August 23, 2005
Blood Tests and Insulin Injections, Type 2
Question from South Carolina, USA:
I’m monitoring glucose levels for type 2 diabetes and trying to keep them normal through diet and exercise. Strangely, my levels are sometimes higher in the morning after fasting through the night. For example, after eating dinner of tofu and vegetables last night, my level went down from 202 mg/dl [11.2 mmol/L] before eating to 180 mg/dl [10.0 mmol/L] an hour after eating! This morning, an initial test reading was 189 mg/dl [10.5 mmol/L]. Two hours later, my blood sugar was 212 mg/dl [11.8 mmol/L]. This seems strange to me. Can the tofu and vegetables lower the level that much? Why is the level higher in the morning, followed by an increase? I am very confused by the readings I have been getting during this first week of monitoring. I have triple checked the monitor instructions and the test strip and control give consistent readings. I am 6 feet, 3 inches and weigh 265 pounds.
Answer:
Your question is very common one to ask. Simple reasoning says if you don’t eat anything, your sugars should not get higher. However, one of the basic abnormalities in type 2 diabetes is an inability to suppress the very high output of sugar by the liver. Normally, the liver only puts out enough glucose through the conversion of metabolic intermediates (gluconeogenesis) or the breakdown of the glucose polymer (glycogenolysis). This keeps the brain happy as it has to have an obligate source of glucose to continue to work. However, in diabetes, the liver puts out too much glucose during the early morning hours, which is why your sugars are high in the morning. Successful treatment of your diabetes includes strategies that will normalize the fasting glucose.
JTL
