# Is there a risk to slightly elevated glucose with normal A1c? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [April 21, 2025, 4:58am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292 "2025-04-21T04:58:02Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Procrustus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/procrustus/32/2994_2.png) [@Procrustus](https://boards.straightdope.com/u/Procrustus)\ **Post date:** [April 22, 2025, 1:00am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/21 "2025-04-22T01:00:28Z")
Is pizza really that bad for you? Please say no. ---
**Author:** ![LSLGuy](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lslguy/32/5813_2.png) [@LSLGuy](https://boards.straightdope.com/u/LSLGuy)\ **Post date:** [April 22, 2025, 1:38am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/22 "2025-04-22T01:38:34Z")
Asks the guy with “crust” as the middle of his name. 🙂 IANA medical anything, but IMO pizza is pretty much pure concentrated awful from a nutritional POV. ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [April 22, 2025, 1:50am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/23 "2025-04-22T01:50:44Z")
Pizza doesn’t seem like much of an outlier compared to other normal foods, like sandwiches, pasta, anything with white rice, anything potato based, etc. Sure, a problem if you’re already diabetic but otherwise doesn’t seem like a big deal. You wouldn’t want that to be the _only_ thing you eat, but that’s true of anything. ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [April 22, 2025, 2:27am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/24 "2025-04-22T02:27:41Z")
Exactly the best advice. If you’re doing it purely for science and to occupy yourself. I say go for it. Either way, _“if”_ you were to become diabetic theres no real humanwide baseline. My diabetes is not _your_ diabetes. It’s challenging to create your own normal because so many things change, everything. Sometime multi-daily sometime over a period of time. Eating. Exercise. Digesting. Gaining or losing weight. Hormones. Pregnancy. Emotional upheaval, of any kind. Travel. Hydration. Temperature. Weather of all kinds. Illness. There’s so many balls in the air and you’re just trying to stay in some kind of balance. Good luck on your experiments, though. ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [April 23, 2025, 3:17am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/25 "2025-04-23T03:17:04Z")
> [@LSLGuy](#): > > I know that idea sounds pretty off-putting at first, but after a bit of practice / experience finger sticks are no big deal. The CGM is still on its way, but the fingerprick meter (a Contour Next One) arrived and I gave it a shot. Attempt 1 was a failure–not enough blood and trying to add more just smeared it around. Used the “3” setting on the fingerprick device. For attempt 2 I massaged the finger a bit more to get a larger droplet, but it still wasn’t enough at first. I tried adding more and it did finally give a reading, but only 57, which seemed like a mistake. In both cases the blood stopped flowing in \<30 s, so there wasn’t much opportunity for a large drop. For attempt 3 I cranked the fingerprick device up to the max 5 and finally got a decent drop of blood (and it kinda hurt, too). That gave a reading of 88, which seems… reasonable. It’s been ~24 hours since my last meal and about 7 hours since my coffee, which had some cream and sugar. Anyway, I guess this is fine but I’m not too impressed at the bad reading. I’ll eat and try again after. ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [April 23, 2025, 3:28am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/26 "2025-04-23T03:28:14Z")
Low BG. LOW BG will kill you. It can happen incredibly quickly. You have 88. Something happens you get a dip. Before you realize it you’re too low and you are laying on the floor. Good luck convincing a passerby to help. They’ll either think you’re drunk or infected with something. You’ll die before anyone figures it out. Without lots of luck. That’s too low for walking around, trying to do something. I implore you to spread your meal out into several small meals. I’ll sleep better if you find out your meter is calibrating or glitching. Oh, the finger lancing is a learned thing. It gets easier. Try your pinky. They generally bleed good. Pince it at the joint before sticking. ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [April 23, 2025, 3:55am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/27 "2025-04-23T03:55:27Z")
Isn’t 88 a perfectly normal daytime reading? Most sources I see seem to think that’s reasonable for both fasting and non-fasting cases. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [April 23, 2025, 4:12am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/28 "2025-04-23T04:12:42Z")
> [@Dr.Strangelove](#): > > Isn’t 88 a perfectly normal daytime reading? Yes. 70 is normal too. Yes you need a good drop of blood. If you get that good sample it is a more accurate number than the CGM provides. The CGM though will give you the trend data you are curious about. Anyway you have now already proven that your actual FBG is under 100. The open question might be if your morning level over 100 is a Dawn phenomenon (response to morning hormone shifts normal for circadian rhythms), or a Somogyi phenomenon - meaning your intermittent fasting is causing true low blood sugars in the middle of the night and it is coming up as a rebound to that. ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [April 23, 2025, 4:18am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/29 "2025-04-23T04:18:42Z")
Thanks. I’ve had my taco dinner. As **LSLGuy** suggested above, I’ll take some more readings 30, 60, 90, and 120 minutes after. And when the CGM arrives I’ll be able to compare one against the other. The morning trend should be interesting. As well as if anything odd happens overnight. ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [April 23, 2025, 4:25am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/30 "2025-04-23T04:25:21Z")
_Normal_ is relative to your system. If you ride low it is perfectly ok. 88 scares me. I get goofy about 85. I go down well before 70. I’m anxious to see your readings. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [April 23, 2025, 5:04am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/31 "2025-04-23T05:04:39Z")
My A1c crept into prediabetic range, and i, also, got a cgm to play around with. 15 days of reasonably accurate measures is cheaper than a single A1c test. Which seems crazy, honestly. I also suspect you are seeing the dawn effect. What i learned from the cgm: - Sleep matters a lot. My glucose drops reliably when i low down and close my eyes, even if i don’t quite sleep. It rises sharply shortly after i wake up, which i believe is normal and healthy. - Stress matters a lot. Driving in heavy rain? My glucose surges. - It takes more exercise than i expected to lower my blood sugar. Amble around for an hour? Not much impact. Walk briskly for 20+ minutes? My glucose drops. Strength training? No impact. - After a meal i get a spike, but it generally drops quickly after that. Unless i overeat substantially, in which case my blood sugar can stay high-ish for an extended period. A really sharp rise means a really sharp drop – I’m not diabetic. A more gradual rise can lead to lingering high glucose levels. I think this is different for people who actually have diabetes. (I was sharing values with a friend with type 2 diabetes who was playing around with a cgm the same time i was. Certainly his patterns were very different from mine.) By the way, a continuous glucose monitor measures glucose in interstitial fluid, which is intrinsically a different value than what’s in your blood. What matters most for you overall health is glucose in arterial blood, but capillary blood is a better proxy than interstitial fluid. Also, there’s a lot of noise in these measurements, because a lot of things influence glucose levels. I saw a study that found that the pattern of high glucose was different between finger sticks and cgms, and the authors were all in a tizzy that people might make bad decisions as a result. But having a background in reading data, i think the real story was that all the things they were measuring were functionally the same, and random noise overwhelmed any real-but-insignificant differences. Also, they are pretty good in terms of showing patterns, but the absolute levels can be off by 8-10%, which can certainly be the difference between prediabetes and normal. Anyway, i was clearly prediabetic. My fasting blood sugar, A1c, and my first 2 weeks on a CGM are all consistent with prediabetes. I wore it in large part to decide whether to go on metformin. I need to download all the data and send it to my doctor, but my initial impression is that the metformin moved my numbers from pre-diabetic to pretty-damn-normal. I’m old enough that it’s still not clear that it’s worth taking metformin, so that will be a discussion. (It takes a while to move from pre-diabetes to diabetes, and perhaps something else will kill me first.) Also, wearing a CGM taught me that i really need more aerobic exercise in my life. “Getting enough steps” and strength exercises are no-doubt good for me in other ways, but they just don’t cut it for reducing blood sugar. Which suggests that’s something l should do more often. I didn’t learn anything actionable about my diet. In theory i should improve my sleep hygiene, but i don’t see that actually happening. I suspect you are worrying about nothing. But a CGM is cheap, and may very well give you enough information to stop worrying. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [April 23, 2025, 5:10am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/32 "2025-04-23T05:10:31Z")
> [@Beckdawrek](#): > > _Normal_ is relative to your system. > > If you ride low it is perfectly ok. > > 88 scares me. > I get goofy about 85. > I go down well before 70. > > I’m anxious to see your readings. YMMV, but i felt great at 88. I felt fine at 70. Perfectly functional. Maybe a little tired. I got readings lower than that in the middle of the night, but the OTC monitor i used isn’t rated for levels below 70 and may not be accurate. ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [April 23, 2025, 6:19am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/33 "2025-04-23T06:19:00Z")
I probably should just shut up. My diabetic experience is different than Type 2. Plus I’m very brittle. I’m in compliance as best I can be. I’m at a stage, now were its a series of putting out little fires, everyday. Dialysis days are always a challenge. Yeah. I’ll shut up now. ---
**Author:** ![Dr.Strangelove](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dr.strangelove/32/6613_2.png) [@Dr.Strangelove](https://boards.straightdope.com/u/Dr.Strangelove)\ **Post date:** [April 23, 2025, 6:50am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/34 "2025-04-23T06:50:34Z")
> [@puzzlegal](#): > > I also suspect you are seeing the dawn effect. Thanks for the good info. That or the Somogyi phenomenon definitely seem like the best explanations. As for my readings today: Pre-meal: 88 30 min after finishing meal (about 60 min after starting): 131 60 min: 126 90 min: 114 120 min: 120 150 min: 100 Maybe a bit of measurement error on the 120 min figure–or some kind of double spike–but regardless, this all seems like normal levels of post-prandial glucose levels. I don’t think I’m killing my pancreas with my OMAD eating habit. Carnitas tacos for dinner. As a guess, around 1500 cal, with 400 from the flour tortillas. Pretty fat/protein heavy. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [April 23, 2025, 2:00pm UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/35 "2025-04-23T14:00:11Z")
> [@puzzlegal](#): > > I’m old enough that it’s still not clear that it’s worth taking metformin, so that will be a discussion. (It takes a while to move from pre-diabetes to diabetes, and perhaps something else will kill me first.) Pretty sure we’ve had this discussion but worth revisiting. Metformin is interesting. Full of on the one and on the other hands. On the one hand it works well to reduce the risk of moving from prediabetes to diabetes and increases the odds of moving the other direction. OTOH so does a healthy diet and a balanced exercise plan. But metformin _may_ do more than that. It may, by other mechanisms, also slow the generic aging process and reduce risks of a whole basket of diseases of aging. Very suggestive evidence and a larger trial “Targeting Aging with Metformin” ([TAME](https://www.afar.org/tame-trial) but where does the E come from?) is aimed at earning an official indication for that purpose. OTOH _so does a healthy diet and a balanced exercise plan_! That with more than suggestive evidence. And with a wider basket of benefits. And unfortunately doing both does not seem synergistic or even additive. Metformin appears to blunt the body’s adaptations to exercise. > [@puzzlegal](#): > > Strength training? No impact. You are likely seeing impact of strength training on lowering prediabetes to diabetes risk. In longer term adaptations, not immediate response. Over time more lean body mass is a bigger reservoir to respond to insulin; it is less of a stimulus for an immediate drop in blood sugar though, could even trigger some mild elevation in response to the short moderate stress. (Moderate stress followed by adequate recovery is in general a good thing.) > [@Dr.Strangelove](#): > > That or the Somogyi phenomenon definitely seem like the best explanations. FWIW (nothing but I wonder) I have no idea how low an asymptomatic low blood sugar in the wee morning hours (that triggers the Somogyi rebound) would have to be to be of any concern in a non diabetic. Or if intermittent fasting alone could get someone to a concerning level. I don’t _think_ so? ---
**Author:** ![Beckdawrek](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/beckdawrek/32/3647_2.png) [@Beckdawrek](https://boards.straightdope.com/u/Beckdawrek)\ **Post date:** [April 24, 2025, 1:02am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/36 "2025-04-24T01:02:07Z")
I thought the Somogyi effect was just for people on Insulin. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [April 24, 2025, 1:16am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/37 "2025-04-24T01:16:22Z")
> [@Beckdawrek](#): > > _Normal_ is relative to your system. > > If you ride low it is perfectly ok. > > 88 scares me. > I get goofy about 85. > I go down well before 70. > > I’m anxious to see your readings. I’ve had issues with hypoglycemia. For me, early warning signals that my blood sugar is low are basically the following: - Getting a song stuck in my head (not sure why this happens, but it does) - trembling hands (my body releasing adrenaline) - faces on the TV start to look scary (a sign of my body releasing adrenaline) If it progresses I get confused. However I’ve never passed out from it luckily. I’ve had readings in the 50s mg/dl and my worst symptom was moderate discomfort. However I didn’t remember to take my readings when it was even worse than the moderate discomfort I get in the 50s. I have known people who were up and walking with readings in the 30s. Looking online, some people said they were walking around in the 20s. When it gets bad, it takes a couple hours to fully recover from after I eat. The articles saying it’ll be fixed in 15 minutes aren’t accurate for me. I guess it takes my body a couple hours to fix the damage. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [April 24, 2025, 1:41am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/38 "2025-04-24T01:41:49Z")
That’s my “I think so.” And I really do. It’s the usual context. But I am not sure it is absolutely true. ---
**Author:** ![puzzlegal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puzzlegal/32/3827_2.png) [@puzzlegal](https://boards.straightdope.com/u/puzzlegal)\ **Post date:** [April 24, 2025, 3:01am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/39 "2025-04-24T03:01:42Z")
> [@DSeid](#): > > You are likely seeing impact of strength training on lowering prediabetes to diabetes risk. In longer term adaptations, not immediate response. That’s probably true. And it’s not as if i was contemplating dropping the weight lifting just because it doesn’t lower my glucose. But i do it primarily so i can do shit (lift things, carry things, move my body in useful ways, etc.) not for metabolic health > [@DSeid](#): > > And unfortunately doing both does not seem synergistic or even additive. Metformin appears to blunt the body’s adaptations to exercise. So long as metformin plus exercise isn’t notably worse than exercise alone, i don’t really see an issue with that ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [April 24, 2025, 3:33am UTC](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292/40 "2025-04-24T03:33:21Z")
> [@puzzlegal](#): > > So long as metformin plus exercise isn’t notably worse than exercise alone, i don’t really see an issue with that Depends on what’s measured but probably not reaching a notable level. Several articles like [this one](https://www.researchgate.net/publication/51758214_Independent_and_Combined_Effects_of_Exercise_Training_and_Metformin_on_Insulin_Sensitivity_in_Individuals_With_Prediabetes) with slightly less impact on insulin sensitivity in prediabetes when both compared to exercise alone. But none individually reaching statistical significance, let alone “notably”. A bit stronger of a case for metformin slightly blunting the [response to strength training](https://pubmed.ncbi.nlm.nih.gov/31557380/) in elderly adults. But statistically significant may not be clinically meaningful. [Previous page](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292.md?page=1) [Next page](https://boards.straightdope.com/t/is-there-a-risk-to-slightly-elevated-glucose-with-normal-a1c/1017292.md?page=3)