Please explain high blood glucose reading.

In My Humble Opinion
1

Obligatory disclaimer, none of you are my physician, and if my busy physician had the time I would ask him, but I usually have other issues to talk to him about. I don’t think this is a vital question, but it’s bugging me.

I have had Type II Diabetes since 1997. I have never had a good understanding of all the mechanics of the disease. I have learned that potatoes, rice and pasta make my sugars spike, gravy and other savory foods as well. It’s not all about consuming processed and/or sugary food.

What I do not understand is why, when I do not eat, my blood glucose readings are so high. I have had nothing today except for unsweetened iced tea, I just checked my blood, and it’s 209. That is with two doses of two oral meds (morning Metformin 1,000 mgs and Actos 45 mgs and evening just the same amount of Metformin). I will inject 40 units of Lantus at 9:30. So why is my blood sugar so high? frustrated

2

In 17 years, your doctor has always been too busy to discuss this with you? And you don’t think this is a vital question?

3

Thank you for you oh so helpful comment.

4

Do you only use insulin once a day? You may need to do twice a day for better control.

Someone who knows more will hopefully say whether this is too over simplified:
Glucose in blood comes from the liver. If you don’t eat, your liver is still putting glucose into your bloodstream for your muscles and brain to have energy to function. Your pancreas aren’t producing enough insulin to balance any excess glucose, or your fat cells are causing resistance to what insulin the pancreas are producing, even if it’s enough. So you have to take extra insulin to make up for the insufficiency or resistance, plus you have to eat regularly so your liver isn’t dumping glucose when it’s sensing you’ve gone too long without food.

5

When you haven’t eaten for a while, its no longer the food providing glucose directly

Its probably your liver providing the glucose, and the fat, muscle cells are not taking it up.

However these can be either caused by low insulin, or any or all of the three cell types (liver,fat,muscle) ignoring the insulin.

So its too complicated for us… you need your doctor to tell you what the tests say.

You might be getting worse, type II does get worse as insulin resistance comes into play.

Did you manage to control obesity ? You could deny your liver the fat that it would use to make glucose…

6

When you eat, your body takes your food and makes it into sugar and sticks it in your blood. The insulin, either from your pancreas or your shot, acts like an key. Your cells have membranes covered in special insulin receptors. They’re like the “lock” on the cell membrane. The insulin fits into the lock and “opens” the cell membrane, allowing the sugar in your blood to go into your cells. Sometimes these insulin receptors get wrecked and the insulin won’t open them anymore. This is called “insulin resistance.”

The number on the glucometer is how many sugar molecules are in a small amount of blood. The higher the number, the more sugar is hanging out in your blood and not going into your cells where it can be used. Two things can cause high blood sugar levels: not enough insulin (not enough keys for the locks) OR not enough insulin receptors which are unlockable by the insulin. If you have enough insulin, but your cells are insulin resistant (their “locks” have been broken so that insulin can’t open them) then even if you have enough insulin, the sugar still can’t get in.

Diabetes is usually a combination of issues: not enough insulin and too many broken insulin receptors. Type I diabetics don’t make any insulin at all, and always need to get it from a needle. Their insulin receptors are usually in pretty good shape, at least for many years after their diagnosis. They have to check their blood sugar a lot and make sure they’re taking enough insulin, but once they take their insulin, their body responds pretty quickly and their blood sugar comes down. Type II diabetics may be making some insulin, but their insulin receptors are damaged. They often need to increase their dose of medicine insulin to get enough insulin in to really crank those locks that are left. They don’t always respond as well to insulin, and can keep high blood sugars even after they take it. There just aren’t enough working locks, even with the insulin. Your Actos is supposed to help fix these locks, or signal your body to make more of them (I forget exactly how, but it decreases insulin resistance.)

Usually, as you’ve figured out, your body makes sugar in your blood from food.* When you don’t eat for a while, your body releases this stuff called glycogen and turns it into sugar, like **Isilder **said. So even though you haven’t eaten sugar, there’s now sugar in your blood. It needs your insulin (from your body or your needle) before it can get into the cells.

It takes a few hours of not eating for your body to decide you’re obviously starving to death and to release glycogen. So that’s why you can sometimes take your blood sugar and it’s reasonable, and then even without eating anything, your blood sugar will go up. Your liver decided to save you and release stuff that turns into sugar in your blood. Your metformin is designed to repress this action of your liver and reduce how much glycogen it puts out, but it can only reduce it, not eliminate it.
*ALL food will raise your blood sugar, sweet or savory. Sweets raise it more quickly because food sugars are very easy to turn into blood sugar, so it does it fast. That gives your body less time to put out what insulin it can to start opening those locks. Protein and fat can also be turned into blood sugar, but it takes longer because there are more steps to the process. It’s not your body’s first choice - it would rather turn those sugary foods into blood sugar - but if all you eat is protein and fat, you’ll still see a blood sugar increase.

7

Medical questions are best suited to IMHO.

Colibri
General Questions Moderator

8

I’ve seen gravy recipes with a ton of sugar (or honey). “Sugary” does not equal “sweet”.

Other people have given more detailed explanations, but re. spikes, you’ll be more likely to get one when you’re eating simpler sugars (often called “faster” because they’re digested faster, they get to blood faster) such as table sugar, fruit, honey, syrup, starches that have been cooked a lot… than more complex ones (wholegrains, pasta al dente rather than mushy).

9

Gravy also usually has flour.

10

I’m getting the impression (possibly wrongly) that his glucose readings are as high if not higher when he starves himself than when he eats regular food. Does the liver produce glucose at that kind of amount? The liver only stores about 100 grams of carbs in glycogen. I guess there is gluconeogenesis too.

I think a person normally only has about 4-5g sugar in their blood when their readings are normal. So maybe it is possible, but I have no idea how it works. If he has a reading of 209, that would work out to about 10g of sugar in his bloodstream. Does liver glycogen and gluconeogenesis produce enough sugar to keep readings high w/o food?

11

Are you seeing an endocrinologist in addition to your GP? Your post makes it sound as if you’re not, and you should be. My GP treated me for type II diabetes for months, when it turned out to be late-onset type I, only diagnosed after he gave up and referred me to an endo.

12

Okay, first I am a she, not a he. I will keep this as brief as I can.

When I was still living in Alaska, married to a commercial fisherman, I had no trouble with getting seen by my GP, and it was he who dx’d my many health issues, and getting the medication I needed. I went from very healthy, active Alaskan woman living in the Bush, to moving into town (Kodiak) from the village (Larsen Bay). After living in town for four years I became increasingly ill. Yes, I did gain weight in part because of my decreased activity (stay at home mom, no longer having to get firewood, butcher meat, and the rest of the very active lifestyle I was used to) and in part because my husband felt that if I was fat then he wouldn’t have to worry about me cheating on him while he was out fishing. That was his guilty conscience nagging at him, but still, I did put on weight and that is ultimately my fault.

I became disabled while married, and there is a laundry list of issues with my health, severe arthritis, spinal stenosis, degenerative disk disease, sle/undifferentiated autoimmune disorder/fibromyalgia, hypertension and Type II diabetes, etc. I am dependent on a walker or a wheelchair, and during my last trip to the physical therapist she told me that I am no longer safe walking with just a cane in the house. I did the pain pill thing for six years, which nearly killed me. I quit morphine cold when my GP told me that the pills were going to kill me. It was hell, and I now take meloxicam once a day for pain and inflammation, and flexeril for the muscle spasms.

I divorced my husband in 2010 and moved back home as my mother was in terminal liver failure, in fact she died a year ago today. As a result of some really bad circumstances I found myself having to fight for disability here in Washington. It took just under a year to be granted disability, during that time I had no access to medication. My blood glucose was 480 and higher. For almost a year.

I had been taking metformin and glipizide, and with diet and water aerobics three times a week I was doing quite well while still in Kodiak. Once I received my medical I refilled my prescriptions, and within a month my bg was in the low 200’s. I found an internist who added the Lantus, and I was getting pretty good levels, 120 to 150. It was not a good fit with that doctor, travel being part of the problem, so I found another internist closer to home. My A1C when I began seeing the new doc and taking my meds regularly was 14. After I began seeing my new doc he added actos to the metformin and glipizide and my A1C dropped rapidly to, at last check, 7.2. He then removed the glipizide, saying it would help me to lose weight, and that once my A1C is in the 6’s he will begin weaning me off the lantus.

I had lost a super significant amount of weight eating a modified Adkins diet, meaning that certain vegetables and fruits were encouraged in addition to protein. As I alluded to, my income has been drastically reduced, which means that meats, fish and fresh produce are not in the budget. I try to focus on protein and avoid carbs, but the fact is, after I pay the regular bills (electricity, water/sewer/garbage and a very basic cable/telephone/internet package) I do not have the money to eat three meals a day, even going to the food bank twice a week. In fact, there are more days when I do not eat than there are that I do. Hence my original question.

I took my nighttime meds at 6:00 and have injected the insulin. I just took my bg and it’s at 188. I have had no food, and only water and unsweetened iced tea. It’s weird how when I do not eat my readings are higher that when I do eat.

I feel I need to add that while yes, I use flour and pan drippings with a bit of milk or water to make gravy, I have never added any sweetener. It sounds gross. Also, I have broken a personal rule to not disclose my financial situation. It’s embarrassing and sounds, to me at least, like I am looking for a handout. I do not have a rabbit, and even if I did I don’t need the SDMB to pay for it’s air conditioning. If you read this far, thank you.

13

The simplest explanation for your sugar readings is that literally being out of food is stressful and stress causes the release of many hormones that raise blood sugar. See here.

14

Please note in that link the bit about the Somogyi reaction. You may have had a hypoglycemic episode earlier and be catching the rebound.

BTW, we did have a thread not very long ago entitled the “The cheap nutritious challenge!” which you might find useful in brainstorming how to make get the most nutrition bang out of whatever you have in your food budget buck.

Hope things turn around for the better quickly!