44 replies to this topic

[Nate-2004]

So my A1c came back recently with another drop in points to 5.2%.  I'm not even pre-diabetic. I've been off the keto diet now for a few weeks. Every time I test my blood glucose in the morning prior to eating, however, it's always over 100.

 

This morning I measured twice an hour apart, it was 119 and then 120.  

 

These measurements have been pretty persistent for the last year or so, both on and off keto.

 

According to 23 and Me data analyzed by Prometheus, I am predisposed to have higher morning blood glucose. Is this anything to worry about at all? Should I even bother trying to change this?

 

Should I be fasting in the mornings because of this (i.e. wait till afternoons to eat)?

 

What is happening here?  I have tried Googling this and the only thing that shows up is "dawn phenomenon" but it's not supposed to be so high, plus that's for diabetics.

 

Another hint out there said that men with more muscle mass tend to have higher fasted blood glucose. I do tend to have a bit of muscle mass, I've always had that, especially during my body building years.

 

I guess the main question is whether this is anything I should be worried about. The secondary question is, why does this happen?

 

 

 

 

 

[tunt01]

I have a friend with similar issues.  He thought he was pre-diabetic, but his A1C always came back normal low. 

 

I think it's a long-term risk factor for dementia and indicates peripheral insulin resistance (or insulin insufficiency).  My guess is there is some kind of metabolic behavior that is askew, because the muscles are refusing glucose (sparing behavior).  The muscles/brain (hypothalamus) react to cortisol, the body thinks its starving in some way or it isn't fat adapted properly for a period of fasting, and therefore gluconeogenesis is upregulated more significantly.  I'm not sure what the answer is other than to have great peripheral insulin/glucose sensitivity and avoid anything that would mess with that (like ketogenic diets, cortisol inducing behavior like coffee, poor sleep schedules).  I'm not 100% clear on whether I'm correct on the metabolism, because I've been brainstorming this matter.

 

I think fasting in the AM is fine, w/ your genetic disposition.  It may just mean that your cortisol awakening response is more reactive to the stress of starting the day w/o food, which is fine.  But you need to go out and walk (non-insulin mediated uptake of glucose) and get blue light exposure.

 

I'd be curious to see other people's thoughts.

Edited by prophets, 03 April 2018 - 02:59 PM.

[pamojja]

 

So my A1c came back recently with another drop in points to 5.2%.  I'm not even pre-diabetic. I've been off the keto diet now for a few weeks. Every time I test my blood glucose in the morning prior to eating, however, it's always over 100.

 

Be aware that HbA1c can be highly misleading (http://www.longecity...156#entry797721). I got that phenomena too, but only after a 7-day water fast where it seems my gluconeogensis seriously got ramped up.

 

However, there are other tests to go sure you aren't worsening insulin resistance. Easiest would be to find your highest spike in blood-glucose after a meal, and then test those post-prandial spikes too, beside fasting glucose.

 

 

With a fasting insulin or a C-peptide lab test additional to your fasting glucose you could calculate your insulin-sensitivity with this online-calculator.

Edited by pamojja, 03 April 2018 - 04:37 PM.

[Nate-2004]

 

 

So my A1c came back recently with another drop in points to 5.2%.  I'm not even pre-diabetic. I've been off the keto diet now for a few weeks. Every time I test my blood glucose in the morning prior to eating, however, it's always over 100.

 

Be aware that HbA1c can be highly misleading (http://www.longecity...156#entry797721). I got that phenomena too, but only after a 7-day water fast where it seems my gluconeogensis seriously got ramped up.

 

However, there are other tests to go sure you aren't worsening insulin resistance. Easiest would be to find your highest spike in blood-glucose after a meal, and then test those post-prandial spikes too, beside fasting glucose.

 

 

 

With a fasting insulin or a C-peptide lab test additional to your fasting glucose you could calculate your insulin-sensitivity with this online-calculator.

 

 

That all seems way over my head right now. I guess I'll have to consult an endocrinologist or something.

[Benko]

On the other hand, if someone is diabetic, their red blood cells live shorter lives than non-diabetics. This means diabetics and those with high blood sugar will test with falsely low A1c levels.  

https://chriskresser...eliable-marker/

 

NOT saying you are diabetic. But if I were you, I'd get my fasting insulin tested, and buy a glucometer and see how your blood sugar responds to various meals.  

[pamojja]

That all seems way over my head right now. I guess I'll have to consult an endocrinologist or something.

 

1 endocrinologist gave me a T2D diagnosis on account of a simple once-off Hb1Ac (6.2%; in average has been 5.1%), a 2nd endocrinologist refuted that diagnosis again. Their knowledge is very variable, and are really helpful for getting lab-tests only. Unless they refuse even that, as so often happens where they see nothing for medication yet (as with prediabetes). And wait till you're ready for polypharmacy.

 

It's rather simple. Homa calculator tells your insuline-resistant pretty forward, with only fasting glucose and fasting insulin (or C-peptide). A fasting glucose over 100 and a consistent post-prandial glucose above 125 mg/dl is defined as prediabetes.

 

Personally I would be more concerned about your post-prandial glucose spikes. Because that is the one number easy to modify with dietary intervention and some time regular testing.

Edited by pamojja, 03 April 2018 - 05:21 PM.

[Nate-2004]

Well, I don't wanna get too hypochondriacal here, I'm almost positive I'm not even remotely prediabetic. I mean I'm in incredibly good shape for my age, most people would not call me overweight and despite my above average muscle mass my BMI is still only 24. I exercise 4x a week, I get quality sleep and most of my diet over the past couple of years has been largely healthy, even if I do have a sweet tooth. I fasted quite a lot last year and also did the ketogenic diet, but that had no real apparent effect on my FBG. It's still always around 100 to 120 in the mornings for whatever reason. 

 

I'm just concerned here but maybe this is normal. I will try getting some labs done as you say and check that Homa app or have them test me and let me know what my insulin resistance is. I guess we'll see. I'm testing my post lunch glucose in about 30 mins here and hopefully it's not anything serious.

[Nate-2004]

So I tested it again about 20 mins after my lunch, though I had an apple earlier today at 11:00, it's 14:24 now, I tested at 105, not sure what this means.

[tunt01]

So I tested it again about 20 mins after my lunch, though I had an apple earlier today at 11:00, it's 14:24 now, I tested at 105, not sure what this means.

 

I'm not sure 20 mins after lunch matters.  The first phase of insulin release is pretty significant.  I would be more interested in the 1 HR and 2 HR values.  If there is an insulin resistance problem, sugar will just sit in your blood after being digested and the first spike of insulin that drives down glucose in the first ~15 mins won't mean much.

[pamojja]

So I tested it again about 20 mins after my lunch, though I had an apple earlier today at 11:00, it's 14:24 now, I tested at 105, not sure what this means.

 

The highest spike can be at an individual time-span, mine and probably most it's around 60 minutes after having a meal. If that 105 mg/dl didn't rise further, and you could replicate that further times with you usual other meals, it would mean pre-diabetes is most unlikely.

[Benko]

Agree--have whatever is a large meal for you, and measure your blood sugar  e.g. 60, 90, 120 min .  If those measurements are fine i.e. dont go very high and come back to normal, then it sounds unlikely you are diabetic or have to worry.

 

It couldn't hurt to still get the fasting insulin .

 

Finding an endocrinologist who has any clue about 23 and me or fasting glucose levels in lifters will be a non-trivial exercise.

 

 

 

 

Edited by Benko, 03 April 2018 - 09:35 PM.

[Nate-2004]

Right well, I had eaten an apple with peanut butter just 2 hours before I ate the chicken parm sandwich on toasted bread. 

 

Also I just tested again when I got home, I realize this is 3 hours later not 2, but I tested at 91. I also just ate a bunch of seeds though so that may be driving it down who knows.

 

I'll be testing at 1 and 2 hrs after lunch tomorrow. We shall see where I'm at.

[misterE]

From what I understand; during nighttime, glucocorticoids increase to produce glucose. Low-carb diets, as well as fasting, starvation and frank diabetes all increase glucocorticoids, which then in return gives rise to the elevated blood-sugar commonly seen.

[xEva]

But how reliable is your glucose meter? 

 

For years I used ReliOn, and it was dirt cheap and very accurate. Then a year or two ago they came up with strips that were even cheaper (and no longer are selling the strips for the old model). So I switched -- and my blood glucose went up 10-15 points. Since I don't check often, it took me a while to realize that the problem was in the meter.

 

I take it along, when I have blood  drawn and record it right there. Before, it was one point (!) above the lab reading, which I thought was amazingly accurate for a home tester. But last time it was ~17 points higher. Supposedly, there is a way to recalibrate it. Anyone done it? Or is it simpler to trash it and get a new one? What brand?

[pamojja]

But how reliable is your glucose meter? 

 

For years I used ReliOn, and it was dirt cheap and very accurate. Then a year or two ago they came up with strips that were even cheaper (and no longer are selling the strips for the old model). So I switched -- and my blood glucose went up 10-15 points. Since I don't check often, it took me a while to realize that the problem was in the meter.

 

I take it along, when I have blood  drawn and record it right there. Before, it was one point (!) above the lab reading, which I thought was amazingly accurate for a home tester. But last time it was ~17 points higher. Supposedly, there is a way to recalibrate it. Anyone done it? Or is it simpler to trash it and get a new one? What brand?

 

The cheapest (teststrips) I got here I also tested along with lab-testing. The variance I've got is about +/- 5 mg/dl.

 

With my glucose meter there is a calibration liquid to ascertain the particular batch of teststrips isn't off. In which case you only would replace the particular teststrips batch.

[pamojja]

Even lab tests aren't as dependent as it seems. For example with my last blood draw they tested serum calcium twice: 2.25 and 2.51mmol/l in the same blood draw! (2.15-2.55 normal range). To get more dependable number I never give much credence to just one value, but test it fasting as well as postprandial for up to 1 month at a time and notice the averages, at least twice a year to compare for improvements.

Edited by pamojja, 04 April 2018 - 12:10 PM.

[Nate-2004]

I have been wondering the same thing actually. I use PrecisionXtra, it couples as a ketone reader as well. The strips are pretty expensive but perhaps I should get a new one? I don't know which one to buy otherwise. If they can be off by as much as 20 points that might explain my issues, though it's still kind of high even if it were really 99 in the morning instead of 119. This morning it was 122 mg/dl. I'm going to test it again 1 and 2 hrs after lunch today and if it's lower then perhaps I'm just an alien.

[HaplogroupW]

Here's how different meters can read.

 

 

I like that Keto Mojo measures hematocrit and hemoglobin, which I'm hoping helps them produce a  more accurate glucose result.

Edited by HaplogroupW, 04 April 2018 - 06:00 PM.

[Nate-2004]

 

Here's how different meters can read.

 

 

 

I like that Keto Mojo measures hematocrit and hemoglobin, which I'm hoping helps them produce a  more accurate glucose result.

 

 

Wow that's discouraging, how do you even know what's good?

[xEva]

that's the new ReliOn in the middle of the shot, and it does not know how to show anything less than a 90

 

 

Here's how different meters can read.

 

 

 

I like that Keto Mojo measures hematocrit and hemoglobin, which I'm hoping helps them produce a  more accurate glucose result.

 

 

 

Actually, usually it's the other way around. The simpler the thing, the less chances it has to falter (given otherwise comparable quality). I learned that when I played with a keto meter, which also had glucose strips, and I could compare it with the old ReliOn and 2 others. And while the others went all over the place, the old ReliOn was very consistent (and, it turned out, remarkably precise). But the keto meter did the worse glucose readings -- it seemed to do well with ketones though (I played with it during a fast and knew what to expect)..

[pamojja]

Wow that's discouraging, how do you even know what's good?

 

Actually very encouraging. You know it once you compared taken along with lab tests a couple of times. Every cheapo I bought did the job with +/- 5 mg/dl - remarkable reliable in my experience. Never tried expensives.

 

And you know it even better once you reverted prediabetes armored with such a cheap meter.
 

[Nate-2004]

Well, it doesn't really look like I have prediabetes at all. My blood glucose taken 1 and 2 hours after a sizable lunch was actually less than it measured this morning in a fasted state, 91 and 104 respectively. It was 122 this morning in a fasted state.

 

So what's the deal here? Am I just a weirdo?

 

Is it my muscle mass? I'm nearly 5'11, 180cm tall and 174 to 179 (~80kg) in weight. I have a 31 waist. While I have a bit of belly pudge, most of the weight on me is muscle I think. I measured at 14% bodyfat on a really good day recently though I think that fluctuates a bit. My visceral fat scored a 4 on a 1 to 10 scale, they said ideally it could be 3.

 

I don't have the body or the energy of a diabetic. I also try to get 30g of fiber a day somehow, even if on that day I eat like shit. What can I say I love cookies and stuff. I also take EGCG in the mornings on an empty stomach, and I fast intermittently but really it's just time restricted feeding, but not every day religiously. I put cocoa extract in my coffee which should contain plenty of catechins, known for lowering glucose, I take garlic, also known for lowering glucose, I also take ceylon cinnamon, also known for lowering glucose. I also take berberine 400mg 3x daily but not in the past few days. I skipped all these things except EGCG the last two days because I've been testing my FBG issues.

 

Wow that's discouraging, how do you even know what's good?

 

Actually very encouraging. You know it once you compared taken along with lab tests a couple of times. Every cheapo I bought did the job with +/- 5 mg/dl - remarkable reliable in my experience. Never tried expensives.

 

And you know it even better once you reverted prediabetes armored with such a cheap meter.
 

 

 

Eva, Pam, what meter would you recommend?

[pamojja]

Only used those with cheapest test-strips widely available in every Supermarket here (Medisana), probably not available in the states.

[Benko]

OK so you're not prediabetic.    The explanation for the early AM elevated blood sugar is likely be as misterE said: elevated cathecholaimenes/cortisol, etc.  OVertraining could do this, but doesn't sound like applicable now.  YOu might at least get a 24 hour saliva cortisol to look for elevated PM cortisol.  Addressing whatever is doing this is likely worthwhile because of the other effects of elevated cortisol/cathcholamines longterm.

[xEva]

I don't know what's good now and am looking for a recommendation myself

[tunt01]

I just tested 3 meters out of curiosity.  Walmart Relion Premier Blu and Abbott Precision Xtra gave me virtually identical results.  True Metrix was off by ~20 points consistently.

Edited by prophets, 05 April 2018 - 01:11 AM.

[xEva]

I just tested 3 meters out of curiosity.  Walmart Relion and Abbott Precision Xtra gave me virtually identical results.  True Metrix was off by ~20 points consistently.

 
 
but which ReliOn you have? A fat-flat new one or a slenderish-stick old one?
take a look, first old and then new:
 
old: 

new:

[xEva]

Ah! I just found out that they still make and sell that old version of ReliOn (I guess our Walmart removed it while they were pushing the new model). It's called ReliOn micro and it uses the same strips (~$20 per 50) as their 'confirm' model. Stay away from fat-flat one which is called 'prime'.

[tunt01]

Please note I edited my prior comment to distinguish the Relion as Premier Blu model type.

Edited by prophets, 05 April 2018 - 01:12 AM.

[HaplogroupW]

Wow that's discouraging, how do you even know what's good?

 

 

Well I don't know for sure, yet. Next time I have a blood draw, I intend to measure with all three and see which is closest to the lab value.

 

FWIW the offsets between their readings are very consistent. It's not like there's large standard-deviation, normally-distributed noise superimposed such that one time one is high, then next time another is. The keto mojo always reads that much lower than the others, and the NovoMax always reads the highest. At least the several times I compared them from the same blood drop. None of them reads "all over the place" as xEva suggested might be the problem. The ones that are wrong (whichever they are) are consistently so.