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High blood glucose in the whole twelve am hours

P

PeterH55

Newbie
Messages
4
Hi all,

I'm a newbie and would like to get some help on an issue that appears to be broader than the dawn phenomenon/effect. I have been tested as being pre-diabetic (6.7 mmol/l) and so I invested in a Continuous Glucose Monitor (CGM) to help reduce my blood glucose levels. I eat mostly low carb, usually skip breakfast and practice intermittent fasting (occasionally 24+ hours) and so I used the CGM to examine the impact different foods had on me (eating out having supposedly low carb has the worst effect as do seed oils and artificial "keto friendly" sweeteners). Over the last 53 days I've reduced my estimated HbA1c from 6.5% to 5.5%. Excellent, I thought to myself. However, although my daily average blood glucose readings are less than 6.0 mol/l (mostly, less than 5.7 mol/l) from midnight through to midday, they are always high (high 6 mol/l and occasionally over 7.0 mol/l) and then in the pm hours until midnight the blood glucose readings are at the low end (4.0 mol/l to 5.0 mol/l). I've spoken to two GPs (I live in the country) and they think everything's OK so "just lose a bit of weight and do some more exercise and you'll be fine". I've read quite a bit about the dawn effect but my situation appears to be much broader than the 2.00 am to 8.00 am "normal" dawn effect.

Any ideas?

Thank you,

Peter
 
Welcome to the forums.
PeterH55 said:
I have been tested as being pre-diabetic (6.7 mmol/l) and so I invested in a Continuous Glucose Monitor (CGM) to help reduce my blood glucose levels. I
Click to expand...

Do you ever check your cgm readings against a conventional meter. They work better for some people than others and it could be that they are consistently over reading...

A regards those readings, they are still in normal range, though it may be that they'll come down further as your body gets moe used to the low carb and insulin resistance reduces. It may be that the drip feed of sugar from your liver to keep you going overnight is just a little too high???
 
EllieM said:
Welcome to the forums.


Do you ever check your cgm readings against a conventional meter. They work better for some people than others and it could be that they are consistently over reading...

A regards those readings, they are still in normal range, though it may be that they'll come down further as your body gets moe used to the low carb and insulin resistance reduces. It may be that the drip feed of sugar from your liver to keep you going overnight is just a little too high???
Click to expand...
EllieM said:
Welcome to the forums.


Do you ever check your cgm readings against a conventional meter. They work better for some people than others and it could be that they are consistently over reading...

A regards those readings, they are still in normal range, though it may be that they'll come down further as your body gets moe used to the low carb and insulin resistance reduces. It may be that the drip feed of sugar from your liver to keep you going overnight is just a little too high???
Click to expand...

Thanks EllenM,

Much appreciated and thanks for the welcome. I have checked my blood against a conventional meter once or twice so will check a bit more to observe any trend. I suspect what you've said is correct and I need to keep working to reduce my apparent insulin resistance and to wring out the glucose stored in my liver.

Thank you again,

Peter
 
I have the exact same issue. My morning reading is higher than my pre-bedtime one, and fasting BG is higher than my HbA1c would suggest. I've talked to my doctor about it a few times. First she was like "That's weird," and next time "Oh I've heard of that," but no explanations or solutions. I think it's more likely to be the Somogyi effect than DP as I just don't respond well to longer fasts and my BG is lowest between meals as the day progresses. Afternoons I'm in the 4s, mornings 6 or so. Crazy.
 
I saw better results on my current routine of eating every 12 hours, morning and evening, than eating at lunchtime and evening only.
I think that the years of low calorie diets and not eating for too long caused the result.
 
PeterH55 said:
Hi all,

I'm a newbie and would like to get some help on an issue that appears to be broader than the dawn phenomenon/effect. I have been tested as being pre-diabetic (6.7 mmol/l) and so I invested in a Continuous Glucose Monitor (CGM) to help reduce my blood glucose levels. I eat mostly low carb, usually skip breakfast and practice intermittent fasting (occasionally 24+ hours) and so I used the CGM to examine the impact different foods had on me (eating out having supposedly low carb has the worst effect as do seed oils and artificial "keto friendly" sweeteners). Over the last 53 days I've reduced my estimated HbA1c from 6.5% to 5.5%. Excellent, I thought to myself. However, although my daily average blood glucose readings are less than 6.0 mol/l (mostly, less than 5.7 mol/l) from midnight through to midday, they are always high (high 6 mol/l and occasionally over 7.0 mol/l) and then in the pm hours until midnight the blood glucose readings are at the low end (4.0 mol/l to 5.0 mol/l). I've spoken to two GPs (I live in the country) and they think everything's OK so "just lose a bit of weight and do some more exercise and you'll be fine". I've read quite a bit about the dawn effect but my situation appears to be much broader than the 2.00 am to 8.00 am "normal" dawn effect.

Any ideas?

Thank you,

Peter
Click to expand...

I have more or less the same issue.

From around midnight to midday my BG climbs steadily.
After midday my BG drops and is probably lowest in the evening.
It doesn't seem to be tied directly to what I eat although what I eat can change the levels within the pattern.

Have a search for Extended Dawn Phenomenon.

I suspect that it may be mainly due to the release of glucagon by the Alpha cells.
https://www.diabetes.co.uk/body/glucagon.html
Assuming this is so, and the glucagon release finished by noon, then insulin can then take your BG down again.
I know that I can cope far better with carbs after noon than before.
It is still not clear if this is due to changes in insulin sensitivity or to changes in glucagon production.

See also https://en.wikipedia.org/wiki/Glucagon.

So you are not alone but I still don't understand the fine detail, nor how to counteract it.
I was going to arrange a private consultation with an endocrinologist but then Covid intervened.
 
VioletFoxtrot said:
I have the exact same issue. My morning reading is higher than my pre-bedtime one, and fasting BG is higher than my HbA1c would suggest. I've talked to my doctor about it a few times. First she was like "That's weird," and next time "Oh I've heard of that," but no explanations or solutions. I think it's more likely to be the Somogyi effect than DP as I just don't respond well to longer fasts and my BG is lowest between meals as the day progresses. Afternoons I'm in the 4s, mornings 6 or so. Crazy.
Click to expand...

Thanks VioletFoxtrot,

It certainly is crazy. Glad I'm not the only one (sort of). I'm going to try some more extended fasts and see whether the effect is still apparent after a second night of fasting. Have read a bit on Somogyi and will look into it a bit more. It certainly doesn't seem the same as everything I've read on DP.

Thank you again,

Peter
 
Resurgam said:
I saw better results on my current routine of eating every 12 hours, morning and evening, than eating at lunchtime and evening only.
I think that the years of low calorie diets and not eating for too long caused the result.
Click to expand...

Thanks Resurgam,

Over the years I've seen a gradual increase in fasting blood glucose. However, none of my doctors have ever seen the "need" to measure HbA1c or insulin etc., so I don't really have the history to test. Like you, I went through years of low calorie eating and I suspect the damage will take some time to overcome.

Thank you
 
VioletFoxtrot said:
I have the exact same issue. My morning reading is higher than my pre-bedtime one, and fasting BG is higher than my HbA1c would suggest. I've talked to my doctor about it a few times. First she was like "That's weird," and next time "Oh I've heard of that," but no explanations or solutions. I think it's more likely to be the Somogyi effect than DP as I just don't respond well to longer fasts and my BG is lowest between meals as the day progresses. Afternoons I'm in the 4s, mornings 6 or so. Crazy.
Click to expand...

Thanks for introducing me to the Somogyi effect.
https://www.diabetes.co.uk/blood-glucose/somogyi-phenomenon.html
seems to indicate that it may be a feature of T1s who go too low overnight.

However I do see some similarities:
"Somogyi theorised that prolonged levels of untreated hypoglycemia could lead to stress (due to low blood sugar) and a high blood sugar levels rebound.

This is a defensive response by the body as it released endocrine hormone glucagon, backed up by the stress hormones cortisol and epinephrine.

This means an instant increase in blood glucose, and stress hormones cause insulin resistance for several hours, and this in turn leads to elevated blood sugar."

Confusingly, it says of Dawn Phenomenon:
"The Dawn Effect (or Dawn Phenomenon) is a morning rise in blood sugar which occurs as a response to waning levels of insulin and a surge in growth hormones."
Which may (or may not) be the same as the standard explanation that your body gives you a shot of glucose when you wake to give you energy to start the day.
I can certainly see a pronounced spike in BG just before I wake.
I see this on my Freestyle Libre when I scan directly after waking.
I also see it when I scan straight after waking for a wee in the middle of the night.

Looking at one specific phrase:
"This means an instant increase in blood glucose, and stress hormones cause insulin resistance for several hours, and this in turn leads to elevated blood sugar."
this looks as though it could explain the prolonged rise from 06:00 to 12:00.

All very confusing.
 
PeterH55 said:
Thanks Resurgam,

Over the years I've seen a gradual increase in fasting blood glucose. However, none of my doctors have ever seen the "need" to measure HbA1c or insulin etc., so I don't really have the history to test. Like you, I went through years of low calorie eating and I suspect the damage will take some time to overcome.

Thank you
Click to expand...
I am still waiting to see my Hba1c match my blood glucose levels - in theory the Hba1c should be in the 30s to match up - but there is no direct correlation, it was matched up simply by comparing the two numbers when testing individuals. I suspect that it was drawn up using people who had not been so badly hammered by dieting under medical supervision.
 
PeterH55 said:
Thanks VioletFoxtrot,

It certainly is crazy. Glad I'm not the only one (sort of). I'm going to try some more extended fasts and see whether the effect is still apparent after a second night of fasting. Have read a bit on Somogyi and will look into it a bit more. It certainly doesn't seem the same as everything I've read on DP.

Thank you again,

Peter
Click to expand...
same!!! just posted in intro! i wake at say 80mg. i make coffee and brfore i drink it spikes to 170-200! then up it goes. i have swapped to splitting my basal (30uAM30uPm) i use 10 (yes 10) rapid insulin. and am STILL lingering at 200 until 2ish pm. THEN i start to bottom out for hours. this is 6 hours after insulin. crazy. im forcing food in am. 0 carb like bacon and eggs.

so annoying to be doing it all right and still have 8A1C!
 
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