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Diabetes

Blood sugar variance

05/09/2008

Question:

I am a type II diabetic. I check my sugar level (finger test) twice a day as prescribed by my doctor. My first reading is when I wake up which varies between 109 to 134. Get this, it does not matter if I have a small breakfast, cereal, or a big breakfast, bacon and eggs, my sugar level drops clear down to 69 to 82. Is that par for the course? Unusual? What does that mean?

Answer:

I would need more information than that to figure out why that is occurring and what the implications are.  First question is whether you feel perfectly fine with the lower sugars or whether you are having symptoms of a low blood sugar; second question is what is the time of the lower blood sugars relative to the higher ones; third is whether you are on any kind of treatment for diabetes; and fourth is what your blood sugars are at other times of day.  I would also throw in there whether your meter has been calibrated lately and whether to trust the absolute values of the blood sugars.  If the readings are reliable, you are not on treatment for diabetes, you are not feeling symptomatic and then depending on the timing of the results, it may just be that you have a sufficient insulin response to food that it brings your sugars down but that some other mechanism is making the early morning sugars higher.  The explanation for the higher sugar in the morning depends in part on when and what you last ate - do you eat late at night or in the middle of the night?  It could relate to food intake or to hormonal or liver-related mechanisms.  If your sugars are that low after the meal and you are having symptoms and you are on treatment for your diabetes, perhaps your treatment needs to be backed off.  As you can imagine, differing answers to the individual questions could change  the overall response I would give.

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Response by:

Robert M Cohen, MD Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati