Waking 'spike'

[velofan]

One other thing I've noted in the past three days is that I get a bit of a spike, or at least a rise, on waking - I understand that's perfectly normal. I've been taking my morning reading about half an hour after waking, which has consistently been 5.9-6 mmol/l, but if I'd done it on waking, it would have been below 5.5. So, which is the 'correct' fasting level? I appreciate it's only a small difference, but given that one boundary line is set at 5.5, I'm interested - and trying to learn! (Have already learned that potato in pretty much any form has a dire effect!).

 

[ajbod]

Due to the acceptable tolerances of Glucometers, all of those figures are essentially the same. Everybodys system kicks out glucose from the liver to get us going, until we can catch our food. The time this happens is unique to all of us. You may think it has risen since waking, when in fact it may have dropped slightly. you cannot get total accuracy, so have to work on trends. So if you always take your readings at half an hour after waking up, then that is the figure to use. Only a CGM would give the data to know more, but those still work to the same tolerances.

 

[KennyA]

One other thing I've noted in the past three days is that I get a bit of a spike, or at least a rise, on waking - I understand that's perfectly normal. I've been taking my morning reading about half an hour after waking, which has consistently been 5.9-6 mmol/l, but if I'd done it on waking, it would have been below 5.5. So, which is the 'correct' fasting level? I appreciate it's only a small difference, but given that one boundary line is set at 5.5, I'm interested - and trying to learn! (Have already learned that potato in pretty much any form has a dire effect!).

There's no "correct" fasting level. It is what it is. I know (only because I used a CGM for a couple of weeks) that my BGs have a cliff-edge drop from low to very low around 4am: then they start to rise, steadily. And they can go on rising for at least 10 hours, unless I eat something (four almonds will stop it). My experience is that fasting levels eventually slowly reduce but as they're largely controlled by your liver's decisions (rather than food intake) there's not very much you can do directly in the short term.

The idea is that you're comparing yourself with yourself, not a "standard" fasting bg level (which doesn't exist as a universal figure anyway). It's struck me recently that there isn't a great deal of understanding about what "normal" non-diabetic BG numbers and patterns look like: however as more people have a try at (particularly) using a CGM there's a bit more info and understanding around. Unfortunately it's unstructured and largely in posts on the internet where people are panicking because the graph shows the BG values rising and falling. This is normal, but seems to be unexpected.

 

[velofan]

Really informative, both, thank you very much. I totally get the rising and falling (wouldn't have thought otherwise!), but it's the amounts that I'm not sure about, both levels and increases. Following on from your comments KennyA about lack of understanding on 'normal' figures, does the same apply to other areas? I'm interested in particular as to what is normal and what isn't around post-prandial increases and levels, especially given the guidelines I've read that say there aren't any for non diabetics. So, for instance, I get a steep increase after eating porridge (up to 10.4 within 15 mins of eating), which fairly rapidly comes back down (back to 6.5 one hour after eating). Potato appears to do the same, whereas pulses don't. Normal or not? In principle, I would expect a rise and fall, and those figures suggest control, but should I be trying to minimis/reduce these spikes (there's a fair amount out there that says I should, but if they're normal...?). I have used porridge as my go to food on race mornings (I'm a keen orienteer, racing up to 70 mins), but am even keener to take my HbA1C back down to below prediabetic levels! Just trying to get my head around what these figures really mean (if anything).

 

[KennyA]

Really informative, both, thank you very much. Following on from your comments KennyA about lack of understanding on 'normal' figures, does the same apply to other areas? I'm interested in particular as to what is normal and what isn't around post-prandial increases and levels, especially given the guidelines I've read that say there aren't any for non diabetics. So, for instance, I get a steep increase after eating porridge (up to 10.4 within 15 mins of eating), which fairly rapidly comes under control (back to 6.5 one hour after eating). Potato appears to do the same, whereas pulses don't. Normal or not? Should I be trying to minimise these spikes (there's a fair amount out there that says I should, but if they're normal...?). I have used porridge as my go to food on race mornings (I'm a keen orienteer, racing up to 70 mins), but am even keener to take my HbA1C back down to below prediabetic levels! Just trying to get my head around what these figures really mean (if anything).

Im not surprised you get those sorts of effects with porridge and potato, both heavy carb items. It's a normal and expected rise. "Spikes" to me is not the right word to describe an expected and predictable rise after eating carb.

The testing before and at +2hrs is intended to show how well (or not) your system copes with whatever it is you eat. The accepted target is a difference of no more than +2 between first and second readings and the second reading should be 7.8 or less.

If your figures are coming back within that sort of range consistently, then it demonstrates that at present you are dealing with that level of carb. Of course it's putting a steady load on your insulin response and - as you're currently describing yourself as pre-diabetic - that might be contributing to you becoming more insulin resistant.

I probably went out of normal blood glucose range around 2010, maybe earlier. Nobody told me. I continued to eat a "healthy" diet high in carbs and including porridge, bread, rice, pasta, potato, fruit and beer. Never ate a lot of sweet things. It took about ten years to reach the "automatic diagnosis" level of +48, but along the way I'd acquired a number of nasty and painful diabetic symptoms.

So I guess it depends where your current HbA1c results are, and what they're doing long term. If you want to reduce them, then I'd recommend low-carbing. I went full keto (20g carb/day) and it worked very quickly for me. Given that you apprear to still have a reasonable insulin response (your post-meal readings would not be coming down so quickly after porridge and potato if you didn't) you may not need to make a huge change.

 

[velofan]

That's really helpful - particularly in helping with the overall picture. I describe myself as pre-diabetic as Ive had HbA1c levels at lower end for past 3-4 years (max 44) - due another test through GP next week. I did a fairly strict low carb initially, but not keto, which brought weight, HbA1c, blood pressure and cholesterol levels all down, and have since kept to a slightly less strict one since, which appears to keep things down. As I've got hold of a Libre2, I'm currently trying foods out to see how I react, with the aim of pushing harder to take below 42, whilst still enabling my sport (at which very competitive!). Normally don't touch potato for instance, but have used porridge as explained above. I think what this is starting to tell me is that insulin response is still ok, but need to ration these occasions carefully, and sustain low carb as norm. Am going to experiment with food combinations etc to see what works and doesn't for me. Thank you for your detailed (and very clear) response.

 

[Omar51]

One other thing I've noted in the past three days is that I get a bit of a spike, or at least a rise, on waking - I understand that's perfectly normal. I've been taking my morning reading about half an hour after waking, which has consistently been 5.9-6 mmol/l, but if I'd done it on waking, it would have been below 5.5. So, which is the 'correct' fasting level? I appreciate it's only a small difference, but given that one boundary line is set at 5.5, I'm interested - and trying to learn! (Have already learned that potato in pretty much any form has a dire effect!).

I will for sure go with the waking up test results!