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Journalism of Courage
One of the commonest problems that people with diabetes face is a spike in early morning blood sugar, also referred to as fasting blood glucose. The main reason is the excessive production of glucose in the liver. One of the main actions of insulin is controlling the production and release of glucose in the liver.
Glucose is stored in the liver in the form of glycogen. If the insulin action is not proper, that is if there is either insulin deficiency or insulin resistance, the glycogen begins to break down into glucose. This process is called glycogenolysis. As a result, blood glucose levels start rising in the morning. This occurs even in people without diabetes to some extent but the levels still remain within normal limits.
Sometimes the fasting blood sugar spike is because of the hormone cortisol, levels of which go down in the night and reach their lowest point around 3 or 4 am. After that, cortisol levels begin to rise and with it, blood glucose levels, even if one has not had any food or drink. Cortisol levels keep increasing till 10 am. This is one of the reasons why post breakfast blood sugars tend to go very high among those with diabetes.
When treating diabetes, we have to fix the fasting levels first. If we fix that, postprandial or post-meal glucose levels will also come down. The starting point of the glucose will be much lower.
One of the main reasons why the blood glucose levels are high in the morning is because you consume excess carbohydrates or calories at night. Hence, the first step in reducing the fasting blood glucose levels is to reduce the carbohydrates and calories in your last meal before you sleep. This reduces glucose levels considerably.
The next step is exercise. Walk for five to ten minutes after dinner. This will bring down the post-meal blood glucose as well as the fasting glucose level the next day. Of course, if sugar levels continue to be stubborn, we have to use medication.
One of the most effective medications to bring down fasting glucose levels is metformin. Other oral anti-diabetic drugs can also work but metformin works the best. If fasting glucose levels are much elevated, above 200 or 250 mg/dL (normal range is below 100 mg/dL), a long-acting insulin given at night can control blood glucose levels.
Several methods can be tried.
1) The first is to reduce carbohydrate intake and replace it with protein. Get rid of bread and have omelette or besan pancakes so that glucose levels do not rise as much. If you have to have some carbs, go for the slow sugar-releasing complex carbs and make smart food combinations with protein and fibre that delay digestion and stall blood sugar spikes. Good sources of fibre include beans, whole grains and fruit.
2) Second, take your drugs, either tablets or insulin, 15 to 30 minutes before breakfast.
3) Get moving and take small walk breaks at work.
All you need is smart planning to keep yourself energised.
(Dr Mohan is Chairman, Dr Mohan’s Diabetes Specialities Centre, Chennai)
