Hello, I am a new memeber! I have a peculiar problem!!

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Ron AKA replied on Wed, May 6 2009 2:58 PM

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suneeti:

I am so glad that I joined Joslin discussion boards. Now I have someone to share my worries with! I was diagnosed with type 2 about 5 years ago It has been under control with 2 500mg metformin tablets a day and a1c stays between 6.5 and 7.0.  But recently I noticed that my morning sugar level fluctuates more and more. It used to be between 90 and 110. Now it can be upto 125. I have several concerns:

• Will it continue to fluctuate more and more as the disease gets older?
• I have noticed that if I eat something with carbohydrate (or even sugar!) later in the evening, say about 8 o' clock there is a better chance that the sugar will be around 110. But if I finish my dinner at 6 o' clock and then do not eat anything till next morning the chances are sugar will be higher! Of course my doctor does not believe this and says I am making some mistake.
• If I check blood sugar before exercising and it is normal, it could be as high as 150 after exercising! Wherever I have read, it should drop, shouldn't it?

I wonder if any of you have similar issues and how did you handle it. I feel this might be the reason that my a1c count stays higher than it should.

Actually your problem is very common with diabetics. It is caused by your liver dumping sugar to wake you up in the morning and get energy for the day. Same thing happens in non-diabetics, but for them insulin is also produced to keep BG normal. In diabetics it results in higher BG before insulin starts to work. If you Google dawn effect or phenomenon you should find lots of hits.

I find exercise late at night or eat a snack of high glycemic index carbs (couple of crackers) right before bedtime, it can be reduced some. My theory is that BG peaks up a bit after the snack, causing insulin to be released. This is followed by lower BG, and hopefully you wake up before they start to rise again. Another option to talk to your doctor about is increasing the metformin dose. 1000 mg per day is quite low, and most use 1500-2000 to get good BG control.

Exercise is complicated, especially in type 1's. In type 2's one issue is insulin resistance. When you exercise your muscles will likely ask for more glucose so they can work. The liver responds by dumping glucose. But, since most type 2's have resistance to insulin, the lowering effect of insulin is delayed, and in the mean time blood glucose goes up. I find the best time to exercise is right after eating. My BG is going to go up anyway and that is going to stimulate lots of insulin which will bring it back down. While that is going on you can get your exercise in without BG going any higher than it normally does, and when it comes back down it is likely to stay down longer. If you exercise in the AM I find it best to eat first (and as early as possible), then then immediately exercise.

Hope that helps some, and welcome to the forum!

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RobertIA replied on Wed, May 6 2009 5:21 PM

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suneeti,  Ron AKA has probably the best answer.   He did miss the point - you stated 2500mg and he wrote 1000mg of Metformin. 

Just realize that Doctors can be wrong even if they won't admit it.  You are wise to ask for confirmation and read this discussion board.  Be prepared to discuss this with your doctor further.  Ask the doctor if he has heard of the "Dawn Effect" or phenom.  Some people do not have this happen, but others do.  Just realize that in diabetes - what works for one person may not work for the next.  There are too many variables to be considered; such as stress, sleep apnea, foods consumed, daily habits, and many more.  Glycemic index of foods is a large variable as is the lows (hypoglycemia) and when they occur.  

Many of us have set our goals for the A1c results to be below 6.0 (between 4.5 and 6.0).  The 7.0 set by the ADA and the 6.5 set by the Endocrinology Group are just safety factors to reduce liability.  

Good luck, Bob

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Ron AKA replied on Wed, May 6 2009 8:19 PM

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RobertIA:

He did miss the point - you stated 2500mg and he wrote 1000mg of Metformin. 

Bob, yes I read it as 2 X 500 per day. It it is 2500, then that is essentially the max for metformin of 2550 (3 X 850). However, it does not do much to increase above 2000 in any case.

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Spirit replied on Thu, May 7 2009 9:18 AM

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Suneeti:  To find that a small snack before bedtime actually lowers your mroning number is not at all unusual.  My dietitian recommended that as part of my meal plan and I have found it effective.  Doctors often only focus on the broadest principles of diabetic management through diet.  It is the dietitian who looks at the details as well as the overall picture.  Ron gave a good explanation of why this happens.  So, trust your own meter and your observations.  And keep eating a bedtime snack!

About exercise, this can be a little hard to predict at times.  Timing of exercise and duration can be important factors here.  If you exercise too strenouosly when your bg was on its way down and you hit a low in the middle of the exercise you can experience an undetected low during exercise.  When a low happens your liver releases glucose to compensate and you can end up with a higher reading than you expect.  Try adjusting the time of exercise.  Start with about one hour after eating and play around with different times on either side of that line.  Try also to vary the intensity of the exercise.  I have found that several short periods of exercise spaced throughout the day after eating are far more effective for me than one longer, more intense period of exercise.  We are all a bit different, so keep testing to find what works best for you.

Spirit

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suneeti replied on Thu, May 7 2009 2:58 PM

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Thanks Ron. It makes perfect sense to me. BG is high at fasting because like you say, my body has released more glucose than I can handle (secretion of various hormones that they talk about on Mayo site) and again after exercise when too much glucose is released.

I am going to try eating a couple of crackers two hours before bedtime and exercise after breakfast.

Thanks again for helping.

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suneeti replied on Thu, May 7 2009 3:04 PM

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That's a very good suggestion, breaking total exercise in several short segments. I normally walk/do yoga for 1 hr. 15 minutes. So it is not very vigorous. But breaking it into 2 shorter periods won't hurt.

Thanks for you excellent suggestion.

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Spirit replied on Thu, May 7 2009 3:35 PM

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Suneeti:  A lot of getting it right in terms of diabetes management is testing things like foods and exercise and timing of both.  There is a certain period of trial and error in the beginning stages.  At first, you may go through quite a few test strips to find the right routine for you, but this diminishes greatly as you discover what works best for you. 

Spirit

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lebrecht replied on Thu, May 7 2009 6:42 PM

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Each person reacts differently so I suggest that you test and make adjustments for you alone. Yes, the numbers change as time goes on.  However the better you monitor and the more you exercise and eat right the better control you will have.

WE MUST BE our own doctors with this disease.  Listen to your own body and do what it tells you.  OH NO!   NO not when it tells you to eat that chocolate cake!

Anne

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Ron AKA replied on Fri, May 8 2009 12:34 AM

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suneeti:

I am going to try eating a couple of crackers two hours before bedtime

My experience is that you will get the best effect by eating it as late as possible -- i.e. right before bedtime.