November 16, 2007

When to Test Blood Sugar in Type 2

One of the topics that comes up a lot in the email I get from visitors to my What They Don't Tell You About Diabetes web site is the question of when is the best time to test your blood sugar.

A lot of doctors still tell people with Type 2 to test first thing in the morning and before meals. That was what I was told at diagnosis in 1998. People who test using this schedule may tell you their blood sugar is usually 120 mg/dl, which sounds pretty good, except that since this is a fasting number it usually hides the information that the person's blood sugar maybe going to 250 mg/dl or higher after every meal.

Research has shown that for people with Type 2 diabetes--especially those who have been diagnosed recently and still retain some beta cell function--it is the high spikes after meals that contribute most heavily to raising the A1c and causing complications. If you only test your fasting blood sugar, you will not know anything about how high your blood sugar is spiking after meals, so you won't know which foods are toxic to you because they cause dangerous spikes.

If you are like most people with Type 2 your access to the very expensive blood sugar testing strips is limited. You may have to pay for strips yourself or your insurance may pay for a single box each month. That means that you need to use each strip as efficiently as possible. Here are some strategies that you can use to get the information out of your blood tests that will let you drop your A1c back into the healthy zone.

  1. Keep a written log that matches what you eat with the test result you get.
    Even though your meter may keep a list of your readings, these readings are meaningless unless you know what food you ate that resulted in each particular reading. If you write down what portion size of which food you ate and match it to the blood sugar you saw after eating it, you will accumulate the information you need to eliminate toxic foods and replace them with those that do not raise your blood sugars.


  2. Determine when your blood sugar reaches its highest point after eating.
    Your goal is to bring your blood sugar peaks below the level that we know cause complications. To do this, you need to learn when your blood sugar hits its highest level. Research studies show that the average person sees a blood sugar peak 75 minutes after eating carbohydrate.

    But you're not average, you're you. So the first thing you need to do is determine when your own blood sugar peak occurs. Start out by testing at 1 hour, 1.5 hours, 2 hours, and 3 hours. Do this for three meals. You should start seeing at which time the highest reading occurs. That's the time you should plan to test in the future.

    Don't test at 30 minutes after eating. Though many people see a high at this point, research has shown that brief peaks at 30 minutes after eating do not correlate with an increased incidence of complications. The one hour reading is the earliest that you should concern yourself about.

    If you eat pasta which digests very slowly you may see a peak much later than usual. You should test for peaks from pasta 4 or 5 hours after eating if you don't see them in the first 3 hours.


  3. Eliminate the Foods that Cause Unacceptable Spikes.
    You can test all you want, but if you don't use the test result to eliminate the foods that cause blood sugar spikes, you might as well not test at all. Testing is the most powerful tool you have as a person with diabetes to regain your health, but you must act on the information you get from your testing.

    If you see an unacceptable high blood sugar reading, the only way to bring it down is to cut back on the amount of carbohydrate in your meal. Carbohydrates are what raise blood sugar, and despite what you may read in books written by people who do not have diabetes, every gram of carbohydrate you eat will raise your blood sugar no matter whether it is supposedly "healthy", "low glycemic" or the label says it is magically treated to keep it from raising blood sugar.

    So if your blood sugar is too high after eating a meal, determine where the carbs came from that raised your blood sugar in that meal, and cut back on the carbohydrate food or eliminate it completely.


  4. Nutritional Software Can Help You Discover Where The Carbs Are
    I like LifeForm. Others use Fitday. Find a reliable source of nutritional information and look up the foods you eat to see where the carbs are coming from. Read the labels on the prepared foods you buy and be careful to note the portion sizes which are almost always much less than you eat. For example, have you ever gotten "2.5" servings out of a can of Campbell's soup? No. I didn't think so. But that's the portion size given on the label, so if you eat half the can, you're getting 20% more carbs than are listed on the label.


  5. Shoot for Healthy Blood Sugar Targets
    These are the targets that will give you an A1c in the 5% range no matter how high your A1c is now. If you don't believe me, check out THIS PAGE of reports from people who have used these targets to dramatically lower their A1cs.

    One hour after eating: under 140 mg/dl (7.8 mmol/l)

    Two hours after eating: under 120 mg/dl (6.7 mmol/l)

    If you can do better than this, go for it. Normal people rarely go over 120 mg/dl ever and are usually under 100 mg/dl at 2 hours after eating.


  6. Use Generic Meters and Strips if Access is Limited

  7. Wal-mart sells the Relion meter for $8.88 and the strips are less than half the price of the name brand strips. They work just as well. The drugstore brand meters made by TrueTrak are also much cheaper than the brand name strips, though the strips may lose their accuracy over time, once the vial is opened. Companies give away "free" meters only to get you using their overpriced strips. Don't pay full price for name brand strips. It isn't necessary. You can sometimes get good deals on strips on eBay but check the expiration date. Don't buy expired strips and don't buy strips by mail when it is hot as the heat can destroy them.

81 comments:

dave_lull said...

Hi Jenny,

I sent this posting to a friend of mine. She replied:

". . . this is ENORMOUSLY useful and I found the questions here to be the most crucial -- and hard to get answers for -- of any I had."

Regards,
Dave

Tim said...

Great post, thanks. I made a lot of progress in my weight and how I feel by just working on keeping peaks down as you describe.

Now I'm working on getting average blood sugar down to 83 as recommended by Dr Bernstein, and making some progress. My sense is that if you check blood sugar 2 hours after a meal and it is back to 83, then you are probably not getting too high, but I am going to check at 75 minutes after eating for a few days to make sure.

Jenny said...

If I were always at 83 at 2 hours after eating, I would be thrilled.

I can't do that with diet alone, because of the way my form of diabetes works. But it is worth noting that almost a decade of being closer to 100 at 2 hours has not given me any neuropathy, retinopathy, or kidney changes.

And before that I was in the mid 100s most of the time but probably under 140.

My guess--and it is a guess, modified by what research there is--is that keeping under that magic 140 mg/dl at all times might be what it takes to avoid complications.

Anonymous said...

This has been very helpful! I do have a question and wonder if anyone else has the same issue. Instead of dropping at night while I sleep I go up, example, I can be perhaps 147 2 hours after a meal, get up the next morning and be 181. Any suggestions?

Jenny said...

Anonymous,

There are several things that can make your blood sugar go up in the morning.

1. Food digesting slowly from dinner.

2. "Dawn phenomenon" where the body naturally raises blood sugar first thing in the morning.

3. Counterregulation where if you are taking a drug that stimulates insulin secretion or injecting insulin and do too much you may go low in the middle of the night and the body dumps stress hormones to raise the blood sugar. I blogged about counterregulation HERE.

Anonymous said...

Anonymous,
I have the "dawn phenonemom" and I combat it with a small protein snack an hour before bedtime. I will have a few nuts, low fat string cheese, or smoked salmon on a small multigrain cracker.
Good luck, Mary

Joan said...

Wow! I am so glad I found your site. I am a "prediabetic" - one of those who the doctor tells how great you are doing with an A1C of 7 and FBG of 138. Thank goodness, his new PA was very disturbed by my readings and told me to get moving and lose some weight. I actually thought I had a healthy diet; lots of vegetables, whole grains, fruit, chicken, fish, etc. I bought a meter and was alarmed to see that my blood sugar was rising to almost 200 after a meal. I read all the ADA recommendations about foods but following their recommendations meant I was eating way more carbs than before. My eyesight was getting worse, I was crabby, depressed. After reading TEST, TEST, TEST and starting my food journal, I saw the facts about what I was eating. In one day, I have been able to make minor adjustments and my BG is only going up to @140 after a meal and then going down to less than 100. My FBG this morning was 117.
Thank you for giving us this information. I realize that many people here are fighting a much more serious situation but if you have helped me avoid organ damage and medication, you will have done a good thing.

Kay said...

This is brand new to me. This website is by far the best I have found. I am trying to determine when my blood sugar spikes posyt-meal. Do I also need to test after a mid-day apple,a piece of sugar-free gum (2Grams of carbs)a coffee with skim milk and sweetnlow,a half dozen almonds etc. Do I need/want to know how these things affect my blood sugar as well? Thanks so much in advance for your answers.

Jenny said...

Kay,

It really depends on how many blood sugar strips you have. Most people are limited in their access to strips, so they will test with the goal of figuring out how far a given number of grams of carbs will raise their blood sugar.

If you know that you don't see a significant rise in your blood sugar until you eat 12 grams of carbohydrate, for example, then you know that 2 grams won't make an appreciable difference in your blood sugar, and you probably don't need to test things that contain 2 grams.

Anonymous said...

hi there! i just wanna know if you guys are taking any medications on top of the diet you are doing?...or you're just doing plain diet and exercise......thanks

Jenny said...

This is a very old post, so you probably won't hear from too many people. But the devoted readers of the blog tend to be a mix of people who do it with diet alone and people who use carb control along with oral drugs and/or insulin.

Octavio said...

Hello all,

I just started following my blood sugar because
I have had dizziness after meals with a lot of carbs
and mild dizziness from the time I wake up until around 5 in the afternoon. I will see an endocrinologist in approx two weeks but I want to bring some info for him, other than my HA1C test (5.1) and fasting blood gluocose (85, 70, 90, so far)

I have found this webpage pretty interesting to read. However, I have this little piece of criticism:
when Jenny refers to ideal values for glucose concentrations (fasting, after one hour, etc..) they do not include a range, say 85 +/- 10 ug/mL.

Also, I have noticed the result of my fasting tests change whether I take it just after I wake up or I do it after 20 minutes of walking around my apartment. I am guessing too that if I eat breakfast and I go walking (I am going to do the experiment)
my reading after one hour will be different than if I sit at home enjoyng this blog.

Don't take me wrong, I think this is a honest and very nice source of information (will keep on reading), but I am a scientist and I like asking questions and performing experiments :)

PS.

Are there any studies on the effects of stress on
metabolism?

Jenny said...

Octavio,

If you can walk off carbs consider yourself fortunate. It suggests your blood sugar is still very manageable.

For most of us by the time we have a diabetes diagnosis, it takes high intensity exercise to make any kind of a significant dent in blood sugar after meals.

Elizabeth said...

My mother is very thin. She has type II diabetes. Her sugars are generally 115-120 when fasting. With a carb restricted diet, they spike to about 150 without medication. Without a carb restricted diet they spike to 250 without medication. Using 500 mg of metformin 2x per day, her BG is reduced by about 40 points from what it would normally spike to according to what I outlined above.

My question is: how can I adjust her diet to make her gain weight and/or prevent the further loss of weight. Her weight is now being maintained at about 108 lbs, but she will easily lose weight if we're not careful. We seem to feed her constantly with vegetables and lean meat. Pasta, potatoes, rice, bread, etc. all cause spikes so we avoid them. What else can I do?

Thanks for advice about how and when to test. I never got any advice on how to do it despite asking many questions. I, personally, have had hypoglycemia problems and went on the Atkins diet many years ago, so I had some knowlege about blood glucose issues. On my own, I decided to take my mother's glucose several times a day to figure out some things. You confirmed what I saw when no one else gave me much assistance. Thanks again.

Jenny said...

Elizabeth,

This is too complex a question to be answered fully in a comment here. The short answer is that fat is safe to eat as long as blood sugar is well controlled and eating more fat will help your mom maintain her weight.

Athena M said...

Jenny, I know you said this in 2007, "Don't test at 30 minutes....brief peaks at 30 minutes after eating do not correlate with an increased incidence of complications" but I just read it today and I have those 30 minute peaks and thought that should be when I test. Now I know better, thank you! I'm also reading your 101 book and it's great. I wish my older brother had found your information years ago as he has many more complications now. Thank you SO much for all you do and write. --Athena from nearby.

Nancy Larson said...

Was diagnosed April 27th with type 2. Doctor at the time advised me to test twice a week pre breakfast. But I didn't like my numbers, so I started testing once a day, always before breakfast and got readings of 125-145 after fasting for no less than 8 hours.
One night, I tested two hours after a meal and I was 105, thought I was upside down and started questioning my doctorts thinking.
I have an appointment with an Endrocronologist in three weeks and hope he can get me on schedule.
My doctor believes, exercise and diet is the answer, I believe there is something else going on here and I do NOT want neuropathy, eye problems or liver and kidney problems, so start off on the right foot, I will continue to stay there.
Has had no high sugar or lots of carbs past my mouth since April 27 and lost 17 lbs to date and enver felt better. Prior to that I was a sugar addict.

bernice123 said...

So good to find a rational site. I tend to take three hours to get below 120, but that depends a great deal on what I eat. Fasting is almost always 101 exactly. Before dinner (four to five hours after lunch) in the 77 to 95 range, normally right around 85. I had a 122 fasting test at my doctor's in June 2008. He wanted to put me on meds, but I asked him for one year to see if I could improve my situation through my own efforts. Since then I've lost 40 plus pounds and made major changes in my diet, mostly in terms of shifting portions. I reviewed my blood sugar log with him for a second time ten weeks ago and he said though I should remain vigilant, I might never need medication. This guy is very much up on his literature an more proactive than the ADA.

It helps that my favorite meal is a pile of steamed veggies on brown rice with some olive oil and real soy sauce (no sugar, wheat) along with a piece of broiled fish.

Joanna said...

This site has helped me more in my efforts to reduce my blood sugar than any other info I've ever gotten.
I'm trying to do this without med's and am encouraged greatly reading and using your great tips, finding that they are truly working for me. Plus I am better able to help my partner a lot now, he has kidney failure from diabetes, close to dialysis. There were days when I wasn't sure how to cope with any of this, but things have improved so much for us that we are happy most of the time and have a lot of hope.
Doctors gave him only 1 year to live last year, and now give him up to 3 years without dialysis and 1 year to live after that.
This is great, I will check in often and look forward to the great info I get here.

Jenny said...

Joanna, Thanks so much for stopping by and posting of your experiences. Doctors who give those kinds of predictions do so much to ruin lives, especially since they are so often wrong. Sometimes better control can improve very marginal blood sugars. Dr. Bernstein claims they can, and I met someone online who had done it. But even if they can't, many people live a lot longer than a year on dialysis. Wishing you and your partner the very best outcomes.

Princess Fiona said...

very informative post jenny!
just thought i would get some feedback on my readings...
iv been diagnosed with pre-diabetes!
my fasting readings vary between 106 - 110 and 2 hour readings around 110!
my doc has put me on glucophage to control my sugar as i am keen to start a family soon...
with medication do u think these readings are high??

Jenny said...

Princess Fiona, Those readings would make most people with diabetes happy, but they are a tad higher than normal.

Cutting back on carbs would probably help, if you haven't tried that. If you put less demand on your beta cells at meal time they can often come up with more stored insulin to take care of fasting levels.

What's going on at 1 hour after eating would be important to know. If it's under 140 mg/dl at all times, you'd be a lot better off than if it's going way up and then coming down.

tatterd said...

I want to say thanks for this blog, it has been very informative and has helped me a lot. My Dr. recently (two weeks ago) dianosed me as diabetic. I got the metformin and my blood sugar monitor but decided I wanted to monitor my BG levels for a while without the medication as my numbers were so normal. The cost of going into the diabetes education center here is astronmical--two classes of two hours each on two different weekends costs $90.00 dollars an hour, private consultation is $140.00 an hour. My insurance will not cover that so all of my knowledge is from self done research. I am not a stranger to diabetes, my first husband had it, my Dad had it and my sister has it. I am on prednisone for rheumatoid arthritis and have been since 1995. I have bad allergic reactions to other RA medications or I can't afford them even with insurance so I'm cutting down on the prednisone slowly. My problem is my BG numbers are so normal, fasting and after meals, that I even wonder if I have diabetes. I have made a complete change in my diet and have lost 10 pounds in two months, the RA is so quiet that I barely notice it, a miracle for me.
Could the dr's. be wrong? They based this decision on two tests, one taken fasting in Nov. and one not fasting in Dec. In both tests my average blood glucose was elevated but in the first test my
A1C was low, 3.5 and in the Dec. test it was 6.6 I don't understand how they reached the conclusion they did and am wondering just what's really going on. I'm still not taking the metformin and the highest my BG has been was 147 once 2 hours after a meal high in starch, an experiment. It dropped to 95 in 2 hours. Anyone have any advice? I'm bookmarking this site, it's so great to have found it both for the valuable information which has really helped and the support group atmosphere.
Deanna54

Jenny said...

Deanna, People who have RA will often see high blood sugars when their RA is flaring. I know first hand of a person who was able to normalize their blood sugar by making dietary changes that involved removing proteins that seemed to trigger the RA.

So my guess is that your dietary changes have reduced the inflammation that was causing the blood sugars to rise. Inflammation can do that.

Just keep monitoring your blood sugars. You may also be one of those people who do a lot better without gluten. There seems to be a connection between gluten and autoimmune attack on the pancreas in people who have the genes that lead to autoimmune conditions.

Wishing you the best!

ML said...

Thank you so much for such an useful info.

My question: when talking about doing the test after 1 hour, 2 hour..., when is the clock starts? Is it at the beginning of my first bite, or after I've completed the whole meal? I normally take 45 min to 1 hour to eat a meal, therefore it is important to know how should one count the time.

Thanks a lot for clarifying this issue.

Jenny said...

ML, Experiment testing the same meal at different time to find out when your highest value occurs. For most people it's one hour fifteen minutes after they start eating (I saw a study once that established it, and it matches my results) but most people eat pretty fast.

With the slower eating time, you might get a better result one and a half hours after you start eating, or even a bit later.

You want to see if you can find the highest value, because that is what you want to lower.

ML said...

Thanks, Jenny.

My highest value seems to be at 1 hour after my first bite, regardless the interval of my meal taking.

My 1 hour reading seems to be most sensitive to what I ate. But my 2-hour readings are quite similar, they are around 110, no matter what I ate.

I read in several literature, and also am told by my Dr., that the 2 hour reading is the most meaningful number. Some said, if it is below 140 (or, 160), then you don't need to worry about it. Is this reasonable?

I have high reading on the fasting blood sugar (105-115), and my A1C is < 5.9. Sometimes, my 1-hour after breakfast number is lower than the pre-breakfast fasting number.

I am not on any medication right now. But, I am told to "watch out" by my Drs.. Frankly, I am trying very hard to "watch out", but at lost of what to watch for.
Any suggestions?

Thanks in advance.

Jenny said...

ML,

Doctors look at the 2 hour value, because almost all the research focuses on that number. However, heart disease research found the one hour high the most predictive.

Most of us in the online community who have avoided complications long-term focus on that 1 hour number and strive to keep it always under 140 mg/dl and lower if possible.

The best way to do that is to cut way down on the carbohydrates you eat--sugars and starches. The technique described below will get the job done.

How To Lower Your Blood Sugar.

ML said...

Thanks, Jenny.

jess said...

Hi Jenny,
I'm trying to understand the target readings - So if I'm understanding correctly, we're trying to lower our highest reading after a meal, whether that's 1 or 2 hrs after?

So after 1 hr, we should be < 140 and after 2 hrs, we should be < 120?

My reading is 150-200 after 1 hr (so highest then), but after some exercise, can get it to 120 after 2 hrs. Do you think I should be exercising sooner after meals?

Jenny said...

Jess,

Exercising is great, but you can't do it after every meal, so I would suggest cutting back on carbohydrates at your meals so that you aren't going quite so high. When sugars are as high as 200, some of them go into the eye and nerves (which don't require insulin to take in sugar) and even if they come back out, the process over a long period damages them. So the lower you can keep that spike, the better off you'll be long-term.

MissPat said...

I think I have diabetes. It has been rampant in my family and I am 69. My resting glucose is between 95 and 110. I bought strips and a meter and am testing, tracking as you suggested in your wonderful site. My first "just a potato" test got me at 204 in an hour. since then no matter what carbs I eat, whether I eat protein or not I will get a 153 or so spike at 22 carbs. I will be below 120 at 1.5 hours and at/below 100 at 2 hours. I don't need to lose weight and am unsure how to get lower while still eating. Your thoughts?

Jenny said...

It's possible the first time you tested you had something sugary on your finger. The rest of your readings are high normal and just mean you should go a bit easier on your carbohydrate intake. But unless you see more readings over 200 you aren't diabetic.

jakp0602 said...

Hi Jenny,

I have recently started taking glyburide 5mg and meformin 1000mg after having been diagnosed with type 2 diabetes. I've read your information about keeping my 1 hour spike below 140 and I wanted to know if drinking lots of water will skew my blood glucose readings? You see I'm on a diuretic pill in conjunction with my high blood pressure medication to help control my blood pressure. This makes me constantly thirsty and in response I drink lots and lots of water, especially with meals. Will drinking lots of water say 64 oz. an hour sometimes skew my 1 hour after eating blood sugar readings?

Thank You!

Jenny said...

Jakp0602,

Drinking that much water could lower your readings, but more importantly, it could also deplete your electrolytes and be very dangerous to your heart.

You need to talk to your doctor and tell him or her that you are drinking that much water at meals. It isn't normal to be that thirsty even when taking diuretics, and could be dangerous.

Mama bear said...

Hi Jenny! Thank you so much for this wonderful blog. I have found it FAR more helpful than other other info on the web regarding target ranges for blood sugar. I'm currently 33 weeks pregnant with my second baby. I was diagnosed with gestational diabetes at 27 weeks. So far I have not been put on any medications but the diabetic counselor I am working with has suggested that I am a good candidate for meds. My fasting is almost never above 82. It generally stays in the 78-80 range. My 1 hour post prandial readings are very rarely over 120 (I would say they get this high after roughly 3 or 4 meals in the week-usually dinner when I incorporate more carbs). I have been given a target range below 120 at 1 hour. Yet everything I have read suggests that below 140 at one hour and below 120 at two hours are normal reading. At my 2 hour post prandial readings, I am almost never higher than 100. Does this sound medication worthy to you? I have a lot of anxiety just thinking about taking meds when I believe to have my diabetes under pretty good control. What are your thoughts?

Jenny said...

Mama Bear,

The blood sugar targets in pregnancy are lower than they are otherwise because the blood is diluted, but yours sound like they are still in good control. Given how little we know about the effects of almost all of the newer diabetes drugs on a fetus, you should discuss this with an obstetrician and demand very good reasons for taking any drug before you do so.

There is a lot of new research coming out which discusses "epigenetics" which is a fancy word for the way that the environment (including the mother's body) changes the expression of genes in the fetus. The effects of many drugs, like SSRIs and even NSAIDS don't show up in offspring for 20 or 30 years because no one is looking for them.

Traditionally the only drug given to pregnant women has been insulin, which is advisable if she is running sugars well over 140 mg/dl. But your blood sugars are much too low to be able to take insulin safely.

If the drug merchants are pushing new, barely tested drugs with huge side effects on pregnant women for sugars only slightly over the recommended targets they are even more venal and unconcerned about the fate of the people who enrich them than I had thought.

Penny said...

Just had Glucose fasting test. BS was 100 after fasting and then 45 2 hours after the glucose drink. Anyone know what this means

Jenny said...

Penny,

It means that in response to the huge dose of glucose used in the test you developed reactive hypoglycemia. This doesn't necessarily mean you are going low in daily life. Testing after meals with a blood sugar meter could answer that question for you.

This can be caused by insulin resistance in the presence of normal insulin production, but for many of us it is a very very early sign that our glucose metabolism isn't normal. As we get older the hypoglycemia "goes away" but is replaced with high blood sugars after eating.

Invest in a cheap blood sugar meter and try the technique you'll find described HERE. If you see your sugars going up at one hour and plunging at 2 hours after eating, cut back on the starches and sugars you eat until you see a flatter pattern. You'll feel better.

Reactive hypos make people very hungry and can contribute to the weight gain that people often wrongly blame for causing diabetes. In fact, the insulin resistance comes first and highs followed by lows can cause that hunger-driven obesity.

Pirate said...

I am new to this. My Doc says I have been too high in the morning on 2 occasions, 107 and 113. She has me doing monitoring. I am doing 1 hour after, 2 hours after, and morning. Tonight, I was 125 at 1 hour and 2 hours. I tested at 3 hours and was at 140. Do I just digest too slow? Thanks.

Jenny said...

Nerve damage to the nerves that control the opening of the stomach valves can cause delayed (and unpredictable) blood sugar highs as much of digestion occurs in the small intestine. This sometimes happens to people who have had diabetes for a long time, but it also occurs in people with normal sugars, sometimes after having a virus. If you see a pattern of the highest reading several hours in, that would be the best time to test.

That said, pasta will usually give highs late, and some combinations of a lot of fat and carbs (like pizza) can do the same.

LRK said...

I have recently been diagnosed as "pre-diabetic".... having had above normal results on two GTT. One where my fasting level was 102 and one where by 2 hour result was 143.

I have bought a meter and have been testing, sometimes 15-20 times a day... trying to figure out my ranges.

My readings hardly ever go below 100 unless it's been 4 - 5 hours since I have eaten. My early morning reading is always in the 105-115 range.

My 1-2 hr after meal readings range from 105 to 147. 147 was the highest ever.

Last night, after not eating for 5 hours, my level dropped to 88 and I could barely stand without my legs buckling. I was so weak and shaky, it was all I could do to get myself to the kitchen to get OJ.

I take metroprolol, HCZT, and lisinopril. I have read that these drugs can raise blood sugars.

I have been trying not to eat at all to get my BS below 100 but that just seems to make me sick. I ave appt. with my doctor at the end of the month but wonder what I can try, in the meantime.

Is it abnormal to always have a BS above 100? Should I really be concerned to get that number below 100 or is this going to be a slow and steady process?

Thank you for your time.

Jenny said...

LRK, The reason you feel weak and shaky at a normal blood sugar is that you are having what is called a "false hypo." You can read about what causes them and how to eliminate them HERE.

Your blood sugars are not in a dangerous level now, especially as they aren't going all that high after eating, but often when they hit the level yours are at, they keep rising, and then they do cause damage.

The best approach to prevent this from happening, if possible, is to cut down on carbs, and gradually you should see your numbers drop. As your body gets used to a lower, more normal fasting level, you won't feel bad at that level.

LRK said...

Thank you so much, Jenny, for your reply.
Is there a diet that you would recommend or a daily/meal carb limit to shoot for? I have read the South Beach diet plan is a good one to follow for blood sugar control. Do you agree or is that just advertising hype?

Jenny said...

LRK, I feel that the South Beach Diet is too generic--I prefer people start out with the technique described HERE to learn what their unique metabolism can handle, rather than eat something because some book says to.

The other problem with South Beach is that it is very vague about the actual details of how to work the diet, and if you haven't been overeating grossly before you start the diet, you may find you don't lose any weight.

LRK said...

One last question!
What are your thoughts on cinnamon supplements for lowering blood sugar numbers?

Jenny said...

I've written up what research has found about cinnamon HERE.

You can use the search feature you'll find on the main Blood Sugar 101 web site and to the right on this blog to find discussions of most topics relevant to diabetes, including foods, medications, and treatments.

LRK said...

Thank you for all your time. I'm learning so much from your site.

Pirate said...

Here is another weird item. I had been drinking some wine daily at dinner, 2 - 3 glasses. My morning levels were usually around 105ish. I stopped the wine. Within a day or two, and for a week later without wine, my levels were always below 100. Everything I read says that wine consumption should actually lower the level but mine goes up. Any ideas? Thanks.

Jenny said...

Pirate,

Everything we all read needs to be tested, because diabetes is NOT a single condition and each of us who has high blood sugar has our own unique underlying reason WHY the sugars are high.

Your experience validates this. Alcohol might lower blood sugars if they are high because the liver is using gluconeogenesis to overproduce glucose while we sleep as drinking blocks gluconeogenesis, but not if something else is going on.

Nyx said...

Hi, Jenny. Thanks for the helpful information. I am a little confused by my own meter readings. I had borderline gestational diabetes 5 years ago (by borderline, that means the ob/gyn said I didn't, but the endocrinologist said I did, because they used different guidelines and I was on the edge). Since I've been feeling bad, I decided to test my blood sugars, hauled out my old meter, and discovered that my morning (fasting) levels were in teh prediabetes range (per various websites). I got concerned about it, but then the battery died. I was thrilled when the last couple of days they were only 85 and 83 in the morning. I was so relieved, because per your website that seemed to be normal. But then when I started testing after meals ... uh oh, it's over 140. an hour and a half after breakfast it was at 156. But when I look at the sample curves you provided, I don't see anyone who has a normal level in the morning but then a high spike after meals. Does this suggest anything in particular? I really would appreciate knowing if you think it is common or if it fits ....

Jenny said...

Nyx,

What you describe is a very common pattern. It is described at length on this page: The Patterns in Which Diabetes Develops

Nyx said...

thanks so much for replying and even so quickly! and for pointing me to that page. I'm still trying to digest it (it's hard!!!), but hopefully this will help me understand what's going on. It is sad that I feel like I can't necessarily rely on a doctor to tell me everything.:( Maybe I could, but I don't really know how to find a good doctor ....

Nyx said...

Hi, Jenny, I finished reading that page, and it sounds like I need to do a glucose tolerance test to check for impaired glucose tolerance. But I'm still a little confused by just how very low my fasting glucose was the last 2 mornings! The study you talk about near the end sounds like the people with normal fasting glucose who went on to develop diabetes, still had slightly higher than normal fasting glucose, but mine was in the low 80s! But I guess I'll have to see what the tolerance test says ....

Jenny said...

Nyx, All of us have trouble finding good doctors. Family doctors don't get specialized training in diabetes. They just get visits from drug company reps who tell them about the latest drugs. Their med school training is very limited and few of them update it over the years. What we know now is quite different from the common wisdom back in the late 1990s.

Hang in there, though. There are a lot of people online doing very well and the techniques that it takes are not all that complex. Fortunately.

Nyx said...

thanks, Jenny, you're very nice.:)

Sheila said...

I was just diagnosed with pre diabetes. My fasting level was 109. Got a meter and tested after lunch half a chicken salad sandwich and apple juice, it was 179. Two hours out it is 120.I know what I ate wasn't the best thing to start with, but I wanted to see what it would be if I ate what I normally ate. When should I test again? Sheila

Jenny said...

Sheila,

Try eating the same sandwich with half the bread and see what happens. Your goal with testing is to figure out how much carbohydrate you can eat and still get normal numbers. This simple explanation should help:
How to Lower Your Blood Sugar.

gwinivere said...

I always have fasting in the 100,s in the last two months it's been up to 126 and 137 fasting twice. One hour after meals have been up to 200 . Three time over, 204 to 235. Do I have diabetes.

Jenny said...

Gwinevere, Very likely you do. The standard definition of diabetes is a fasting blood sugar over 125 mg/dl or repeated random readings over 200 mg/dl.

Try the strategy described here: How To Lower Your Blood Sugar. If that doesn't get your sugars back down into the safe range you need to see your doctor.

Cordypants said...

Hi there. Just looking for some insight.

Type 2, no meds.
My fasting level is usually 5.9, and I've always tested 2-3 hours after meals, usually in the 5.5 - 6.5 range. Only going above when I've had starchy foods like pasta & admittedly overindulged.

I was never ever told to test 1 hour after eating. I was told that that number doesn't matter because "everyone spikes after a meal" and that as long as I was under 7 whenever I test, then I'm in control. Because "it's only when above 7 for prolonged periods of time is when damage occurs".

Those quotes came from 2 different endocrinologists. One was the head of endocrinology even at that particular hospital.

In any case. I randomly tested my blood this morning 1 hour after having two pieces of toast, and my number was 8.9. Normally I wouldn't pay any attention to this because when I test at the two hour range, I'm back below 6.5. Or under 5.5 depending on what I ate.

So I don't really know what I'm asking actually. Just looking for some advice. I'd like to stay off meds.

Jenny said...

The same endocrinologists who tell you that spikes don't matter are the ones who tell you everyone with diabetes gets heart disease and other complications.

I occasionaly hear from doctors who have been diagnosed with diabetes, and they universally express shock at how wrong what they told their patients turned out to be, once they started testing their own blood sugars and looking more carefully at the research.

"Everyone" normal does spike after meal, but no higher than 160 and they are almost all down to about 120 or less by an hour. Those at the top of the range may be on their way to pre-diabetes, too. See the graph HERE to see this documented.

LRK said...

Hi Jenny. I wrote here on the blog, at the beginning of the month, when I had just started learning about my blood sugar problems.

I took your advice, read the pages on your site, and I am happy to report that in that time I have been able to bring my sugars down to the normal range... usually close to 120 after meals and in the 70-90 range when doing random testing.

My one remaining problem is my fasting sugar. It can be as high as 120 in the mornings, usually 105-115. I have found, however, if I either eat dinner very late (an hour before bed) or have a carb snack just before bed, I can bring that number down to the 95-105 range. I will have to play around with this.

I am curious about something though. Let's say I continue to watch my diet, continue to exercise, and keep my sugar levels perfect for the next 6 months. At 6 months, I am scheduled to have another glucose tolerance test... will that test still show a problem or will my body, at some point, regain its ability to metabolize the sugar?

Thank you for all the information that has helped me learn how to control this!

Jenny said...

LRK,

Most of us find that when we control our blood sugar with diet it doesn't alter how we respond on a glucose tolerance test. Our bodies rarely recover the ability to process carbohydrates. But this is true of every supposed diabetes cure, including WLS, where people's diabetes only goes away as long as their stomachs are too small to hold more than a tiny amount of carbohydrate.

Very occasionally, people who lose a lot of weight will report better glucose tolerance, but that isn't common.

The good news is that our likelihood of developing complications stems not from our glucose tolerance test results but from our blood sugar level over time as it is continual exposure to high blood sugar that damages nerves, etc.

One last note, if you have cut your carbs down to a very low level--under 60 grams a day, for example, your body may downregulate the enzymes needed to process a lot of carbs and that can give a falsely high reading on the Glucose Tolerance Test. That is why people on such diets are advised to eat about 100 g a day of carbs for the 3 days before the test.

LRK said...

I'm a bit disappointed to hear that I will never be "cured" as some of what I have read will suggest, but I can live with that, and will continue to work on control.

I try to eat fewer than 20 carbs a day. Are there any dangers or health consequences in doing that?

Jenny said...

LRK,

It is safe to eat a very low carb diet, but many people go through a cycle of enthusiasm, followed by burn out. The important thing is to maintain control, so if you find you carb intake creeping up to where your blood sugars are going up too high it might be time to check out the safe drugs that can help you keep the carbs in range.

A lot of us who have been at this for a very long time find it much easier to maintain at around 100 g a day rather than 20. I ate at a level between 45 and 60 for several year but I feel better at a slightly higher level, though I do need to take meds if I eat that much carb.

Re "curing" diabetes. The people who claim you can do this are ALWAYS people who do NOT have diabetes. What they do have is something they want you to buy.

Unknown said...

Hello Jenny,

I am 35 years old and over weight, I also had gestational dibetes with my son when I was pregnant he is now 21 months old. I have been having issues with feeling light headed and dizzy when I have eating deserts and things so I started tracking my blood sugar.

An example of my fasting #'s this week M-140, T-145, W-201, T-148, today 161.

I have taken random 1-2 hours after eating and they have been 180-360. This is on a low carb no sugar diet. I was not tracking prior to stopping sugar. (I stopped soda and sugar on the day a fell over and passed out because I was dizzy from not eating breakfast)

My A1C was 6.9 but the thing that bothers me is my Doctor states that I am not diabetic. Should I be seeking a second opinion.

Melanie

Jenny said...

Melanie, You MUST get a second opinion. Those fasting blood sugars are well into the diabetic range and if you are getting readings that high while eating a low carb diet, it is possible your pancreas has stopped making insulin.

Many doctors don't understand how greatly a low carb diet lowers blood sugars. If yours are that high while eating low carb, they would be dangerously high were you to eat carbs and could land you in the hospital.

See another doctor as fast as possible and ask to be tested to make sure you are making insulin. You should also be given treatment to lower those sugars as quickly as possible. Insulin might be the way to go since it is the best drug for lowering blood sugars that stay high in the absense of carbohydrates.

Abraham said...

i have heard you can use expired strips up to four months after expiration, is this true? how inaccurate of a reading would strips give after expiration date?

Jenny said...

Abraham,

I don't know the answer for that. The story on the dates on any product is that this is the date after which the manufacturer doesn't guarantee quality.

However, I suspect that some shipping conditions can make strips inaccurate. When I have been mailed strips by the manufacturer they have often given abnormally high readings compared to those I buy at the pharmacy. Perhaps that is coincidental, but it has happened to me at least 4 times over the past decade.

Darkcandle said...

I had the same problem, and at first my Dr.didn't believe I was spiking that high, so naturally, I brought in my charting which showed my last reading before bed as 142. Morning reading at 187! Two full weeks of similar readings later, Dr. suggested I have a snack of no more than 20g of carbs no less than 30min before bedtime. It has helped me alot, but I would talk to your physician about it as you may need to take some insulin medication at night to regulate your blood sugar. I don't know your history, just telling what worked for me. Hope it helps. Good luck.

Abraham said...

just picked up the Accu-chek nano and started using it. its good, BUT, I have been doing two readings. One on the Nano and one on the freestyle lite. They are off by 30-40 points. talk about shady.

@darkcandle: I will try the snack as you said, I am vegan and recently added egg white and whey protein to my diet. just to see the effects. The egg whites have helped. Been using vegetarian fed free range fertile eggs. Saw a new Endo and was told insulin is 98% likely in my case now and we will give it a month. My previous Doctor was sleazy, he told me "type 2 diabetics never need insulin. Type 2 is because you eat junk and are obese". HAHAHA. people who have seen me know I am not obese by a long shot, and have been doing caveman workouts three times a week for over 6 years. I was diagnosed three years ago. So, scratch obesity and lack of exercise.

Jenny said...

Abraham, I am baffled at why Dr. Bernstein, who I otherwise respect so much recommends the AccuChek meters. My experience with them is that they are abysmal.

My ongoing experience with the FreeStyle is that they vary from container to container but are consistent within the container. Ridiculous for what they cost. I've been using strips for 14 years now and it often seems that they are less accurate than they were back then though they cost twice as much.

Runner said...

Hi - I am 54 year old very slender female. 5 ft 4" and 115 pounds. My sister was diagnosed with Lada. She is 5 ft 6 and 105 pounds. Have been taking blood sugar as suggested by your web site and following are numbers

a1c 5.5. FBI 107
Bought strips and began testing.
Ate ahi sushi and 1 hour post meal was 224 2 hours post
129
If I watch what I eat ie salads and such the 1 hour post can stay under 140. If there are carbs such as bread on sandwich or Frozen yogurt or oyster crackers at fish blood sugar will get as high as 229 after 1 hour but fall back to under 120 by 2 hours.
Test fasting every morning and seems to hover around 100 now that I am watching diet..
Blood sugar usually spikes to 150-170 range after most meals that arent extremely low carb.
Dr. has told me that my numbers are in normal range. After reading your site it seems that number should not go above 140.

Now trying to change diet and retake a1c and Fbg in 3 months. Should I be asking to take the Oral glucose test?

Jenny said...

Runner,

There's no reason to take a glucose tolerance test unless you are in the habit of chugging glasses of glucose. What damages our organs are the post-meal blood sugars we experience day in and day out. Control those and you should avoid problems.

That said, with the family history of LADA it is very likely that's what you have. I hope your doctor tested for the relevant antibodies. If you have LADA it would be a good idea to start learning about how to use insulin properly. You might not need it for a while, but the more you know, the easier it will be to get excellent control and eat a diet you find enjoyable.

Eva said...

Hi Jenny,
I have been testing my blood sugar after meals and logging my food choices in order to help control my blood sugar readings. Recently I went to my doctor to tell him that I have concerns about my readings and symptoms. I also have a family history of diabetes on both sides of my family. He told me flat out that I should test myself before meals not after. This made no sense to me but he was emphatic. He said that it is perfectly normal to have spikes and readings of 10 and over after meals. Is he out to lunch?

Jenny said...

Eva,

Your doctor is giving dangerous advice, but it is the American Diabetes Association line which is also picked up by WHO.

The same people who tell you it is normal to spike to 10 mmol/L (180 mg/dl) are the ones who tell you that people with diabetes have a much higher risk of heart attack than normal people, damaged immune systems, and are very likely to develop retinopathy and nerve damage. All those side effects are caused by blood sugars that rise over 7.7 mmol/L (140 mg/dl).

The data that support this conclusion are presented HERE and HERE

Testing your blood sugar before meals rather than after them is an old technique that was useful only to people using a now-outdated insulin protocol that dosed based on pre-meal blood sugar levels. It didn't work well and led to hypos.

Amanda Ogilvy said...

Hi there, I have recently become concerned that I may have Type 2 (many of my family have diabetes and I have become extremely run down over the past year/recurrent oral thrush etc) so I tested my sugar levels 2.5 hrs after eating yesterday with my brothers unit and it read 7.9 .... is this ok? He didnt seem too fussed and said that's normal but after reading your information above 7.9 for a non diabetic is not normal ? Thanks for any help/advice you can offer, I think I shall go to the doctors to confirm all is ok.

Jenny said...

Amanda,

Doctors will tell you it's "okay" but it isn't if your goal is to avoid heart disease. You can read about what blood sugar levels cause heart disease here: http://bloodsugar101.com/15945839.php .

Fortunately, you don't need a doctor's help to improve the situation. You can learn how to lower your blood sugar to safer levels here: http://bloodsugar101.com/how.php .

Tammy Ball said...

I just was put on medication yesterday Metformin 500 mg once daily for type 2 and now I have to check my bc twice daily. This website has really helped me. I just got my machine and checked it for myself for the first time late afternoon 3 hrs after I ate a blt on wheat bread and it was 125. I wonder if the meds are already in my system after 2 days. Any comments, throw them at me. Tomorrow I will check 1 hour after breakfast then 2 hrs after dinner.

Jenny said...

Tammy,

Metformin starts working the day you take it, but it builds up over 2 weeks and becomes a bit more effective. Doctors usually start people on a low dose to allow their digestive systems to adapt, but most people will need a daily dose of 1000 to 2000 mg in order to get the maximum benefit.

Now that you know your 3 hour reading is decent, it would be a better use of your strips to test at 2 hours and if that is good at 1 hour. The most important reading to lower is that 1 hour reading which you would like to see under 140 mg/dl as much as possible. That will do a great deal to prevent complications.

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