Hi!

I bought myself a home glucose meter to get some numbers to take to my doctor when I see him in May. He had tested my fasting blood sugar (90) and my Hemoglobin A1C (6.3) because of persistently elevated cholesterol and triglycerides. I thought a hemoglobin A1C of 6.3 seemed a little high for someone who was not supposed to be a diabetic. I've read that most nondiabetics test at about 5 and a 6.3 is about an average blood sugar level of 120-130.

1 1/2 hours after lunch my blood sugar was 197. I understand this is about equal to a plasma level of 220. From what I have read on the various websites, this is abnormal. 1 hour later, at 2 1/2 hours post prandial, the reading was 80! 2 Hours after dinner my reading was 123, or 138 plasma level. I guess this is considered marginal? Do blood glucose levels vary according to what you've eaten as well as how long ago?

From what I've read, your blood glucose should never be above 200 at any random point in time and ideally, much lower than that. The number 140 sticks in my mind.

Do my readings show some kind of impaired glucose tolerance? My fasting blood sugar is normal and my levels do get down to normal, i.e. 80 at 2 1/2 hours post prandial. Other risk factors include hypertension (controlled with medication), my age (over 45), possible microvascular angina. I have no family history at all.

Could a local injection of cortisone in my elbow one week ago cause something like this? I didn't think local steroids had much of a systemic effect and that is why they are preferred.

Thanks for any opinion

Chris S.

Hi Chris,
It's been some time since your last post. What you've experienced is pretty common, and is called insulin overshoot; some call it rebound. The pancreas overreacts to the signal from the pituitary that says "the sugar's on the way up." So down goes the sugar and the pituitary says "cut it down", and the pancreas shuts it off. This commonly occurs to people who eat toast or drink a sugar soda on an empty stomach. They feel very foggy about an hour later. Hypoglycemics are far worse and can fall into insulin shock with an overdose of their own endogenous insulin. This is because sugar and white bread are absorbed equally as fast into the bloodstream, and it starts an oscillation that finally rings out. For this reason, only the fasting insulin will give you the norm. Different foods are digested in different places in the digestive system, some of which is still there at 16 hours after ingestion, so your sugar can be up when you wake up. Your body has been inactive, but the digestive system has not. That's why people who want to lose weight should eat only a very light supper. Since this is the main meal for most Americans, we have the "fat American". You are borderline, and you can easily control your sugar by following the glycemic index, which you can get from Mendosa.com. It's good that you have a glucose monitor. You'll learn a lot about your own sugar characteristics. From your posts, you appear to be highly analytical and will be on your way to solving this problem. I can only say that keep your sugar to a 170 max, and if you can, to a 110 norm. Over 170 causes heavy glycation and glycosylation damage to the pancreas and eventually kills the islet cells. It is my feeling that the big supper is why we have a near epidemic of diabetes in the U.S. The highest rate is in India; in the land of skinny people. They mostly eat one meal a day....supper. God bless, Oldguy

PS: 1. Yes, cortisone will foul your sugar.
2. A darn good link,,,http://www.mercola.com/2000/oct/8/sugar_cancer.htm/

[This message has been edited by Oldguy (edited 02-28-2001).]

Hi Old Guy:

I had a reply all typed out to you and I lost it somehow. :<( I will try again.

I haven't been around much because I've been concentrating on the tennis elbow problem, but now that its fine, back to my other research

By "110 norm" do you mean fasting levels? I understand your explanation about the rebound insulin. Isn't this what they call "reactive hypoglycemia?" I always thought I had that but have learned what and when to eat to avoid it. (i.e. a donut and coffee at 10 am would send me crashing to the ground and I know I can never eat this and feel well) It hasn't been much of a problem. However, the lunch I had before the 1.5 hour level of approx 200 consisted of chicken,veg,rice soup, one slice of bread with butter (took your suggestion) a cup of vanilla yogurt (can't stand the plain, figure vanilla is better than the other fruit flavored varieties) and a handful of raisins. While not as high in protein as it probably should have been, it is not the type of food that would cause a hypoglycemic reaction in me. In fact, when I tested my blood at 1.5 hours and then again at 2.5 (when it was 80) I felt fine.

I am wondering if I could have impaired glucose tolerance where my body lets the levels rise and then when it realizes it is not working, instructs the pancreas to let out a walloping dose of insulin to get it down to normal levels, which it does. Wouldn't this be a delayed insulin response and a type of "insulin resistance?"

Here is what I really want to know: In a person with this type of insulin response, wouldn't it be better to eat just 3 meals per day (or less if you could stand it) I could easily eat a decent sized snack every 2 hours which would keep my glucose levels up most of the day, with only periodic dips down to normal. I have read that although they might not indicate a clear case of diabetes, glucose levels out of the desirable range for long periods of time can cause the same complications. I am trying to find the cause of my cardiac problems. I did manage to get my triglycerides down from 400 to 167 by cutting down on carboyhdrate intake. Maybe I need to do that even more to keep my glucose levels down. That's hard to do!

Thanks for your opinion

CHris S.

Hi Chris,
Rebound is roughly the same as reactive hypoglycemia except that the baseline is higher. In effect, the levels revolve around a near normal level, and seldom fall below 50. As for serum levels, the glucose monitor is a time/reaction measurement where the reading of a very minute voltage is measured from the time you press the measure button. Variations in the time from applying the blood to the pressing of the start button is one error. This is why I like the Walmart brand of monitor that is the cheapest one out. It's an autostart. Also, there is a 5% variation permissible in test strips. So I wouldn't worry about the variation to the doc's system. The best thing you can do is take yours with, and test at the same time the doc's lab tech does.
Insulin resistance is actually a glycogen storage disease, where the fat cells are not responding to insulin. Muscle cells require very little insulin, if any. My wife is an insulin resistant brittle diabetic. I have put her on an excercycle when her fasting level is 200 or more and had her work 5 minutes. Her blood sugar drops 30 or more points. One hour later, it's back to 200+ without eating a thing.
Another factor unknown to many doctors is exogenous insulin immune response. It's not supposed to be common, but I believe it's because no one thinks about it. Exogenous insulin matches in 19 of 23 points in protein structure to human insulin. In some people, their immune system attacks and destroys the insulin before it enters the blood stream. In this case, a slow release insulin is wiped out as it is released by the suspension. This appears to be insulin resistance, but the insulin just doesn't get there. In these cases, one must test using straight Lispro (fast acting). Where it may take 90+ units of 70/30 per day, one might use 15 units of lispro. This is one of my wife's problems, and I found it while she was in the hospital. She ate more of what she shouldn't there than she did at home and they controlled her sugar with 10 units and less of lispro after each meal. I researched Harrison's on line and found only one small paragraph about this. Our family doc's new nothing of it.
It seems everything affects glucose levels. For women, it's an indicator that their period is due because it's out of control just before and during. Infections are another blight on control. I can only say, diabetes is a terrible disease, and the best way to control it is the most sacraficial way, by strict adhereance to very low carb dieting. God bless, Oldguy