What is my true fasting level?

I haven't worked out which number to trust more as a fasting level.

7am, 8 hours fasting, 5.5 hours sleep level was 5.5 mmol / 5.4 mmol (did a second test a moment later)

9am, 9.5 hours fasting, about 30 mins more sleep level was 5.2 mmol.

I ate late 11pm was still nibbbling and I ate extra carbs than the previous week.

Last week while low carbing my fasting level is anywhere from 4.5 to 5.1 but often high 4s.

Is this morning's level a warning of where things would be if I continued to eat that way or a one-off last meal effect thing?

Antje77 said:

It's still fasting until you eat. I can wake up at 5 or 6, but without some quick acting insulin to catch the glucose my liver dumps upon waking up I can be up to 11 four hours later, still fasting. (I know because I've forgotten this morning dose a couple of times, and in the early days thought I shouldn't take my usual waking up dose when having to take a fasting blood test in the hospital)
Both are true fasting tests, and in my opinion they only prove the uselessness of fasting levels without knowing what bg levels are doing over the day.

All the numbers you quote are non diabetic fasting levels, aren't they?

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Yes, non-diabetic, but I never went back to my old way of eating since having gestational diabetes (5 -6 months ago). I've stayed fairly low carb so I'm just watching things to see if I can eat some carbs again while I'm breastfeeding.

I was fasting this morning before my first HbA1c test (which I expect to be normal since I've not been eating many carbs...) and continued to fast till midday (12 - 13 hours) only because the kids kept me from eating My level dropped to around 4.5 mmol by then. I guess it's a good sign if it drops and doesn't rise too much again by itself, right?

Some mornings the fasting level would creep up but only to the mid-5s. I think prediabetes fasting level is from 6.0mmol in Australia but 5.5mmol in the UK and USA? But I wondered if I only get 5.5 mmol after eating a bit more than usual and it drops with extended fasting (skipping breakfast) then that's completely normal now. Should I worry only if I keep seeing 5.5 mmol - 6.0 mmol day after day maybe? Then pull back on the carbs again.

I think I might be being too strict with how few carbs I've been eating in this postpartum period while breastfeeding so if I can eat carbs more liberally for the next year or two and not end up prediabetic, I might do it just while I'm breastfeeding. I kind of miss fruit and potatoes.. and bread, and cake! Yesterday I had all 4 and that's why I saw 5.5 mmol in the morning I think.

Caprock94 said:

My afternoon fasting levels are always lower than my morning numbers.

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How many hours of fasting have you done by the afternoon?

Jim Lahey said:

If there were any question then I would be more interested in what is happening to my insulin rather than focusing solely on a few numbers from a glucometer. Glucose is only half the picture. The important thing is the level of circulating insulin required to maintain it. If insulin is high then you're flirting with danger. Otherwise not.

Unfortunately there is currently no way (that I'm aware of) to measure insulin in the home. Testing therefore requires either a doctor who really understands diabetes (rare) or private labs. It's debatable whether or not this would be overkill in your situation. Some would argue that it's not necessary, but if it were me and I really wanted to know if I was ok eating carbohydrate then I would first want to know what my pancreas had to say about it.

Focusing only on glucose is like trying to clean up the oil on the driveway without looking for the oil leak.

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Good point. I managed to get a fasting insulin test done when I begged for one a few months ago and it came back at 6.3 mU/L. My fasting glucose that morning was lower than I usually get at home at 4.4 mmol so the HOMA came back at 1.2. That was 2 months postpartum and about 4 months ago. But I don't know how reliable the fasting insulin test is at knowing the whole picture. What do you think? Someone told me 6.3 mU/L fasting insulin is slightly elevated. In Australia, any HOMA under 2 is considered normal.

It is a shame that there is not more awareness about predicting problematic levels insulin resistance before it becomes a blood glucose issue...

I guess like that then it's just sensible for even those with normal blood glucose levels not to overdo it on the carbs so you aren't asking your body to make too much insulin all the time, right?

There is one test that looks at your insulin and glucose over a two hour period too, isn't there? But I doubt I qualify for that test. The doctor didn't want to let me have the fasting insulin test because the guidelines say:
"The main reason to measure insulin is to help determine the cause of low blood glucose (hypoglycaemia) in patients without diabetes when a rare insulin secreting tumour (insulinoma) is suspected.
Sometimes insulin levels are ordered to investigate “insulin resistance” either fasting or as part of an oral glucose tolerance test but there is limited evidence for this purpose."

But at least I had the fasting insulin. And today I went in for my first HbA1C, and also hs-CRP (more arm twisting with a different doc , and also the sdLDL (LDL subfractions) for my cholesterol since my levels have been a bit high for the last few years (but breastfeeding can do that so hopefully it's nothing to worry about). My trigs (0.7 mmol) and HDL (2.89 mmol) were good at last measure. Just have high LDL (5.5 mmol) and total cholesterol of 8.7 mmol. She wanted me on statins.

My cholesterol levels were more worrying to the doctor than anything to do with my insulin or blood glucose. I'm trying not to think about that at the moment. But eating low carb may have pushed my cholesterol up a bit too. I've been trying to have more olive oil and macadamia nuts but I think I still eat more a lot of saturated fat from meat and dairy. And then there's the whole argument that high cholesterol isn't anything to worry about provided the LDL particles are not mostly small and dense. I like the explanations from Ken Sikaris so far. He also says a HbA1c of 5.5 is where your risk of heart disease starts, even though no one will blink an eye at that level yet.

Anyway, I'm just hoping things come back in the normal range so I can eat a potato and a banana here and there and not think about it too much.

ianf0ster said:

Those Lipid figures are not just good - they are great (assuming 'our experts' are correct about overall Cholesterol and total LDL being a distraction). Most (non Stone-Age) doctors seem to concentrate on the Ratio of Trygs to HDL, and yours is fantastic! And as you mention, if your are still in weight loss mode on a Low Carb regime then your LDL is almost certain to be elevated compared to being in the weight stabilisation state.

Of course Dave Feldman is now trying to investigate whether we should be looking at the 'remnant LDL' i.e the damaged LDL.
But from the numbers you have at the moment, things look very good indeed.

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I didn't think about weightloss contributing to an elevated LDL but I have lost all but a kilo or two of the baby weight from my most recent addition so you're probably right there! Still have another 5kg to get back to pre-any babies weight though..

I'll be happier about my cholesterol if the subfraction test shows low small dense LDL. Then the fact that it's higher is probably just due to breastfeeding, weight changes and the fact that I was still healing from a c-section. All good reasons to need cholesterol, aren't they?

As you say, my trigs and HDL look good, so that's the main thing I think.

Just crazy that if I hadn't come across Dave Feldman and then Ken Sikaris, I might have started on a statin like many others do when they are prescribed.
Glad for this forum as well so I stay sensible about carbs and not walk in the dark till I run into a wall like so many do.