Plasma fasting glucose level

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Valley1

Valley1

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Relationship to Diabetes
Type 2
Hi, I’ve recently had a review of my type 2 diabetes with my GP and I’m pleased to say that after a lot of hard work on my diet and exercise that my HbA1c result was 42 mmol/mol. However, my morning fasting glucose level was 7! I reported high morning glucose levels to my GP, but he doesn’t seem to know why this is. I’ve tried to lower it by not eating beyond 8 - 9pm and taking Metformin just before bed, but nothing seems to work! Any ideas? Thanks 🙂
 
Valley1 said:
Hi, I’ve recently had a review of my type 2 diabetes with my GP and I’m pleased to say that after a lot of hard work on my diet and exercise that my HbA1c result was 42 mmol/mol. However, my morning fasting glucose level was 7! I reported high morning glucose levels to my GP, but he doesn’t seem to know why this is. I’ve tried to lower it by not eating beyond 8 - 9pm and taking Metformin just before bed, but nothing seems to work! Any ideas? Thanks 🙂
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It is just something that can happen with many people as the liver tries to be super helpful and releases glucose to give you energy for the day in the absence of food. Referred to as Foot on the Floor Phenomenon by many. Some find testing in bed can show lower readings rather than after pottering about.
People taking insulin can compensate by taking a bit of bolus insulin when they wake up.
If Type 2 there is not a lot that can be done. Keeping a watch on trends probably better than individual readings.
Metformin is probably better taken with food as it is less likely to cause stomach issues. It just works in the background to help the body use the insulin it produces more effectively and perhaps reduce the glucose the liver releases.
 
Congratulations @Valley1 on lowering your HBA1C to the limit of pre-diabetic. That is a fantastic achievement.
I appreciate things are a little different for me as I have Type 1 (not type 2) diabetes but, it is definitely not as simple as "taking some insulin" to compensate for the morning BG rise as it is not that predictable. The two things I have found that help are
- Exercise the day before. For me this has to be something that raises my heart rate. I thin of it as using up some of the glucose in my liver which is will dump the next morning.
- Eating as soon after waking up as possible. This will tell my liver that I am not starving and it can stop giving me extra glucose. If I delay my breakfast, my liver dump will continue and my BG rise will carry on.

I have also read that people with type 2 find their morning BG is often the last one to come down so maybe you are being a bit impatient and you will get there.
 
Valley1 said:
Hi, I’ve recently had a review of my type 2 diabetes with my GP and I’m pleased to say that after a lot of hard work on my diet and exercise that my HbA1c result was 42 mmol/mol. However, my morning fasting glucose level was 7! I reported high morning glucose levels to my GP, but he doesn’t seem to know why this is. I’ve tried to lower it by not eating beyond 8 - 9pm and taking Metformin just before bed, but nothing seems to work! Any ideas? Thanks 🙂
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Well done if the 42 is down from wherever you were. With 42-47 being a pre-diabetes diagnosis, and being consistently over 7 suggesting a possibility of pre-diabetes, your readings are actually roughly in sync.
 
Read about this described as the Dawn Phenomenon. Here's a little about possible causes:
www.mayoclinic.org

The dawn phenomenon: What can you do?

Take steps to prevent this early-morning increase in blood sugar.
www.mayoclinic.org www.mayoclinic.org

In my own experience my morning reading can be quite a lot lower if I wake up a few hours early, so I would guess it's associated with the natural daily rhythm of hormone release. I've read on another forum that some people who don't usually eat much of a breakfast control it by eating something very small like few nuts with their morning coffee, and that this apparently stops the liver from releasing more glucose into the bloodstream in the morning than is typical later in the day. A tiny amount of food can apparently kick it out of 'morning mode'.

Metformin has an elimination half-life in the blood of around 17 to 18 hours, meaning it takes that long for 50% of the dose from a single pill to be expelled by the body. 3% of a given dose will still be in your body 88 hours after taking it. Taking it later than usual won't make a huge difference to levels in the blood the following morning - there'll still be plenty of it in your system if you take it at mealtimes.
 
Yes, great effort by you @Valley1. Your hard work has served you well.

I have found a trick or technique to stop that first thing BG rise. This might be rather unique to my status as someone with absolutely no pancreas, since I have none of the 4 pancreatic hormones that would normally do their own little dance to kick-start one's day - but I offer the suggestion since I think the effort involved is very slight for anyone and at least worth trying.

For the last 9+ months I have taken to bed a couple (or 3) very small and extremely low carb content "mini-snacks". These are typically 2 or 3 one mouthful snacks of a lump of (non-crumbly) cheese, with a single walnut or brazil nut (or other low carb nuts, so not cashews for example)
(or a morsel of cold meat instead of the nut). I immediately eat a mini-snack if I wake during the night needing the bathroom, or as soon as I wake for my planned morning start. I eat straightaway, before I commit to any sense of action after waking and I'll eat a second (or third) mini-snack if I've been awake for a while before getting out of bed. The principle is to convince my body that I'm awake and I already have protein and fat reaching my digestive system, so don't need that helpful release of glucose from my liver's glucose store.

I have found this has been a consistent way of stopping (or at least noticeably reducing) both the Dawn Phenomena (DP) or the FOTF response and it has been a rare day that this hasn't worked for me. Preparing a little snack box the night before is a bit of a faff and selecting foods that don't introduce crumbs into bed is important(ish!). But I've found the benefit has outweighed the effort needed.
 
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