Blood sugar... Should I be concerned?

[Cecropia]

For a long time, I'd been meaning to pick up a meter and monitor my blood sugar.  In my last two pregnancies, I failed my initial glucose screenings but passed the 3 hour ones.  For my last 3 hour test, I crashed at the end down into the 40's. I knew then that I probably had some metabolic issues, but I just let it go.

I just haven't felt right in forever, and a lot of sugar/carbs made me feel worse.  I cleaned up my diet about 3 years ago, going low carb (these days net 40 or less), trying to get in X cups of vegetables a day, etc.  It helped with some of my health issues.  Most of my daily carbs would come from 1/2 cup of white rice at my main meal, which is the grain my gut can tolerate the best.  I have been intermittent fasting, too, which also helps with digestion... but I'm flirting with being underweight, so I have to be careful to get enough calories in.

About a month ago, I finally started checking my glucose.  I was surprised to see fasting numbers consistently over 100 -- for a week!  I cut out the rice, replacing it with oatmeal or wheat, and my fasting numbers dropped a little, but they are almost always in the mid-90's.  Only once have I seen a number below 90.  It wouldn't take much to push me into the prediabetes numbers.  I've never seen a post-meal number reach 130.  However, I bought an at-home A1C test kit and my result is 5.2.  I feel good about that result, but I am afraid that my fasting numbers still indicate that something is up with my metabolism -- or that they may be just high enough to label me prediabetic when my doctor does my universal screening in a couple of years (even if I'm really not).

I'm a little stuck in thinking of ways to improve my numbers.  I have my digestive issues, which don't handle higher fiber grains/starches well at all (lower glycemic generally means higher fiber).  But I feel I need that serving of grain/starch at dinner to help keep my weight stable.  I've tried going back to three meals a day to help with eating enough, but that takes me a step backward in my digestive progress.  I'm doing it anyway to gain a few more pounds, so that I have a cushion to remove the high glycemic foods completely and see if my fasting numbers are better.  I can exercise more, to be sure, and I'm trying to do that.  Of course, that means working in more calories, somehow!  I don't want to overreact, but I also don't want to ignore early warning signs.  My immediate family includes Type II.  What do you think?

Edited October 22, 2021 by Cecropia
Typed a wrong number!

[Katy]

Try cutting your saturated fat to nothing and see if that helps or makes it worse. 

The only thing I’ve heard that stops raising numbers in the morning long term is fasting. 

[Tanaqui]

You obviously are concerned, so you should probably just suck it up and make a special appointment with your doctor to discuss it, and to perhaps get a referral to a dietician.

[Dmmetler]

Try checking a bit later. Some people get a dawn effect where they get a big dump of blood sugar right when waking up, so fasting numbers look really high, but level out fairly soon. If your  fasting numbers are higher than your after breakfast ones, that’s a really good sign that your fasting numbers would be a lot lower if you take them a little later. 

[Cecropia]

30 minutes ago, Dmmetler said:

Try checking a bit later. Some people get a dawn effect where they get a big dump of blood sugar right when waking up, so fasting numbers look really high, but level out fairly soon. If your  fasting numbers are higher than your after breakfast ones, that’s a really good sign that your fasting numbers would be a lot lower if you take them a little later. 

Would it be dawn effect if I have been up for 3+ hours (testing around noon or 1:00)?  I usually test right before my first meal.

[freesia]

I wouldn't be too concerned.  I would cut down on carbs and just monitor my fasting glucose. Your A1C is good and you easily got into the 90s.

[Dmmetler]

5 minutes ago, Cecropia said:

Would it be dawn effect if I have been up for 3+ hours (testing around noon or 1:00)?  I usually test right before my first meal.

Probably not. It usually is a dump between about 2:00 AM and 8:00 AM, and burns off after that. I’ve learned that when I need to do blood sugar testing for my insurance biometric screen, I need to set the appointment At about 9:30-10:00 so my fasting sugars have dropped, because if they take it before about 9:00, it will be high, but after that, it will be normal-no clue why they use fasting blood sugar and not A1C….

[melmichigan]

5 hours ago, Cecropia said:

  I've never seen a post-meal number reach 120. 

What are your post-meal numbers?

 

[Cecropia]

5 hours ago, melmichigan said:

What are your post-meal numbers?

Oops, I should have written "I've never seen a post-meal number reach 130."  Going to fix that.  Usually my glucose will be about 115 one hour after I started eating, peaking at 2 hours where it gets into the 120's before slowly decreasing.  The highest reading I've ever gotten is 128, I think?  I'm eating high fat/moderate protein/low carb meals, which slow digestion and delay the peak a bit.

Honestly, when I consider tweaking my macronutrients, it's so confusing because I read that too much fat or too much protein can increase insulin sensitivity, and of course those nefarious carbs... all the macros are suspicious!

[Jean in Newcastle]

I do not know a single doctor who would think that your numbers were bad or needed any tweaking.  Fasting numbers really don't mean all that much.  Your numbers two hours after eating are fine. 

 

 

[BeachGal]

Blood glucose does not provide enough information about what is happening metabolically. High blood glucose is more the secondary effect. When blood glucose can't get into your cells, it circulates and acts like shards of glass and that causes a lot of damage. What would be better to check out is your fasting insulin which can be too high for decades before you start seeing higher blood glucose numbers. Both excess insulin and blood glucose damage your body. Blood glucose is just easier to measure than insulin.

At this point you could read Benjamin Bikman's book Why We Get Sick which explains how excess insulin causes health problems and what you can do to optimize your levels. This is Bikman's area of expertise; he's not some "woo" researcher. He also has a YouTube channel.

Another test you might want to consider is the Omega-3 Index which is an easy finger prick test you can do at home. The $100 test would give you more information but the $50 would be fine, too.

https://omegaquant.com/shop/

 

Edited October 22, 2021 by BeachGal

[kokotg]

my fasting numbers are always high (at home I get in the high 80s/low 90s usually, but it's generally a little higher when I get blood work done for whatever reason); my NP says not to worry about it because my A1C is fine. (I tended to fail the 1 hour/pass the 3 hour when pregnant, too, and I have a strong family history of diabetes, so I watch it pretty closely). 

[melmichigan]

I agree with @Jean in NewcastleI don't know of a doctor that would be worried about your numbers.  I wouldn't change anything and I'm extremely careful with my numbers.

Edited October 22, 2021 by melmichigan

[BeachGal]

Type 2 diabetes starts with insulin. By the time fasting blood glucose rises, the excess insulin has been damaging the body for years. Failing glucose screenings, crashing, not feeling right after eating a lot of sugar/carbs points to a possible insulin problem. It does not take much to become insulin resistant. At the very least, testing insulin could provide useful information and this is rarely tested by MDs.

 

https://labs.selfdecode.com/blog/fasting-insulin-test/

Insulin levels are usually out of order long before there are abnormalities in blood sugar levels. That’s why a blood sugar test might come back completely normal even if you are suffering from insulin resistance.

 

https://www.dietdoctor.com/can-normal-blood-sugar-still-insulin-resistant -- Jason Fung who is now advising eating a high protein diet for some:

Can one have normal HbA1c and be insulin resistant?

Yes. There are many different manifestations of insulin resistance, only one of which is elevated HbA1c. I prefer to call these manifestations of ‘hyperinsulinemia’ instead of insulin resistance. Hyperinsulinemia causes all of the facets of the metabolic syndrome including high blood pressure, high triglycerides and low HDL, increased abdominal obesity and high blood glucose (which can be measured by elevated A1C). Sometimes hyperinsulinemia is manifested by abdominal obesity and other time, elevated blood glucose (type 2 diabetes), but the overall problem is the same. 

By calling it hyperinsulinemia rather than insulin resistance, the solution becomes obvious. If the problem is too much insulin, then lower it. How? LCHF diets and intermittent fasting.

[Carol in Cal.]

That doesn’t sound too bad, but I would suggest considering taking a short walk every time you eat carbs—by short I mean 10 minutes.  That tends to open up your insulin receptors and prevent blood sugar peaks.  If you’re headed down the path toward insulin resistance, it’s a good preventative.  It doesn’t address your fasting BS problem per se, but it does effect the overall system quite a bit.  My source is “Reversing Diabetes” by Julian Whitaker.

[BeachGal]

Besides post-pandrial exercise, any thing that helps build muscle will help especially as we age.

Eating starchy carbs, such as rice, at the end of the meal prevents spikes, also.

Optimizing sleep and paying attention to Circadian rhythms.

Changes don't have to be big or complicated; small changes make a big difference over time.

 

ETA A recent study estimates that about 85% of American adults are insulin resistant. It's not uncommon.

Edited October 24, 2021 by BeachGal
added information