Pre-diabetes: higher glucose in the morning than 2 hours after lunch.

[sgiossi]

Hello,
I am now 43. I've had some cholesterol for years (family issue) and was advised to change my lifestyle. I also have fatty liver. All blood tests for liver functions have always been fine. Cholesterol has never been very high so I was advised to keep it under control with diet and exercise. I started losing weight through exercise and diet in July ( 10 kg already) as I had put on weight because of the lockdowns. In September, because I had been suffering from some itching, the GP asked me to take various blood tests, including those for glucose. The HbA1c result was 41 mmol/mol, while glucose (fasting) was 4.9. The GP said that my HbA1c values were close to pre-diabetes. I had a new blood test back in January, and the result for glucose (fasting) was 5.7.

To be honest, I don't understand why this problem started. I never had any problem with glucose before. I associated it to taking Tamsulosin (apparently, it might increase glucose in the blood) so in agreement with my urologist I stopped taking it as I don't have a very serious condition. I decided to modify my diet again, eating food with more fibre and reducing sugar intake. However, when I check my glucose in the morning with Accu-check instant, the value is usually between 5.2 and 6.0. Once it was even 6.2/6.4. I also keep checking glucose two hours after the meal, in particular in the evening. It's usually between 5.5 and 6.1. Despite food intake, the values during fasting and after 2 hours are very close.

I don't really get it. I am not entirely sure why I have this problem with glucose right now despite improving diet and doing significant exercise. I walk with moderate intensity at least 80 minutes a day. I am not sure if I should worry or not. My parents and other close family members don't have diabetes. Could this be related to some serious issue with my pancreas?
What's going on?

 

[plantae]

For higher readings in the mornings, there's a thing called the "dawn phenomenon". Google that and it may provide some answers. I do know that, for me, the same amount of carbs I consume at breakfast cause a higher BSL peak compared to the same amount of carbs at lunch (even if it's the same food!) But that might be a side effect of my insulin, which I know you're not on so possibly not relevant.

My DN wants my night time readings to roughly match my waking/fasting BSL readings. Have you asked if this is something you should aim for, and if 5.5 at night and 5.2 in the morning are roughly the same or if those numbers are a concern?

 

[plantae]

What makes you suspect pancreatic issues? Have you had any pain? There are tests and scans your GP (ok, the GP can't do scans but they can order them) can do to rule out pancreas issues

 

[sgiossi]

For higher readings in the mornings, there's a thing called the "dawn phenomenon". Google that and it may provide some answers. I do know that, for me, the same amount of carbs I consume at breakfast cause a higher BSL peak compared to the same amount of carbs at lunch (even if it's the same food!) But that might be a side effect of my insulin, which I know you're not on so possibly not relevant.

My DN wants my night time readings to roughly match my waking/fasting BSL readings. Have you asked if this is something you should aim for, and if 5.5 at night and 5.2 in the morning are roughly the same or if those numbers are a concern?

Thank you for your reply.
I knew about the dawn phenomenon but my understanding was that this is about peaks in the morning, not about sugar being higher than during the glucose peak two hours after lunch.
Even when I eat a lot, I never really reach the level of glucose that would make me diabetic.
That's why I was wondering why only my morning readings are in the pre-diabetes area.
The GP has only suggested improving my diet, losing some weight and doing more exercise, which I do. However, this doesn't seem to affect my glucose readings.

 

[sgiossi]

Thank you for your reply.
I knew what the dawn phenomeno was. H

What makes you suspect pancreatic issues? Have you had any pain? There are tests and scans your GP (ok, the GP can't do scans but they can order them) can do to rule out pancreas issues

It's because of this problem came up in just a few months.
Glucose readings had always been fine. I started doing exercise and losing weights at least 6/8 months ago because I wanted to reduce my cholesterol and fatty liver.

 

[KennyA]

Hello,
I am now 43. I've had some cholesterol for years (family issue) and was advised to change my lifestyle. I also have fatty liver. All blood tests for liver functions have always been fine. Cholesterol has never been very high so I was advised to keep it under control with diet and exercise. I started losing weight through exercise and diet in July ( 10 kg already) as I had put on weight because of the lockdowns. In September, because I had been suffering from some itching, the GP asked me to take various blood tests, including those for glucose. The HbA1c result was 41 mmol/mol, while glucose (fasting) was 4.9. The GP said that my HbA1c values were close to pre-diabetes. I had a new blood test back in January, and the result for glucose (fasting) was 5.7.

To be honest, I don't understand why this problem started. I never had any problem with glucose before. I associated it to taking Tamsulosin (apparently, it might increase glucose in the blood) so in agreement with my urologist I stopped taking it as I don't have a very serious condition. I decided to modify my diet again, eating food with more fibre and reducing sugar intake. However, when I check my glucose in the morning with Accu-check instant, the value is usually between 5.2 and 6.0. Once it was even 6.2/6.4. I also keep checking glucose two hours after the meal, in particular in the evening. It's usually between 5.5 and 6.1. Despite food intake, the values during fasting and after 2 hours are very close.

I don't really get it. I am not entirely sure why I have this problem with glucose right now despite improving diet and doing significant exercise. I walk with moderate intensity at least 80 minutes a day. I am not sure if I should worry or not. My parents and other close family members don't have diabetes. Could this be related to some serious issue with my pancreas?
What's going on?

Your result values - all those you've quoted - are normal. By definition, anyone at the top end of normal will be "close to pre-diabetes". Most "non-diabetic" people have A1c scores that fall somewhere between 38 and 42.

However the trend here is probably important, rather than just the single reading. If your A1c results have been steadily rising that might indicate an issue. Do you know if that is the case?

6.2/6.4 mmol/l in the morning is really neither unusual nor high. One thing to beware of is that a lot of information on the internet is from the US, where they use different values. Americans will sometimes talk about a value of 7 being "diabetic" - but this in US terms means 7% (an A1c value) rather than 7mmol/l. It can lead to a lot of confusion. I'm attaching a pic that enables you to see the difference and convert one to the other.

 

[sgiossi]

Hi Kenny,
Thank you such a detailed explanation.
The problem is that I don't really have a lot of records about A1c testing.
The first record I have goes back to 2020. My A1c testing was 40. In September 2022 was 41.
I have more information about glucose (fasting) as glucose was included in various blood test results. Back many years ago, I had results ranging between 4.4 and 4.8. Now, as you can see, it has increased and it is closer to prediabetes levels.

I don't really understand how my body works. For instance, I have read that those with pre-diabetes should try to have dinner earlier and get proper rest.
Yesterday, I had dinner at about 8 PM. Had two sandwiches with pork sausages, then some fruit salad. I drank water with lemon.
Then I was really busy doing stuff on my computer and went to bed really late. It was about 2:30/3 AM. I woke up at 8 and I am tired.
I decided to check my glucose at 2:30 AM. It was 5.7. At 8:30 AM, it was 5.2.
Sometimes when I sleep more, I am less tired and eat better glucose is higher ....

 

[plantae]

I decided to check my glucose at 2:30 AM. It was 5.7. At 8:30 AM, it was 5.2.
Sometimes when I sleep more, I am less tired and eat better glucose is higher ....

But those values are not high are they? When I was diagnosed I was in the 20s (mmol/L). As an average I'm in the 4s to 6s now (most of the time) and my diabetic nurse wants me to be in the 7s so I can develop hypo awareness. Are we talking the same units here? Because 5.7, to me, is about smack bang in the middle where a non-diabetic would be

 

[sgiossi]

But those values are not high are they? When I was diagnosed I was in the 20s (mmol/L). As an average I'm in the 4s to 6s now (most of the time) and my diabetic nurse wants me to be in the 7s so I can develop hypo awareness. Are we talking the same units here? Because 5.7, to me, is about smack bang in the middle where a non-diabetic would be

As to glucose (fasting and not fasting), I use mmol/l (standard unit in the UK). For H
bA1c, it's also mmol/ml. It was the GP telling me that my HbAc1 was basically prediabetes. My last (lab, not home test) for glucose gave 5.7 (fasting).

 

[plantae]

Thank you for your reply.
I knew what the dawn phenomeno was. H

It's because of this problem came up in just a few months.
Glucose readings had always been fine. I started doing exercise and losing weights at least 6/8 months ago because I wanted to reduce my cholesterol and fatty liver.

In my experience (and I have a lot, but I'm not a doctor), if you have pancreatic issues, you would also be experiencing a lot of pain. If in doubt ask your Dr for the blood tests

 

[plantae]

As to glucose (fasting and not fasting), I use mmol/l (standard unit in the UK). For H
bA1c, it's also mmol/ml. It was the GP telling me that my HbAc1 was basically prediabetes. My last (lab, not home test) for glucose gave 5.7 (fasting).

Yes, but 5.7 is pretty much normal isn't it?

5.7 tells me that a) your pancreatic beta cells (insulin to "absorb" sugar ) are working properly in homeostatis with your b) pancreatic alpha cells (glucagon to "release" sugar). It seems normal to me. But if it was me I'd ask another Doctor. As an uninformed internet user not making a diagnosis I see nothing unusual

 

[saky]

Hi Kenny,
Thank you such a detailed explanation.
The problem is that I don't really have a lot of records about A1c testing.
The first record I have goes back to 2020. My A1c testing was 40. In September 2022 was 41.
I have more information about glucose (fasting) as glucose was included in various blood test results. Back many years ago, I had results ranging between 4.4 and 4.8. Now, as you can see, it has increased and it is closer to prediabetes levels.

I don't really understand how my body works. For instance, I have read that those with pre-diabetes should try to have dinner earlier and get proper rest.
Yesterday, I had dinner at about 8 PM. Had two sandwiches with pork sausages, then some fruit salad. I drank water with lemon.
Then I was really busy doing stuff on my computer and went to bed really late. It was about 2:30/3 AM. I woke up at 8 and I am tired.
I decided to check my glucose at 2:30 AM. It was 5.7. At 8:30 AM, it was 5.2.
Sometimes when I sleep more, I am less tired and eat better glucose is higher ....

Fruits can cause spike in blood sugar even for prediabetics. You can still eat low sugar fruits like berries - straw berries, avacado, rasp berries, black berries, blue berries, goose berries, star fruit etc.
Try eliminating all sugar from your diet.
I too faced similar situation when I was 42.5 years....my fasting sugars were in normal range but hba1c was 5.8% and post prandial sugars were high (136mg/dl, 142mg/dl.....)
I eliminated sugar, and fruits and began eating low carb diet.......eliminated rice, rotis, oats etc..........then hba1c were in the normal range(5.1%-5.4%)
since i eliminated all high carb food my post prandial values also reduced.
I used cgm(free style libre) to monitor my sugar values to learn what foods cause spikes..

 

[KennyA]

Hi Kenny,
Thank you such a detailed explanation.
The problem is that I don't really have a lot of records about A1c testing.
The first record I have goes back to 2020. My A1c testing was 40. In September 2022 was 41.
I have more information about glucose (fasting) as glucose was included in various blood test results. Back many years ago, I had results ranging between 4.4 and 4.8. Now, as you can see, it has increased and it is closer to prediabetes levels.

I don't really understand how my body works. For instance, I have read that those with pre-diabetes should try to have dinner earlier and get proper rest.
Yesterday, I had dinner at about 8 PM. Had two sandwiches with pork sausages, then some fruit salad. I drank water with lemon.
Then I was really busy doing stuff on my computer and went to bed really late. It was about 2:30/3 AM. I woke up at 8 and I am tired.
I decided to check my glucose at 2:30 AM. It was 5.7. At 8:30 AM, it was 5.2.
Sometimes when I sleep more, I am less tired and eat better glucose is higher ....

Your two scores are essentially the same. If you look at my A1c results they've bounced between 36 and 38. I think it's the same result, but there's a bit of allowable error in the test, just your car speedometer is allowed to be a little bit off.

Not sure about the glucose fasting. A lot could depend on other factors. And those are snapshot results - the A1c gives you a basic "average" over three months or so.

I read a lot of advice supposed to be helpful to T2s, but the useful stuff in my opinion boils down to eat less carb.
Getting enough rest is good in itself, but I'm not sure how relevant it would be to BGs in the long run compared to adjesting carb intake.

I think the meal you ate was pretty high in carb - there was bread, filler in the sausages, fruit, and lemon. A fair bit of that ws fructose. And your BG was normal afterward, which is good, and shows that your system handled that carb load.

 

[sgiossi]

Yes, but 5.7 is pretty much normal isn't it?

5.7 tells me that a) your pancreatic beta cells (insulin to "absorb" sugar ) are working properly in homeostatis with your b) pancreatic alpha cells (glucagon to "release" sugar). It seems normal to me. But if it was me I'd ask another Doctor. As an uninformed internet user not making a diagnosis I see nothing unusual

You know, paradoxically the issue started when I finally lost weight and started doing constant exercise ...Today my morning glucose is 5.8

 

[sgiossi]

Your two scores are essentially the same. If you look at my A1c results they've bounced between 36 and 38. I think it's the same result, but there's a bit of allowable error in the test, just your car speedometer is allowed to be a little bit off.

Not sure about the glucose fasting. A lot could depend on other factors. And those are snapshot results - the A1c gives you a basic "average" over three months or so.

I read a lot of advice supposed to be helpful to T2s, but the useful stuff in my opinion boils down to eat less carb.
Getting enough rest is good in itself, but I'm not sure how relevant it would be to BGs in the long run compared to adjesting carb intake.

I think the meal you ate was pretty high in carb - there was bread, filler in the sausages, fruit, and lemon. A fair bit of that ws fructose. And your BG was normal afterward, which is good, and shows that your system handled that carb load.

That's what I don't understand. Yesterday I had the same meal, and today glucose is 5.8

 

[sgiossi]

Fruits can cause spike in blood sugar even for prediabetics. You can still eat low sugar fruits like berries - straw berries, avacado, rasp berries, black berries, blue berries, goose berries, star fruit etc.
Try eliminating all sugar from your diet.
I too faced similar situation when I was 42.5 years....my fasting sugars were in normal range but hba1c was 5.8% and post prandial sugars were high (136mg/dl, 142mg/dl.....)
I eliminated sugar, and fruits and began eating low carb diet.......eliminated rice, rotis, oats etc..........then hba1c were in the normal range(5.1%-5.4%)
since i eliminated all high carb food my post prandial values also reduced.
I used cgm(free style libre) to monitor my sugar values to learn what foods cause spikes..

I've significantly reduced sugar. Can food like walnuts or almonds help? I l have started eating them because I read they can be beneficial to reduce glucose in the blood. I have stopped eating things like grapes.
I eat only natural yogurt with low sugar and rarely eat anything sweet. I used to drink juice and Coke from time to time and now I have basically removed the first and drink Coke once a week only. I do eat pasta from time time. It's hard to remove that as well but when I do so I avoid bread. What's cgm?

 

[plantae]

You know, paradoxically the issue started when I finally lost weight and started doing constant exercise ...Today my morning glucose is 5.8

Is 5.8 concerning?

 

[sgiossi]

Is 5.8 concerning?

It's pre diabetes, isn't it? I was told it should be below 5.6 when fasting.

 

[plantae]

It's pre diabetes, isn't it? I was told it should be below 5.6 when fasting.

I don't know. Normal non-diabetic BSLs are 4.0 to 8.0. 5.8 is pretty much smack in the middle (6.0) which is why I'm asking

 

[sgiossi]

I don't know. Normal non-diabetic BSLs are 4.0 to 8.0. 5.8 is pretty much smack in the middle (6.0) which is why I'm asking

Doesn't diabetes start from 7 mmol/l when fasting?
That is what confuses me. My GP told me that above 5.6 it's already pre-diabetes, and 7 is diabetes and told me I am too close to prediabetes values.