fluctuating before breakfast glucose levels

[gus201]

Can somebody explain to me why my morning(bbkfast) glucose levels fluctuate like they appear to be doing.  I try to eat dinner at about the same time also I take two 500 mg metformin pills in the morning and one in the evening with meals.  I try to stay away from bad carbs, sugars and starches.  I read labels very carefully to avoid pitfalls.  Or are my sugar levels ok.  I feel like I should have my levels down below 120 mg/dl, or am I expecting too much.  

[gus201]

As you know from my previous posting, I have been having a great deal of problems with gastric distress,i.e. Gastric reflux, bloating, etc.  I decided to conduct a little experiment on myself hoping that I would not do too much harm.  I decided to take myself of Metformin on Thursday of last week and monitor my glucose levels very carefully.  My fasting levels have not gone higher than 113 with most readings in the 90's.  Gastric problems have gone away.  With some great trepidation I called my doctor this afternoon and told them what I had done.  I was expecting some kind of negative comments but he decided to take me of metformin and wants me to continue monitoring my glucose levels and call him back.  See what happens.  This being a holiday weekend I did do some grilling, meat, corn in the husk and vegetables.  Felt great.  

[WaveRider]

I should add, be sure to double check with your pharmacist and/or go online for drug interactions. Even OTC's can raise issues with prescribed meds.

[WaveRider]

I've had and sometimes get acid reflux [AF] mostly caused by Metformin. I also was told to stay away from spicy foods which increases the chance of AF. I was prescribed Ranitidine [helps with GERD] taking one pill when needed, usually once or twice a year. Does the trick in under 20 minutes. OTC's don't work.

[gus201]

This is a question for anyone that can give me some insight into my most recent problem.  Anybody on Metformin having bad gastric discomfort ?  Lately I have developed a very strong gastric reflex problem, especially at night along with a great deal of gas that can be rather embarrassing.  None of the over the counter meds seem to help.  

[WaveRider]

A 102 postprandial is pretty good news. I try not to fret too much about numbers, even w/a good working thyroid they have a tendency to fluctuate a bit. I try to just keep them in the same proximity ± 20 mg/dl. Ditto on life!

[Zoelula]

Excellent! Glad you had a good time! You have a great attitude, keep up the good work!

[gus201]

Went out to dinner had ribs, corn on the cob, coleslaw and unsweetened ice tea and my glocose two hours later is only 102.  Hows that!  Tomorrow morning it will probably be 150!  

So many things that can go wrong with our bodies.  Enjoy life to the fullest!  

Thank you all.

[Zoelula]

I knew he'd like yours better, Gus..lol

[WaveRider]

I hope I got this right....
Normal = Euthyroid
Low TSH, high thyroxine, high T4 = Hyperthyroid
High TSH, low thyroxine, low T4 = Hypothyroid

Thanks for the clarification Gus!

[Zoelula]

Whew, way over my head, Gus. Without understanding the mechanism,  basically the TSH readings are upside down: A low number like I had last year of .087 means severely hyperthyroid. A high number like Gus has of 65 means severely hypothyroid. I find it confusing to talk about "high" and "low" so just prefer hyper or hypo. (Wave Rider, you probably wanted an explanation more like Gus'!

In answer to your question, Gus, I don't technically have either! (How's that for a confusing response). I was originally diagnosed with hyperthyroidism (Graves Disease to be exact) back in 1994. They could not regulate it with meds so they destroyed my thyroid gland with radiation. I then was put on Synthroid to replace thyroid function. Stable on the same dose for 13 years. Then when I was diagnosed with diabetes that destabilized my thyroid level for some reason and I became, though I didn't know it, because the symptoms were more subtle, severely hyperthyroid again (the .087). The doc adjusted my dose and I stabilized. Recently I became aware I was off kilter again, this time a tad low (5.1, nothing compared to your numbers) and the endo changed my dose again to get me back in range. My understanding is that either hyper-or hypo thyroid can make it difficult to manage blood glucose.

[gus201]

I'll try to be of some assistance to you.  There are three conditions when making reference to thyroid function.  Normal is referred to as Euthyroid, Hypothyroid indicates low amounts of the hormone thyroxine circulating in the blood stream. Hyperthyroid means you have a high level of the thyroxine (T4)hormone in circulation. Low levels of thyroxine (Hypothyroid) picked up by the pituitary gland prompts an increase in the production of Thyroid stimulating hormone (TSH).  If the thyroid gland is not functioning and can't produce thyroxine in response to TSH, than TSH production will continue, consequently increased levels TSH with low T4. The opposite when you have an over active Thyroid gland with increase T4 production (Hyperthyroid) and low levels of TSH. This is control by a negative feedback mechanism which is different than glucose metabolism. Did I muddle it up more?

[WaveRider]

Help me out. As I was reading your two conversations I got stymied as to why hyper, as in hyperthyroid, means below the low level range, and hypo, as in hypothyroid, means above the high level range in μIU/mL?
When compared to diabetes hyper, as in hyperglycemic, means above and hypo, as in hypoglycemic, means below in mg/dl? Anyone know the reason[s] to the discrepancy? No  big deal just my curiosity.

[gus201]

Thank you for your birthday wishes!  Yes, I just learned of plans to go out to dinner, now I'm worrying how this will effect my levels.  But illness cannot put a crimp on our lives.  At my age life is too short to not enjoy.  I get up in the morning looking forward to a good day, if it turns out not to be, well tomorrow is another day.  Just out of curiosity, do you not have hyperthyroidism. I mean with TSH levels that low, the pituitary gland with signal the thyroid gland to produce more thyroxine thereby increasing the level of thyroxine in the blood stream.

Thanks again and have a good day.

[Zoelula]

Hi Gus

Hey, happy birthday! With all that is going on for you, I hope you and your wife do something fun to celebrate!

I understand about worrying. I've done way too much of that myself since February when I got started on insulin and my numbers have been on a roller coaster...and I DON"T LIKE rollercoasters! Yes, your numbers can be fine-tuned for a bit more consistency but you (and I) will get there in time. I'm learning that it's a process and there is a lot to learn. Sounds like your science background will come in handy! For me, my highly probable Type 1.5 diagnosis means my body is producing varying amounts of insulin which can make it hard to be stable. For you your hypothyroidism can certainly account for inconsistent numbers and you are on your way to correcting that problem.

I apologize for my ignorance; since I posted this someone else mentioned hypothyroid levels of 85. Mine usually tend off in the other direction when they destabilize (.087) or just a bit low like they are now (5.13), so I was unfamiliar with those kind of numbers!

Enjoy your day!
Zoe

[gus201]

Yes I'm quite sure.  I was a Supervisor  Clinical Laboratory Scientist working in a clinical chemistry lab and I have seen quite a few TSH's in that range. A TSH that high is accompanied with an undetectable  T4 or Free T4 which I had. The first Thyroid panel I had done did have a TSH of >100, the second one three weeks ago was at 67.  I think that is why I still have classical symptoms  of hypothyroidism, fatigue legs get very tired when I exercise or do yard work, muscles ache.  A general rundown feeling.  Hopefully with the increase in Synthroid med I'll start feeling better.  

Maybe I'm worrying to much about my glucose levels, being new at this.  I'm kind of paranoid with everything else that's going on with me.  I don't know if the side effects of my cancer medicine is causing me to feel the way I am.  I try not to dwell on it and just continue enjoying life.  I work part time, work on the yard and take care of my Boxer and English Bulldog and the wife.  

I have done a 2 hour post-prandial and it was 128, so guess that is good.  I looked up Type 1.5 and yes its not something to worry about.  

Thank you for your comments, I appreciate it very much.  Have a good day and by the way its my 64th birthday today.

[Zoelula]

I've never heard of a TSH in that range, Gus. Normal range at my lab is .27 to 4.20. My doctor increased my Synthroid from 100 to 125 because I am at 5.13. Are you quite sure that is the correct number? If you are that hypothyroid that would most certainly explain your having trouble stabilizing your diabetes and your numbers aren't all that bad. You might want to measure your numbers two hours after eating. What you need is a fasting number (that should be 70-100) and a post-prandial number (two hours after eating) that should be under 140, though some accept under 180.

Have you been given a diabetic educator to work with? I wouldn't worry too much about Type 1.5, it is just something else to consider.

[gus201]

My TSH level was 67 mIU/L  When first diagnosed it was >100mIU/L. with a T4 of <1.0 (basically not measurable). I was first diagnosed with diabetes in march of this year and have been on metformin 500 mg three times a day since. The synthroid med that I am on has brought  the TSH down but not to where it should be.  Hopefully with the increase in my synthroid medication it will come down.  Studies have been published that show a correlation between my Cancer medication, Sutent, and a decrease in thyroid function.

I have never heard of Type 1.5 Diabetes!  Doctor has not mentioned the possibility of an autoimmune disorder.  I have been on some kind of oral cancer medication now for five years.  These are recently approved therapies for renal cell carcinoma.  I was told that glucose levels of less than 130 would be good for me.  I feel that I don't have all the information that I need.  I'll look up type 1.5 and read up on it. Thanks

[Zoelula]

Do you mean 6.7 on the TSH, Gus? Yes, that is high and unstable thyroid can definitely make it difficult to stabilize diabetes so be sure that gets back in target range.

You don't mention how the doctor views your numbers and what his treatment plan is. Waverider is absolutely right that you can control with diet and exercise but it is important to be on the correct meds as well. Have your numbers been stable in the past? How long have you been diagnosed? If you have been Type 2 for awhile and your numbers are no longer stable you might be producing insufficient insulin and the test Waverider mentioned can determine if you in fact need to go on insulin at this point.

I don't want to complicate the issue, but if your thyroid is stabilized, you practice good nutrition and exercise and have a good weight level and you still aren't stable you might want to consult with an endocrinologist to see if you are in fact not a Type 2, but a 1.5. Those of us with autoimmune disorders (I too suffered from thyroid disease) are often found to have 1.5 which is an autoimmune type of diabetes and needs to be treated with insulin.

[gus201]

Ya, I don't have a functional thyroid.  My cancer meds created a hypothyroid condition and I am now on synthroid.  Last THS I had done was 67 which is high.  My doctor increased  the synthroid dosage  to 175 micrograms, up from 150. Doctor suspects that the hypothyroid condition may have brought on diabetes.  

[WaveRider]

Now I see what you mean by fluctuations; some good, some borderline, others high. Have you had a thyroid TSH test performed? An irregular thyroid can disrupt your glucose levels. Also, your pancreas checked. There is a test called the C-Peptide that checks to see if your pancreas is producing the right amounts of insulin when needed. One or both could be contributing factors
to your irregular fluctuations.

Continue to monitor your nutrition while staying away form bad carbs and junk foods. Get down  to normal weight and try to figure out an exercise routine. Take a brief walk after lunch. Walking really helps to lower and stabilize your glucose levels. Sounds off the wall but it's true. And do make an appointment to see your PCP and have those two organs checked asap.

Good luck and good health.

[gus201]

I'll give you some examples of my readings, starting from today working backwards:
5/18  before bkf. 145, before dinner 89
5/17    "             100,  "                 120
5/16     "            80,      "               95
5/15      "           114            "         103
5/14       "           108           "         40
5/13       "           122           "         108
5/12       "           na             "         101
5/11        "          161           "           79
5/10        "          155           "           98

I've maintained my weight, even lost a couple more pounds, down to 195lbs
Have not exercise as much as I would like but have done some.

[WaveRider]

"Can somebody explain to me why my morning(bbkfast) glucose levels fluctuate like they appear to be doing."
You kept your glucose levels a secret.

"Or are my sugar levels ok"
You kept this a secret too.

"I try to stay away from bad carbs, sugars and starches.  I read labels very carefully to avoid pitfalls."
That's an attaboy, gus. But are you also keeping a normal weight and doing moderate exercise daily? These help to lower your glucose level. eg, a thirty minute brisk walk does wonders.

"I feel like I should have my levels down below 120 mg/dl, or am I expecting too much."
Normal is 70-99 mg/dl fasting [prandial] before breakfast and <140 mg/dl after meals. This is not an easy goal for type 2 diabetics and for most, unobtainable. Your goal of 120 mg/dl is a good start and not expecting too much.