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February 3, 2004

Type 2

Question from Menominee, Minnesota, USA:

I have always had a problem with my glucose level in the morning. I'm taking these medications presently: Glipizide 5 mg (1 morning, 2 evening) Metformin HCL 500 mg (1 1/2 at noon and 2 1/2 at bedtime) Zocor 40 mg (1 at bedtime) Synthroid 0.15 mg (1 at morning) Supplements: (All at 1 each per day in morning) Selenium 200 mcg Magnesium 133 mg Zinc 5 mg Folic Acid 400 mcg My evening readings vary from 85 to 125 [4.7-6.9 mmol/L]. Morning readings are 185 to 230 mg/dl [10.3-12.8 mmol/L]. I take my readings before meals about the same time every day.

Answer:

My understanding is that you would like to know why that is or what to do to improve your glucose levels in the am. First, fasting hyperglycemia is a result of the liver making too much glucose during the night while you are sleeping. In a sense, this is a form of insulin resistance because increased sensitivity to insulin or increased insulin helps to decrease fasting glucose. When fasting hyperglycemia occurs in a situation like yours, I am often of the thought that your medication should be increased to address the higher sugars. At this point, you may want to add a dose of long-acting insulin at night or add another pill to achieve this.

JTL