Why is my blood sugar in the range of 80-90 mg/dl [4.4-5 mmol/L] in the morning and doesn’t go up until I have eaten? Is this normal for people with type 2 diabetes? What is normal? This is new for me, and I’m as confused as when I first found out I had diabetes. Please help!

In the earliest stages of type 2 diabetes, the body is typically able to provide enough background insulin from your own pancreas to effectively keep blood sugar levels in the normal range. That normal fasting range is 70-109 mg/dl [3.9-6.1 mmol/L], similar to the numbers you are seeing. Carbohydrates in a meal or snack will cause a rise in blood sugar. In the person who does not have diabetes, this rise in blood sugar is met with an immediate increase in insulin output called “first phase insulin release” from the pancreas. This is followed by continued “second phase” insulin release. Combined, these two phases of insulin release from the pancreas keep blood sugar levels within a “normal” range (less than 140 mg/dl [7.8 mmol/L] ), regardless of the amount of carbohydrate intake.

In the earliest stages of Type 2 diabetes, it is the first phase insulin response that is lost initially. This results in substantial elevations in postprandial blood sugar levels. It can be followed by an overproduction of insulin during second phase insulin release to compensate for those higher blood sugars. Some people may experience reactive hypoglycemia at this point. Because of the insulin resistance that is the hallmark of diabetes, it is possible that even the higher amounts of insulin released do not adequately control blood sugar levels. After a number of years, we can often observe an eventual decline in beta cell insulin production, despite medical and nutrition therapy.

There are many new medical therapy approaches to Type 2 diabetes, even in its earliest stages. For example, Starlix [nateglinide] is one of the newest oral medications for type 2 diabetes which acts to stimulate the rapid first phase insulin response which was lost. For some people, it can result in a dramatic improvement in immediate postprandial blood sugar levels. It is sometimes used in combination with Glucophage [metformin] which addresses insulin resistance.

You may wish to ask your physician about these options in your treatment plan. Following a lower carbohydrate meal plan may have an impact on your blood sugar numbers as well. The numbers that you are observing are quite typical in type 2 diabetes. We do have a variety of options to use as we attempt to normalize the physiology of blood glucose response.

DMW