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December 6, 2001

Daily Care, Type 2

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Question from Owego, New York, USA:

I am a 64 year old male diagnosed with type 2 diabetes about seven moths ago, and I am now in good control (hemoglobin A1c of 6.2%) with diet and exercise. However, my blood glucose level tends to rise overnight and is usually by 15 to 20 mg/dl [0.8-1.1 mmol/L] in the morning. The increase doesn’t happen every night, but there seems to be no rhyme or reason when it does What causes this? Is there anything I can do to minimize or stop that increase?

Answer:

What you are describing is a cardinal feature of type�2 diabetes. Overnight, in an effort to provide the brain with an obligate source of energy (in this case, glucose), the liver puts out glucose. In diabetes, the amount of glucose put out is excessive and results in high fasting blood sugars. The amount of extra glucose put out by the liver is a measure of the liver’s insulin resistance. Therefore, it is commonly not what you ate the night before that affects your fasting blood sugar, but how your diabetes is being treated.

In your case, you are not on medications, but a persistent elevation in the fasting glucose may be an indication for pharmacologic therapy. As far as diet and exercise, keep up the physical activity and don’t overeat.

JTL