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Medical Forum / Diseases and Disorders / Diabetes / August 2007High variability of FBGs
Question for the group: I've been monitoring my readings for over three months now after somewhat accidentally testing myself in April and seeing some numbers higher than I liked. The patterns I see are relatively normal and mostly make sense. But the morning fasting levels seem to vary more than anything else. I get readings between 83 and 114 on my home glucose meter. These readings have been trending downward somewhat as I have low carbed and lost some weight (near my ideal weight now). But this morning, for no reason I can discern, I got a 112. A few days ago I had a medical checkup, and my lab-measured morning fasting reading was 83. My home measure before driving the few blocks to the lab was 99. My A1c was 5.1. Either my meter is less accurate than I thought, or my FBGs dance around a lot. -- Jim Chinnis Warrenton, Virginia, USA My morning fasting levels are also least predictable of my readings. KC > Question for the group: > [quoted text clipped - 18 lines] > -- > Jim Chinnis Warrenton, Virginia, USA > Question for the group: > [quoted text clipped - 16 lines] > Either my meter is less accurate than I thought, or my FBGs dance around a > lot. My morning numbers always vary. As do all of my other numbers. >Either my meter is less accurate than I thought, or my FBGs dance around a >lot. Probably both... I assume you've done things like use the control fluid and/or made sure the strip number matches the meter number? But FBGs can be a pig. Do you know if you have dawn phenomenon? Eating some nuts with a glass of wine right before bedtime used to knock mine on the head. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 Nicky <ukc802466929@btconnect.com> wrote in part: >>Either my meter is less accurate than I thought, or my FBGs dance around a >>lot. > >Probably both... I assume you've done things like use the control >fluid and/or made sure the strip number matches the meter number? Yes. The control solution doesn't seem to be intended to "calibrate" the strips, though, but only to spot a defective strip batch or meter I also test outliers with a second meter using a different type of strip. >But FBGs can be a pig. Do you know if you have dawn phenomenon? Eating >some nuts with a glass of wine right before bedtime used to knock mine >on the head. I don't think I have the really exaggerated response that is "dawn phenomenon." But my fasting bg is higher in the morning than in the late afternoon or evening by up to 30 points. I'm almost always at 80 or so at bedtime. Morning is anywhere between 83 and 112. I may still have a few pounds to go, and maybe that will make some difference. >Nicky. >T2 dx 05/04 + underactive thyroid >D&E, 100ug thyroxine >Last A1c 5.6% BMI 25 -- Jim Chinnis Warrenton, Virginia, USA > >>Either my meter is less accurate than I thought, or my FBGs dance around a > >>lot. > > >Probably both... I notice my FBS is like a cyclical wave when I look on a graph that I chart with WinGlucofacts 1.31. It goes from the low 90's (rare) to the high 120's, with most of the readings in the 112 to 115 area. I used to notice higher FBS readings on days after I drank a bit more alcohol the night before and slept in a little later (weekends). I also would notice that nearly simultaneous tests done with the same meter and different meters would yield different (by up to 20 mg/dl) results. I used to worry about it more, but nothing I tried seemed to make much difference, so I just chalk it up to the nature of the beast. I'm guessing my liver senses that I need more energy to wake up some mornings and sends out a few extra troops to do the job. Possibly after the heavy drinking my liver has a bit of a "voltage spike" when coming back on-line. I'm sure if I was on meds this could change... but at what price? Andrew t2 D&E, chicken/salad, red wine, fish oil, Stevia ...the list goes on >> >>Either my meter is less accurate than I thought, or my FBGs dance around a >> >>lot. [quoted text clipped - 3 lines] >I notice my FBS is like a cyclical wave when I look on a graph that I >chart with WinGlucofacts 1.31. That's interesting - so's mine - but it maps to my monthly cycle, I didn't realise it would have relevance to someone called Jim :D Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 > >>Either my meter is less accurate than I thought, or my FBGs dance around a > >>lot. [quoted text clipped - 18 lines] > I may still have a few pounds to go, and maybe that will make some > difference. Pounds of VAT matter more than pounds of SAT when it comes to insulin resistance, which you are wrestling with. The practical measure of the former is waist-to-hip ratio (WHR). If your WHR is much greater than 0.85, you likely have more than a few pounds of VAT to still lose. Sadly, your low-carb dieting is probably causing loss of SAT rather loss of VAT. Suggested reading about WHR and coronary disease: http://www.ajcn.org/cgi/content/full/86/1/48 It is only when we are hungry that the body gets rid of the VAT. Be hungry... be healthy... be blessed: http://HeartMDPhD.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist Our friend from atlanta was of the opinion: "Sadly, your low-carb dieting is probably causing loss of SAT rather loss of VAT." Sorry, this is not consistent with the clear research on vat loss. Would be happy to review any you might have to the contrary. Also, exercise is as equally important as diet in vat loss. Just to remind once again, vat is normal and is a endocrine gland which produces hormones inportant for energy metabolsim. Only when found in excess for long periods does it produce other hormones that should be limited by vat loss. It is also a normal energy storage device evolved to store and release energy quickly when food sources wax and wain in areas of large seasonal and other differences. God bless. >Question for the group: > [quoted text clipped - 13 lines] >Either my meter is less accurate than I thought, or my FBGs dance around a >lot. Two points. Mine also vary and jump over 6(108) occasionally; usually when I forget to take my evening metformin these days. However, if the trend is repeated tomorrow it's possible it's a pre-warning of infection. Cheers, Alan, T2, Australia. d&e, metformin 1500mg, ezetrol 10mg Everything in Moderation - Except Laughter. -- http://loraltraveloz.blogspot.com/ latest: Mossman Gorge in the Daintree Rainforest http://loraldiabetes.blogspot.com/ latest: Self-Testing and Type 2 Management Jim, since I believe your test was on a fast, by the time you got to the lab your bgs went down. but essentially, from 83 to 99 is not so much of a variance that I would be concerned. I still think it was the time difference that made the number lower. Loretta > Question for the group: > [quoted text clipped - 13 lines] > Either my meter is less accurate than I thought, or my FBGs dance around a > lot. Home meters are generally +-15% - the FDA requirement is +-20%. Next time, I'd suggest taking your meter along and testing at the same time they take the sample - obviously, BG is not static. The A1C is excellent - nearly in the 'normal' range. I take it you're not on any meds? Timing of meds can have an effect on FBG, as can such things as evening alcohol intake or aspirin levels - there are lots of factors. Try to correlate your FBG's with your previous evening intake of calories, carbs, alcohol, etc. ray <ray@zianet.com> wrote in part: >> Question for the group: >> [quoted text clipped - 17 lines] >I'd suggest taking your meter along and testing at the same time they take >the sample - obviously, BG is not static. I didn't realize my fbg would be determined by the lab or I would have done a calibration. The published data show a mean absolute error of 7% and look to be close to a gaussian distribution about the lab value. >The A1C is excellent - nearly in the 'normal' range. The lab "age-adjusted reference range" for A1c is 4.8 to 5.9. I'm not sure what "normal" means re A1c... > I take it you're not >on any meds? Right. And proclaimed normal by my doctor. >Timing of meds can have an effect on FBG, as can such things >as evening alcohol intake or aspirin levels - there are lots of factors. >Try to correlate your FBG's with your previous evening intake of calories, >carbs, alcohol, etc. I am trying. BMI is 22.7. Waist-to-hip ratio is 0.89. Main strategy at this point is to lose weight while building more muscle. Can't be done fast... -- Jim Chinnis Warrenton, Virginia, USA > I am trying. BMI is 22.7. Waist-to-hip ratio is 0.89. Main strategy at this > point is to lose weight while building more muscle. Can't be done fast... A low-carb diet will make it very difficult to build muscle because there will be increased protein turnover for hepatic gluconeogenesis to supply the brain. Be hungry... be healthy... be blessed: http://HeartMDPhD.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > ray <ray@zianet.com> wrote in part: > [quoted text clipped - 28 lines] > The lab "age-adjusted reference range" for A1c is 4.8 to 5.9. I'm not sure > what "normal" means re A1c... I've never placed much credence in the 'reference range' - AFAIK that's just based on what they see. Normal for a healthy non-diabetic is in the range of 4.5-4.7 or so. >> I take it you're not >>on any meds? > > Right. And proclaimed normal by my doctor. I'm no doc. But - IMHO the doc should have told you you're 'pre-diabetic' if he's actually seen many of your numbers. Basically that means your numbers are higher than normal, and if you don't do something, pretty soon you will be a full fledged diabetic. I'm glad to see that you're taking steps to prevent that. >>Timing of meds can have an effect on FBG, as can such things >>as evening alcohol intake or aspirin levels - there are lots of factors. [quoted text clipped - 3 lines] > I am trying. BMI is 22.7. Waist-to-hip ratio is 0.89. Main strategy at this > point is to lose weight while building more muscle. Can't be done fast... I find that for me, exercise is very important. When I start slacking off, my numbers start creeping up, in spite of low carb diet and oral meds. My best level seems to be when I'm doing about 50 miles per week on bicycle. ray <ray@zianet.com> wrote in part: >> ray <ray@zianet.com> wrote in part: >> [quoted text clipped - 32 lines] >just based on what they see. Normal for a healthy non-diabetic is in the >range of 4.5-4.7 or so. I agree. I might even say the normal healthy range is from about 4.3 to about 4.7. >>> I take it you're not >>>on any meds? [quoted text clipped - 6 lines] >you will be a full fledged diabetic. I'm glad to see that you're taking >steps to prevent that. The labels may not mean much. Most non-diabetics over 40 are probably prediabetic now. >>>Timing of meds can have an effect on FBG, as can such things >>>as evening alcohol intake or aspirin levels - there are lots of factors. [quoted text clipped - 7 lines] >my numbers start creeping up, in spite of low carb diet and oral meds. My >best level seems to be when I'm doing about 50 miles per week on bicycle. I'm keeping bg low with low carbing. And I'm doing cardio about 5 days a week and resistance training every other day for over an hour. I'm still increasing my weights at almost every session, and I've been doing (less) training for years. I'm just glad that I got a bg meter to test myself. I was just trying to see how I reacted to foods with different glycemic loads--just to improve weight loss. A meter reveals the scary changes in bg that most people are oblivious to. -- Jim Chinnis Warrenton, Virginia, USA > > ray <ray@zianet.com> wrote in part: > >> [quoted text clipped - 12 lines] > >>> reading was 83. My home measure before driving the few blocks to the lab was > >>> 99. My A1c was 5.1. Optimal is less than 4.7 > >>> Either my meter is less accurate than I thought, or my FBGs dance around a > >>> lot. [quoted text clipped - 11 lines] > > The lab "age-adjusted reference range" for A1c is 4.8 to 5.9. I'm not sure > > what "normal" means re A1c... That would be the gray area for metabolic syndrome (MetS). > I've never placed much credence in the 'reference range' - AFAIK that's > just based on what they see. Normal for a healthy non-diabetic is in the > range of 4.5-4.7 or so. That would be optimal. > >> I take it you're not > >>on any meds? [quoted text clipped - 3 lines] > I'm no doc. But - IMHO the doc should have told you you're 'pre-diabetic' > if he's actually seen many of your numbers. A "normal" American is 'pre-diabetic' because of overeating (eating until stomach is stretched so that no-longer hungry). > Basically that means your > numbers are higher than normal, and if you don't do something, pretty soon [quoted text clipped - 12 lines] > my numbers start creeping up, in spite of low carb diet and oral meds. My > best level seems to be when I'm doing about 50 miles per week on bicycle. If you choose to lose your VAT (WHR less than 0.85) by eating less, down to the optimal amount thereby becoming healthier (hungrier), you would likely find yourself coming off your oral meds, and having better numbers even when not low-carbing and not exercising: http://HeartMDPhD.com/HolySpirit/Healing This completely free Approach comes with an unprecedented million- dollar guarantee: http://TruthRUS.org/Guarantee Be hungry... be healthy... be blessed: http://HeartMDPhD.com/PressRelease Prayerfully in Jesus' awesome love, Andrew <>< -- Andrew B. Chung, MD/PhD Cardiologist > Question for the group: > [quoted text clipped - 18 lines] > -- > Jim Chinnis Warrenton, Virginia, USA As for the fbg, I'm not the expert here (actually, I'm not even sure I'm here), but I don't think 99 to 83 is that much of a variation, especially considering even the limited physical activity of walking to the car, stooping to get in it, driving with senses alert, getting out of the car, walking to the waiting room..... general messing around between readings. Mine go up and down.... up and down, with a mind of their own anyway. As to this morning, isn't 112 between your usual 83 and 114? .... or did I interpret part that wrong? John Hi Jim: > Question for the group: > [quoted text clipped - 10 lines] > reading was 83. My home measure before driving the few blocks to the lab was > 99. My A1c was 5.1. In other posts in the thread: > I don't think I have the really exaggerated response that is "dawn > phenomenon." But my fasting bg is higher in the morning than in the > late afternoon or evening by up to 30 points. I'm almost always at 80 > or so at bedtime. Morning is anywhere between 83 and 112. ... the > normal healthy range is from about 4.3 to about 4.7. The Christenson's study supports your comment on normal healthy A1c range even though the sample was small. Your FBG levels when they are near 83 are much the same as the sample group. The same could be said your what you are calling late afternoon or evening readings. In Christenson's study the reading at about 4 hours postprandial were about the same as fasting. A1c may vary from lab to lab. You had a 4.5% A1c in January, but was the result from the same lab as your 5.1% reading? There are two HOMA tests that require fasting blood glucose and insulin (C-peptide can be substituted for fasting insulin), one for insulin resistance and the other for beta-cell function. My gut feeling is that your beta-cell function is very normal. Counter regulatory hormones can impact glucose readings at all times of the day, but particularly the morning. Glucagon secretion from the pancreatic alpha-cells is suppressed by insulin in healthy normals humans. I doubt if you have a glucagon related issue. That would narrow it down to the other counter regulatory hormones. Cortisol or cortisone? Growth hormone? Adrenaline? Hierarchy of glycemic thresholds for counterregulatory hormone secretion, symptoms, and cerebral dysfunction - http://ajpendo.physiology.org/cgi/content/abstract/260/1/E67 Frank Jefferson <fwroy@adelphia.netxeopheno> wrote in part: >Hi Jim: >> Question for the group: [quoted text clipped - 28 lines] >A1c may vary from lab to lab. You had a 4.5% A1c in January, but was the >result from the same lab as your 5.1% reading? My latest A1cs: 5.1% 8/1/2007 5.3% ~5/1/2007 4.5% 4/13/2000 (OGTT 2-hr:120) A random non-fasting bg test was 155, which in part precipitated the other tests. All were from the same lab. The 4.5% was over 7 years ago. >There are two HOMA tests that require fasting blood glucose and insulin >(C-peptide can be substituted for fasting insulin), one for insulin [quoted text clipped - 8 lines] >secretion, symptoms, and cerebral dysfunction - >http://ajpendo.physiology.org/cgi/content/abstract/260/1/E67 Thanks. I'm a novice in these areas. I agree that I'm unlikely to have beta cell loss or dysfunction. What problem I have is more likely cortisol or other counterregulatory hormone related, on a backdrop of some IR. Susan has also said much the same thing to me in private email. Instead of going back to school and becoming an endocrinologist, I plan to see what effect increasing insulin sensitivity has. I'm mostly going to see what happens as my weight goes lower and lower and my muscle mass rises. That's not easy, but it's easier than the endocrinologist route... ;-) Thanks for the intelligent inputs. -- Jim Chinnis Warrenton, Virginia, USA |
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