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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.


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.