Managing Your Blood Glucose Ups and Downs

Frequently asked questions
While each person’s diabetes is unique, there are some common problems that diabetes care providers are often asked about, including the following:

Why would my blood glucose be higher in the morning than it is at bedtime the night before?
One possibility is that your liver is releasing lots of glucose into the bloodstream during the night, because the feedback mechanisms to prevent this from occurring are not working. Taking the drug metformin can help in this situation.

Another possible cause is the dawn phenomenon, in which hormones released during the normal waking process cause a rise in blood glucose in the early morning hours. In people who take insulin, adjusting their dose of long-acting insulin or the basal rate on an insulin pump may help to correct this.

Yet another possible cause is the Somogyi effect, in which the body responds to hypoglycemia during the night by releasing hormones that cause the liver to release glucose, thereby restoring blood glucose to a safe level. The treatment in this case is to prevent hypoglycemia during the night, which involves assessing and adjusting your evening meal and medicines.

Why would I have two identical A1C test results in a row when my home blood glucose monitoring results were completely different during the periods leading up to each test?
Your A1C level can be interpreted as an average of all blood glucose levels over three months. When you consider that the average of 76 and 140 is 108, and the average of 30 and 186 is also 108, you can see how three months of in-range blood glucose levels could yield the same A1C as three months that included some out-of-range blood glucose levels.

When your A1C level doesn’t seem to “match” your home blood glucose monitoring results, you may want to vary the times of day at which you check your blood glucose level with your meter. You may find there are times when your blood glucose level is high or low; if these fall into a pattern — for example, you have high blood glucose after lunch pretty much every day — you may need to make some adjustments to your diabetes management plan.

I have downloaded my meter. Now what do I do?
With most meters on the market today, you can transfer your blood glucose monitoring results from your meter to a software program on a computer using a cable provided by or purchased from the meter manufacturer. The software program will have a variety of ways of displaying your blood glucose readings, making it easier for you to assess your overall level of control as well as see patterns in your blood glucose levels, such as frequent highs or lows at particular times of day.

This information is useful to your health-care provider, too, so if you have access to a printer, take a copy of any charts, graphs, or other reports you make to your next appointment to discuss. The first priority when looking over your blood glucose history is to note any episodes of hypoglycemia and their likely cause. The second is to note whether your blood glucose levels first thing in the morning and before meals are within your target range. And then you will want to see whether your after-meal readings are within range.

Consistent problems in any of these areas may be addressed with changes to your medication, meal, or exercise plans. However, since it can be difficult to remember what you ate or when you exercised from one doctor appointment to the next, it helps a lot to keep some records of these details, particularly if you’re noticing out-of-range readings when you monitor your blood glucose.