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My wife had blood work done a few months ago that came back with an A1c of 5.7. She has been low carb for a long time. Her FBS is pretty consistently at 114. All other times come in around 95. Even within 2 hours of a meal. Yesterday her FBS was 150, but 96 at 2 hours after dinner. Any guess (or better yet, knowledge) about what is going on? She is switching Dr.s to my GP and will be having new tests in a couple months. She is going to begin tracking her BG more closely in preparation for this.

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This could be just an elevated reading due to the limited accuracy of the A1c test. But on the other hand there is this 150 reading. At max the healthy body can produce around 20 units of insulin per hour. Without provocation and with a low carbing lifestyle it seems a bit odd to reach that high. T2 often begins with a period of misregulation of glucose control with over- and underproduction of insulin and lows and highs as a result. Is it possible that some new medication might be causing this?

No,she takes zero meds at this time. When she met with my GP they went over her labs from the previous Dr and he said they may start Metformin after the next labs depending on results. It does seem very odd that he A1c is higher than mine. Especially since only her FBS seems out of line. I guess that the good news is she is now well versed in D if this is the issue.

I think it's good that you're on top of this. Measuring her BG throughout the day at different times will give you a better idea of what's going on.

Mean Plasma Glucose calc (from DCCT study):

((5.7 * 35.6) - 77.3) = 125.62 mg/dl

Mean Plasma Glucose calc (the "Nathan Formula" calc):

((5.7 * 33.3) - 86) = 103.81 mg/dl

There's some variation in how the A1C is interpreted. However, if she's consistently showing above 110 mg/dl in the morning fasting readings, it might be time to start a bit of metformin. I can't take it (tummy bomb) but it certainly helps a lot of other folks improve their insulin resistance.

You don't mention exercise, but now would be the time to start a walking program or something similar. For some folks (depending on genetics) that makes all the difference.

This is not unheard of:

Here's a quote from
"There is are a small number of people, often men, whose fasting blood sugar rises quite high, perhaps even into the diabetic range, while their post meal blood sugars remain normal or near normal. This appears to be a slightly different syndrome. Scientists speculate, that these people may have a defect that affects their ability to secrete the basal insulin release that takes place during fasting and sleep." I believe a fasting of 114 would be considered pre-diabetic(personally I think a better name for pre-diabetic is early stage diabetes)

Your plan to test more frequently and at different times to amass more data about what is going on would seem prudent.

Thanks Badmoon. This is very helpful. There are so many twists and turns with D. I figured we could at least get a little insight to prepare for the next appointment.

What's the question, exactly? Are you looking for something wrong with the numbers?

If I average the 4 bg's you mention I see an average of 114, and that's entirely consistent with an A1C of 5.7.

While many hear obsess with post-meal bg's, there's a much larger number of hours spent at FBS levels than post-meal levels and those drive the average a lot.

I'm not concerned with how the 5.7 was arrived at. My question is why my non D wife is having these results. It just seemed odd that here body is doing what it should with meals, but not over night. I figured that I could get more information by bringing it up here than seeing a Dr every few weeks for a few minutes. So far I was right. We know something is not right, we are just looking for a better understanding of what that might be.

Hi Randy. This is an interesting question as most people without D don't test. I have always had problems with fasting numbers and my numbers always go down as soon as I eat. This summer I learned that there are 2 reasons for high morning numbers. One is the Smogyi Effect which is a rebound caused by the sugar going low overnight and the liver responding by pumping out excess sugar. The other is the Dawn Phenomenon where the liver pumps out sugar when it's time to wake up which happens with everyone both D and nonD alike. The problem with those who have D is that the insulin response is ineffective. The only way to tell which it is is to test during the night. I wonder if your wife goes low overnight or if she is getting the DP rush that troubles so many of us? I did random tests over the summer and discovered that I never go low overnight. For me the numbers start to rise at about 4:00 am.

Ditto for me. 4:00 seems to be the witching hour.

Almost forgot about those pesky neutrinos.

The pre-dawn rise in bg's exists even in non-diabetics. I can't really judge what a rise to 114 or 150 means in a non-diabetic.

Pure speculation:
The control of basal blood glucose is an interplay between the liver which releases small amounts of glucose and the pancreas releasing insulin. When insulin levels fall the liver releases a small amount of glucose. But the liver can suffer from insulin resistance too. When the insulin signal fails the liver continues to dump glucose and fasting numbers rise. So this could signal the beginnings of insulin resistance. Metformin works on this defect. The normal post meal number could be because she is low carbing.

In an early stage T2 part of the damage done by readings of 140+ is that the beta cells gradually die from the effects of high glucose/insulin. So in a sense these type of readings do more damage to a pre diabetic than to either a T1 or a later stage T2 who have either no beta cells or a severely degraded number of them.

It could also have been a strip reading the 20% error allowed,which I hope is the case.




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