I have been controlling my blood glucose levels through diet and exercise, but lately my fasting level is between 120 and 130 [6.7 and 7.2 mmol/L]. Do I need medication to lower these fasting numbers, or what can I do to lower them? I try to eat very few carbs for dinner and typically I do not have a snack after 7 pm. If the numbers are in the normal range the rest of the day, should I be concerned about this fasting number?

It is not uncommon in early Type 2 diabetes to see elevations in fasting blood sugar levels as you are describing. This is a result of increasing insulin resistance (the hallmark of Type 2 diabetes) and a resulting rise in liver glycogen release during the pre-dawn hours. While insulin-sensitizing medication (such as metformin) may be a consideration to lower your slight rise in fasting glucose, you may wish to try other options at this point, particularly as you are reporting that your blood sugar levels throughout the day are within normal range. To assure that this is indeed the case, I would first encourage you to know your blood sugar range 1-2 hours after a meal. Look at both low carb choices, and higher carb choices (i.e., a pasta meal) to understand your body’s response to various food types. Keep good records, and discuss your findings with your healthcare team (physician, diabetes educator, dietitian), as these will play into the consideration for medication therapy.

Another point of interest is to understand when your blood sugar rise is occurring by using your blood glucose meter to check blood sugar at bedtime, once during the middle of the night (2-3am) and again upon waking. This should give you and your physician a feel for what your overnight blood sugars are doing. Repeat this experiment both with a bedtime snack and without. Vary the type of snack (carb only, carb & protein, protein only) – in this way you should find what works best for you in managing your overnight and fasting blood sugars. In addition, with the help of your physician and pharmacist, look at whether you are on any medications for other conditions (such as hypertension) which may be affecting your morning blood sugar control. You may also have heard the recent research about cinnamon in the diet benefiting those with pre-diabetes and Type 2 diabetes. Try adding a 1/4 teaspoon of cinnamon to your daily diet, and watch your own sugar levels for similar benefits as those that researchers are reporting, including a 30% reduction in fasting blood sugar. Other factors which should also assist in improving blood sugar control include, of course, weight management and exercise. You may wish to obtain the assistance of healthcare professionals such as dietitians, exercise physiologists, and/or certified diabetes educators to optimize your approach if you feel there is room for improvement. Wishing you best of success in your efforts!

DMW

[Editor’s comment: Regarding the reference to cinnamon, see Cinnamon Improves Glucose and Lipids of People With Type 2 Diabetes.

JSH]