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April 7, 2002

Daily Care

Question from Boston, Massachusetts, USA:

I'm a 38 year old male just recently diagnosed with diabetes. I am on no medication at this time, and I have been noticing recently that my fasting sugars have been above 130 mg/dl [7.2 mmol/L] but are in a much more manageable range later in the day (under 110 mg/dl [6.1 mmol/L]). This is with paying close attention to my carb and sugar intake. It has been a little frustrating due to the fact that I am not overweight, but I am currently losing weight. Any tips?

Answer:

It is not uncommon for people with type�2 diabetes to exhibit elevated morning fasting blood sugars. This happens because insulin resistance (the hallmark of type 2 diabetes) is often most prominent in the pre-dawn and early morning hours and can result in increased production of liver glucose. The blood glucose profile that you describe is typical of what is observed in the early stages of type 2 diabetes. The good news is that you have detected your diabetes quite early, and knowing this can make a big difference in disease progression, treatment, and outcome.

If you have not yet done so, try observing your blood sugar pattern overnight by checking a bedtime sugar level, once again in the middle of the night (2 or 3 am), and finally fasting in the morning. This will help you detect where that rise is occurring.

You may wish to experiment with food intake prior to bedtime — if you are currently prone to snacking after dinner, try patterning your blood sugar response to different food combinations, and to no bedtime snack at all. You may find an approach that works well for you, and has the least (or even a beneficial) effect on your morning blood sugar. A dietitian can be most helpful as a resource in this process and will assist you in maintaining your ideal weight.

You may also want to experiment with the effects of exercise/activity in this way. Remember, “exercise is medicine” and has a direct effect on the reduction of insulin resistance.

Realize that there are also other medications (such as thiazide diuretics, or high dose niacin for cholesterol management) which may contribute to increased insulin resistance and hence elevated fasting blood sugars. Speak to your pharmacist or physician if you are questioning the effects of medications or agents such as these on blood sugar control.

DMW

[Editor’s comment: If you are not overweight and continue losing weight, it may be that you have slowly evolving Late-onset Autoimmune Diabetes of Adulthood (LADA). Please monitor your blood sugars and weight carefully. Should anything change or the weight loss continues, ask your physician for an evaluation to exclude this possibility.

SS]