Morning tests

[toddy35]

Dear all
Apologies I'm sure this will have been covered elsewhere but I'm struggling to find it. Regarding daily BS tests. Other than my first day (and today) I've been avoiding taking readings first thing in the morning. This was really to save lancets/strips because I didn't have many initially. I've now ordered more.
Can someone explain the importance/significance of the early morning/pre-eating test?
I understand the relevance of pre and post eating but what's the significance of the first test of the day? My reading first thing today was 6.3.
One more thing, I'm focused on losing weight and keeping the readings in the normal range. To do this I'm restricting calories to circa 800 a day with 20g a day carb limit (initially I had a few days at 30g). Does that sound an ok approach?
Also at what point do I 'try/test' risky foods eg beans or lentils?

Sorry for asking so much but other than a brief call from the diabetes practice nurse, this is all the support I have.
Many thanks

 

[Daibell]

Hi. Early morning tests can be unreliable due to the overnight liver-dump of glucose so better to focus on pre and post meal testing during the day. Your diet approach sounds good but be aware that you don't really need to think about calories at all. Having the 20/30gm of carbs is really good and will keep BS and weight gain to a minimum. Make up with fats and proteins so you feeling full.

 

[Resurgam]

Early morning testing is purely academic - I have never done it as I can't do anything much to alter it, so I stuck to post meals.
I did not need to restrict calories to lower weight, it happened accidentally anyway.
After decades of being put on low calorie diets if I don't eat for a while my blood glucose goes up and then crashes down, I feel faint, go deathly grey and can become incoherent. These days I eat when I get up and then again in the evening.
Although I am now officially in remission, beans and peas are only ever eaten in small portions and not often because I know I can't cope with the carbs from them, which seem to affect me more than those from other types of lowish carb foods.

 

[ziggy_w]

Hi @toddy35,

Like often, there are two sides to the coin. So, this is my view:

On the one hand, many consider taking a morning reading unhelpful because a) it is often influenced by liver dump and b) they feel that they can't do much to influence it.

On the other hand, tracking fasting levels in the morning might be informative because a) it is part of the diagnostic criteria for T2, b) it helps you monitor progress in improving liver function (as fatty liver in T2 is associated with insulin resistance, which makes insulin less effective in counteracting the liver dump) and c) for me personally, fasting levels tend to influence all other levels throughout the day (i.e. if I wake up higher, I tend to see higher readings throughout the day, no matter what I do.)

So, there are pros and cons to this and the decision whether to test or not pretty much depends on what you want to get out of this.

By the way, personally for the first half year after diagnosis my fasting levels were high (and definitely at diabetic levels although HbA1c was already in the normal range). However, they started coming down as insulin resistance improved. So, taking fasting levels in the beginning can be frustrating and it might possibly be helpful to postpone testing until you feel comfortable with this.

 

[toddy35]

Hi @toddy35,

Like often, there are two sides to the coin. So, this is my view:

On the one hand, many consider taking a morning reading unhelpful because a) it is often influenced by liver dump and b) they feel that they can't do much to influence it.

On the other hand, tracking fasting levels in the morning might be informative because a) it is part of the diagnostic criteria for T2, b) it helps you monitor progress in improving liver function (as fatty liver in T2 is associated with insulin resistance, which makes insulin less effective in counteracting the liver dump) and c) for me personally, fasting levels tend to influence all other levels throughout the day (i.e. if I wake up higher, I tend to see higher readings throughout the day, no matter what I do.)

So, there are pros and cons to this and the decision whether to test or not pretty much depends on what you want to get out of this.

By the way, personally for the first half year after diagnosis my fasting levels were high (and definitely at diabetic levels although HbA1c was already in the normal range). However, they started coming down as insulin resistance improved. So, taking fasting levels in the beginning can be frustrating and it might possibly be helpful to postpone testing until you feel comfortable with this.

Thanks Ziggy that was really helpful. You say above that the morning test helps to monitor improving liver condition. Is there a correlation between your test result and liver health? Please understand I'm not challenging I know literally nothing about this so I might be asking utterly stupid questions. Thanks for sharing your experience too, my morning levels don't seem that high - between 6 -7. I've no idea what a normal figure would be to check this again.

 

[ziggy_w]

Hi @toddy35,

Not sure, I am very good at explaining the way I understand the relationship between insulin resistance, fatty liver and high fasting levels, but I will give it a try.

Insulin resistance can affect several organs, including the muscles, the pancreas and the liver, all of which can become insulin resistant. The reason that the liver becomes insulin resistant (according to the thinking of the likes of Jason Fung and also Roy Taylor) is because fat (triglycerides converted from excess glucose) is stored in the liver instead of fat tissue (because there is no more storage capacity i.e. the number of fat cells that we developed in childhood are full). Others (like Robert Lustig) argue it is primarily fructose, which can only be processed by the liver, that is primarily responsible for this. When the liver becomes fatty and insulin resistant, it will continue releasing glucose even when glucose levels are already high und there is lots of insulin in circulation. (In non-diabetics, circulating insulin will stop glucose production in the liver.) Some would even go as far as saying that the failure of the liver to stop releasing glucose in the presence of insulin is the primary defect in T2D. Here is a link to an article about this https://www.cmghjournal.org/article/S2352-345X(18)30162-0/fulltext.

So, when due to the dawn phenomenon (which also people with normal glucose metabolism experience), blood sugar levels rise, the body will release insulin. In insulin-sensitive people, this will stop the release of glucose from the liver and thus stop the rise in blood sugar levels. However, as described above in insulin-resistant individuals this doesn't happen. Thus, in my mind, the gradual decrease in fasting levels points to increasing insulin sensitivity, especially of the liver, probably due to a defattening of the liver. Personally, I have also seen a decrease in GGT from 37 (high end of normal) to 16 (truly normal) as fasting blood sugars approached normal non-diabetic levels.

Hope this explanation helps, even though I am afraid that there are many who could do a much better job with this.

 

[toddy35]

Hi @toddy35,

Not sure, I am very good at explaining the way I understand the relationship between insulin resistance, fatty liver and high fasting levels, but I will give it a try.

Insulin resistance can affect several organs, including the muscles, the pancreas and the liver, all of which can become insulin resistant. The reason that the liver becomes insulin resistant (according to the thinking of the likes of Jason Fung and also Roy Taylor) is because fat (triglycerides converted from excess glucose) is stored in the liver instead of fat tissue (because there is no more storage capacity i.e. the number of fat cells that we developed in childhood are full). Others (like Robert Lustig) argue it is primarily fructose, which can only be processed by the liver, that is primarily responsible for this. When the liver becomes fatty and insulin resistant, it will continue releasing glucose even when glucose levels are already high und there is lots of insulin in circulation. (In non-diabetics, circulating insulin will stop glucose production in the liver.) Some would even go as far as saying that the failure of the liver to stop releasing glucose in the presence of insulin is the primary defect in T2D. Here is a link to an article about this https://www.cmghjournal.org/article/S2352-345X(18)30162-0/fulltext.

So, when due to the dawn phenomenon (which also people with normal glucose metabolism experience), blood sugar levels rise, the body will release insulin. In insulin-sensitive people, this will stop the release of glucose from the liver and thus stop the rise in blood sugar levels. However, as described above in insulin-resistant individuals this doesn't happen. Thus, in my mind, the gradual decrease in fasting levels points to increasing insulin sensitivity, especially of the liver, probably due to a defattening of the liver. Personally, I have also seen a decrease in GGT from 37 (high end of normal) to 16 (truly normal) as fasting blood sugars approached normal non-diabetic levels.

Hope this explanation helps, even though I am afraid that there are many who could do a much better job with this.

Thanks so much Ziggy, it was kind of you to take the time to explain. It was really helpful. I feel there's so much I need to know and carry about this condition. Sometimes finding it overwhelming but your explanation was helpful.

 

[ziggy_w]

Thanks so much Ziggy, it was kind of you to take the time to explain. It was really helpful. I feel there's so much I need to know and carry about this condition. Sometimes finding it overwhelming but your explanation was helpful.

Hi @toddy35,

Thanks so much for the thumps up on this.

I agree it is a very steep learning curve and it generally takes many years to get to grasp with our condition and glucose metabolism. So, definitely see how it can easily feel overwhelming. In the beginning, there was also only so much I could read or learn without feeling like you.

 

[MrsA2]

@toddy35
Although the instruction say to use a new lancet every time, many find this unnecessary as they are only being used for one person and not by medics. Personally I change mine every month and have never had any problem with doing that. I think I could even stretch the use longer

 

[MrsA2]

Hi Again @toddy35
I'm only about 4 months ahead of you but what I wish I had known....loads!
re testing its your choice
a)You (unless bg levels are already through the roof) can just eat as you did before diagnosis for a couple of weeks but testing , that will show you how you do react to carbs and give you a baseline
b)Or you can go cold turkey straight into very low carb and/or keto then once levels are down, start reintroducing carbs to see effect
c)Or you can take any approach anywhere along the path between these 2. I've ended up on this third path.
I wish I knew what carbs were doing to me, but I had gone onto FAST 800 for 2 months and lost a stone before diagnosis so my last carb eating as a norm was before Christmas.
Since diagnosis I have been mainly low carb with exceptions like when neighbour baked biscuits and for my birthday and for VE celebrations. so I now know a few of the things that may spike me, and am learning daily. There are a lot of variables in this whole malarkey and it does still daunt me at times. But then i have to remind myself that because of my monitor and my testing I now know what I can eat safely and once my levels are even lower I will start trying a few more carbs just to see.,
Although the amount of testing seems a lot it will decrease over time. I am currently trying 2 meals a day 2MAD which uses only 5 strips maximum, waking, and before and after lunch and dinner. If I am eating a meal I now know doesn't affect me (eg a lunch of salad cheese eggs or nuts), then I don't test so my average is only about 3-4 tests a day. Early days I was testing 7 or more times. I do test if I am trying something I haven't tested before, or if I feel i may have had too much of something

Hope this helps, please dont thnk you have to do it all at once. There is far too much to learn and try
KR

 

[toddy35]

Hi Again @toddy35
I'm only about 4 months ahead of you but what I wish I had known....loads!
re testing its your choice
a)You (unless bg levels are already through the roof) can just eat as you did before diagnosis for a couple of weeks but testing , that will show you how you do react to carbs and give you a baseline
b)Or you can go cold turkey straight into very low carb and/or keto then once levels are down, start reintroducing carbs to see effect
c)Or you can take any approach anywhere along the path between these 2. I've ended up on this third path.
I wish I knew what carbs were doing to me, but I had gone onto FAST 800 for 2 months and lost a stone before diagnosis so my last carb eating as a norm was before Christmas.
Since diagnosis I have been mainly low carb with exceptions like when neighbour baked biscuits and for my birthday and for VE celebrations. so I now know a few of the things that may spike me, and am learning daily. There are a lot of variables in this whole malarkey and it does still daunt me at times. But then i have to remind myself that because of my monitor and my testing I now know what I can eat safely and once my levels are even lower I will start trying a few more carbs just to see.,
Although the amount of testing seems a lot it will decrease over time. I am currently trying 2 meals a day 2MAD which uses only 5 strips maximum, waking, and before and after lunch and dinner. If I am eating a meal I now know doesn't affect me (eg a lunch of salad cheese eggs or nuts), then I don't test so my average is only about 3-4 tests a day. Early days I was testing 7 or more times. I do test if I am trying something I haven't tested before, or if I feel i may have had too much of something

Hope this helps, please dont thnk you have to do it all at once. There is far too much to learn and try
KR

Thanks so much Mrs A2 for the note above. It's really helpful to hear others' experience of their early days post diagnosis. I've taken Option B. Straight into low carb which I'd done in the past, before diabetes but not so strict as to 20g a day. I am determined to show the GP I can tackle this and hopefully over the long term reverse it. I've lost a stone since the beginning of June, probably all water but is great but now I seem to have stalled. Fingers crossed it's not for long.
All my readings since I started have been in the 'green/normal' range and I'm keen to keep it that way. Long term I expect I'll have to avoid bread/pasta/cakes but so I am longing to put butter on scone or a slice of toast. But I won't try , at least until I've three months of stable low carb behind me.
Please keep in touch, I'm alone in all this and in lockdown.

 

[OrsonKartt]

Hi. I still take morning readings and I'm about 4 years in..... it gives me an indication of how I am ... on diagnosis I tested many times per day. Before and after meals to cut out spikes morning to see how the day was and before turning in before and after activity ... It was a way of me getting to know me and the way my body responded to the things life threw at it. I've found it very useful. Initially I did a low cal diet ( the newcastle diet) although I'm slim I'd read that to get fat from the Liver and pancreas it was effective. Well it worked but it was brutal. After 8 weeks of 800 caleries per day I settled into low carb . I've gradually reduced these to less than 20 grams per day . For me the slowly slowly approach has worked well enough to get my A1c down to pre diabetic levels . My morning levels fluctuate now between 5 and 7 and like a previous poster a higher level seems to set the mood for the day. My thinking is I'd rather trust the science than trust anything ANYONE says.

 

[toddy35]

Hi. I still take morning readings and I'm about 4 years in..... it gives me an indication of how I am ... on diagnosis I tested many times per day. Before and after meals to cut out spikes morning to see how the day was and before turning in before and after activity ... It was a way of me getting to know me and the way my body responded to the things life threw at it. I've found it very useful. Initially I did a low cal diet ( the newcastle diet) although I'm slim I'd read that to get fat from the Liver and pancreas it was effective. Well it worked but it was brutal. After 8 weeks of 800 caleries per day I settled into low carb . I've gradually reduced these to less than 20 grams per day . For me the slowly slowly approach has worked well enough to get my A1c down to pre diabetic levels . My morning levels fluctuate now between 5 and 7 and like a previous poster a higher level seems to set the mood for the day. My thinking is I'd rather trust the science than trust anything ANYONE says.

Thanks so much for posting Orson, glad to know the Newcastle thing worked for you. I'm also sticking to 800cals 20gcarbs a day but not using shakes or meal replacements. I did the Lighterlife diet a few years ago and while it worked, it was brutal. I tried it again and found I literally could not stomach the shakes/meal replacements. I'm keen not to put my body through that again.

 

[MrsA2]

@toddy35
Theres plenty of things you can put butter on. I found a cauliflower cheese bread recipe that thinks it's a scone, cabbage soaks up a lot and I've even read on here of people putting butter on cheese.
I think it will be too strict to go low carb and 800 cals, that is near starvation and your metabolism may well slow down to compensate.
Try getting a copy of Dr Jason Fung's book The diabetes code. Lots of long words but it made sense to me
And I was diagnosed on the day of lockdown. I know what you are going through

 

[toddy35]

Thanks for the tips about the cauliflower cheese bread (?!*?) I'll google it. Don't worry about the 800cals a day - I've done it before for three months and lost four stone. It's more or less Michael Moseley's Fast 800 but with a few less beans. Having said that I just had a bowl of chilli with beans for dinner. Two hours later my BS had only risen from 4.5 to 4.8. I'm delighted I wasn't sure I could have any beans at all. Fingers crossed it stays like this.
I have Jason Fung's book on the iPad and have just started it.

 

[Tophat1900]

Thanks for the tips about the cauliflower cheese bread (?!*?) I'll google it. Don't worry about the 800cals a day - I've done it before for three months and lost four stone. It's more or less Michael Moseley's Fast 800 but with a few less beans. Having said that I just had a bowl of chilli with beans for dinner. Two hours later my BS had only risen from 4.5 to 4.8. I'm delighted I wasn't sure I could have any beans at all. Fingers crossed it stays like this.
I have Jason Fung's book on the iPad and have just started it.

I would focus more on what Fung says then Mosley if it were me, Fung is just a better resource.

www.dietdoctor.com is a great resource for info and diet also. It sure beats starving yourself on 800 cals a day. It's the carbs that matter, not the calories.

Below is a red link to good info on diet. And good luck on your journey!

 

[ianf0ster]

Hi Toddy35
Rather than say whether I think that that a Fasting BG test is worth doing , I think it's best to focus on what is effectively being tested and how long it is likely to take in order to see results. Then you can make an informed decision!

As has ben mentioned, a fasting BG test is mainly testing the dump of glucose that your liver gives you in order for you to go out caveman/woman style and hunt/gather your breakfast. Most non-diabetics also get a noticeable glucose dump in the morning, but because they are no Insulin Resistant it is soon flattened out.
For us Diabetics, it tends to stay and forms a baseline from which our meals (especially if containing Carbs) raise it higher.

A Low Carb way of eating can immediately control the glucose spikes due to meals can quickly reduce our average BG levels and in most cases it can also help us lose weight without any calorie restriction - in my case I was consuming more calories in the for m of cheese and still losing 1 to 2lbs per week every week. But it only has a slow effect on our 'Dawn Phenomenon' morning glucose dump, so that a single reading is meaningless and you need a lot of them in order to see if they are trending down. Some have reported not seeing a noticeable difference for 2 yrs or more.

So you must ask yourself: 'After I know what my breakfast meal does to my Blood Glucose well that I don't need to test after it, do I still find it useful to measure my fasting BG every day?'

 

[toddy35]

Hi Toddy35
Rather than say whether I think that that a Fasting BG test is worth doing , I think it's best to focus on what is effectively being tested and how long it is likely to take in order to see results. Then you can make an informed decision!

As has ben mentioned, a fasting BG test is mainly testing the dump of glucose that your liver gives you in order for you to go out caveman/woman style and hunt/gather your breakfast. Most non-diabetics also get a noticeable glucose dump in the morning, but because they are no Insulin Resistant it is soon flattened out.
For us Diabetics, it tends to stay and forms a baseline from which our meals (especially if containing Carbs) raise it higher.

A Low Carb way of eating can immediately control the glucose spikes due to meals can quickly reduce our average BG levels and in most cases it can also help us lose weight without any calorie restriction - in my case I was consuming more calories in the for m of cheese and still losing 1 to 2lbs per week every week. But it only has a slow effect on our 'Dawn Phenomenon' morning glucose dump, so that a single reading is meaningless and you need a lot of them in order to see if they are trending down. Some have reported not seeing a noticeable difference for 2 yrs or more.

So you must ask yourself: 'After I know what my breakfast meal does to my Blood Glucose well that I don't need to test after it, do I still find it useful to measure my fasting BG every day?'

Thanks Ian, now I have sufficient strips etc I am recording morning readings and thanks to your post I understand it may be some time before notice a sustainable difference. For now I'm focused on losing weight and maintaining normal scores each day but I'm not having breakfast as I'm sticking to the 16:8 fast. I'm hoping that by tackling these things early on it will make a difference to my 3month HbA1c score and convince the GP I don't need medication.
I confess I also hope to get into a new way of eating before I have to go back to the workplace and certainly before the winter months. Cheers

 

[Robbity]

I still take the occasional fasting test as (a) it's a pre meal check if I'm eating breakfast, and (b) since it generally tends to be my highest level, it's useful when I'm checking my overall average levels.