What does it mean when my fasting blood glucose levels used to be good, and now they are higher—but I am not doing anything differently than I used to?
admin | Mar 14, 2011 | Comments 0
I often get asked to see people with diabetes because their doctor is frustrated with them and has labeled them as being “noncompliant.” Let me say right here that I hate that term and try hard never to use it. It suggests that if these people had just done what their “perfect” doctor had told them to do (and so were “compliant”), then everything would have worked out perfectly! Very often when I talk to patients, it is clear that they are doing everything as “perfectly” as they can, and just as “perfectly” as they used to. But now it doesn’t seem to be working. This is especially common for people with type 2 diabetes who used to wake up with fasting glucose levels in a good range (let’s say 100–130 mg/dL, or 5.5–7.2 mmol/L), but over time their average keeps drifting up.
Now, no matter what they do, even if they eat almost nothing the night before, they can go to bed with a reasonable blood glucose but wake up with a really high number. What has happened, most likely, is that their body is gradually making less insulin than it used to. They used to make enough insulin to stop their liver from releasing too much glucose during the night, but now they don’t make enough. Those patients are not “noncompliant.” They just make less insulin than they used to, through no fault of their own, and so need an adjustment to the treatment that they take for their diabetes.
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