October 7, 2003
Daily Care, Type 2
Question from Stoke-on-Trent, UK:
I have type 2 diabetes treated with 10 mg of Avandia [rosiglitazone] once per day along with 500 mg of metformin three times per day, and I average 8.0 mmol/L [144 mg/dl] in the morning and 5.5 mmol/L [99 mg/dl] before my evening meals. Why are my blood sugars higher in the morning?
One of the cardinal manifestations of diabetes is elevated fasting blood sugars. This occurs as a result of the inability of the liver to have its glucose production rate inhibited adequately by insulin. The liver is responsible for a continuous supply of glucose to provide the brain with fuel. In the presence of diabetes, the liver is either resistant to or does not see enough insulin to suppress the glucose output. That is why you can have a lower glucose before you go to bed and wake up higher in the morning. Medications such as metformin have activity against elevated liver glucose production.