meter which invariably tends to read a little high for me. This plot is illustrative - I have many similar plots but this one shows the properties of the Accu-Chek Instant quite well. I tested each drop of blood with five different meters and did that 14 times to capture a range of readings after a meal. The most accurate known meters used here were the Contour Next (purple dots) and Contour Next One (gold circles). A purple and gold 'bullseye' represents tests where both of these meters gave the exact same reading. These meters are basically the same in how they work and you can see the readings from these two meters are always quite close to one another. The green line represents readings from a Dexcom One+ CGM which had been calibrated earlier in the day using the Contour Next meter.

The pale blue-green circles represent readings from the Accu-Chek Instant. As you can see that meter give the highest reading in every one of the 14 individual tests. I can't put a figure on how must higher than true objective accuracy the 'Instant' reads on average (I don't have enough readings yet, or the math skills to calculate it) but if you get a weird reading from this meter I would suggest testing a second time to confirm, and even if the second reading is very close to the first maybe assume that your true blood glucose level is a little lower than the Accu-Chek Instant says it is.

 

[Lucyr]

I don’t understand how it has gone up?

Your blood sugar goes up and down all the time, it isn’t only affected by food but by lots of other things too

 

[Lucyr]

Check your levels before 3am and see what they are. As this is about the point at which the hormones kick in.

I don’t think it’s helpful to tell a newly diagnosed T2 to get up before 3am to test their blood sugar when their morning result isn’t that bad and they can’t do anything about their morning hormones anyway. Let them get some decent sleep.

 

[harbottle]

I don’t think it’s helpful to tell a newly diagnosed T2 to get up before 3am to test their blood sugar when their morning result isn’t that bad and they can’t do anything about their morning hormones anyway. Let them get some decent sleep.

It's not as if I'm telling them to do it every night.
Just once.

 

[Docb]

Hi @Mediumsmiffy and welcome to the forum.

If you read around the forum you will find I am one of those who encourages people to look at the numbers a bit more broadly. For example you give your weights as 184.64 and 169.41. Is that your weight in pounds? If so, then it is best to forget the numbers after the decimal point and round to the nearest pound because your weight is not constant, it goes up and down all the time and what you are looking for is not an exact weight but a number that reflects your weight at the time. Your weights then become 185 and 169 and that's a big enough difference to say you have lost a lot of weight over a good period. Well done on that and there is a pretty good chance that will be reflected in a lower Hba1c when it is next measured.

Same with your blood glucose readings. Round your meter reading to the nearest whole number - meters cannot measure blood glucose to any better precision - and then look for patterns over a series of readings over days or weeks. That way you can begin to see if your waking reading is consistently higher than at other times of the day. You can begin to see the effect of different meals and perhaps begin to identify particular foodstuffs that are problematical for you.

My thought for you is to get a notebook and pencil and start a diary. Check your BG on waking and at times during the day for a couple of weeks and see what is going on. Put the numbers into a spreadsheet if you are that way inclined or if you are really nerdy, write a bit of software to collate it and do some stats. Whatever you do, you need to stand back and look for broad patterns.

You ask for some targets. I have collected loads of personal data and had a lot of fun looking at it and from that I would suggest that you are in a good place, with an HbA1c below the diagnosis limit, if you can get your waking readings consistently below 7 and rarely get into double figures during the day. It seems to me that you are not along way from that.

 

[JimG]

Hi @Mediumsmiffy and welcome to the forum.

If you read around the forum you will find I am one of those who encourages people to look at the numbers a bit more broadly. For example you give your weights as 184.64 and 169.41. Is that your weight in pounds? If so, then it is best to forget the numbers after the decimal point and round to the nearest pound because your weight is not constant, it goes up and down all the time and what you are looking for is not an exact weight but a number that reflects your weight at the time. Your weights then become 185 and 169 and that's a big enough difference to say you have lost a lot of weight over a good period. Well done on that and there is a pretty good chance that will be reflected in a lower Hba1c when it is next measured.

Same with your blood glucose readings. Round your meter reading to the nearest whole number - meters cannot measure blood glucose to any better precision - and then look for patterns over a series of readings over days or weeks. That way you can begin to see if your waking reading is consistently higher than at other times of the day. You can begin to see the effect of different meals and perhaps begin to identify particular foodstuffs that are problematical for you.

My thought for you is to get a notebook and pencil and start a diary. Check your BG on waking and at times during the day for a couple of weeks and see what is going on. Put the numbers into a spreadsheet if you are that way inclined or if you are really nerdy, write a bit of software to collate it and do some stats. Whatever you do, you need to stand back and look for broad patterns.

You ask for some targets. I have collected loads of personal data and had a lot of fun looking at it and from that I would suggest that you are in a good place, with an HbA1c below the diagnosis limit, if you can get your waking readings consistently below 7 and rarely get into double figures during the day. It seems to me that you are not along way from that.

In the early days of diagnosis I used to stress about individual finger prick tests. It took me a while to accept that, for type 2 on diet control or tablets, an individual test is rather meaningless. It can be affected by lots of things including stress. A few months ago I was in hospital for an operation. It was a day case procedure and so not as serious as some I have been on. The finger prick test before the operation was very high. High enough to worry me but future tests showed that was a blip. As DocB says, look at the trends. I rely on the annual HbA1C and a month's worth of testing every now and then if I've had a spell of not feeling well or to heck after a high reading in hospital. I won't say that plotting on a graph is fun but it does give me a feeling of knowing what is going on and that I have some degree of control.