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    Dr visits-
    barb10562 posted:
    Morning fasting numbers are usually 100-120 but when I have a docts appt and have to fast, my numbers are up to 160-170! How can I keep the down low enough so I get a good reading or do we just have to live with it? Maybe having a snack around midnight will hold the numbers down??
    arealgijoe responded:
    Yes having a snack in the evening often helps. Some people have problems with the DAWN EFFECT; it's where the liver DUMPS glucose, do to what it THINKS is a lack of food/energy adn the body is getting ready for waking up for the day.

    Seems like you are one of those with a body with a variation of WHITE COAT SYNDROME......(not realy quite the same tho).

    For people on insulin with a split basal dose, they can take a unit or 2 less of Lantus at night than the morning to counter the effect. At least that is what my endo advised me should I have a problem with the dawn effect, But ask your doc what he suggest for you.

    Something with a little fat last longer, takes longer to metabolize, but that is not good especially for anyone with cholestrol issue.

    There are a few T2s on here that deal with this a lot, I am sure some will chime in here, about what works for them.

    Laurie Anderson, MSN, RNP, CDOE responded:
    Hi Barb,

    What time do you typically test in the AM to get those fasting numbers? As Gomer mentioned, one cause of an increase in the morning glucose is the dawn phenomenon. This is a rise in glucose starting about 2 hours before you typically get up in the AM and it's the body's way of preparing for the day. The hormones work to increase not only your blood glucose, but also your heart rate, blood pressure, and breathing rate just a bit to prepare you to get out of bed and be ready to move about your day. The dawn phenomenon can cause some people to have their highest blood glucose of the day first thing in the morning. One way to stop this response is to eat some food; once the body realizes that it's receiving another source of glucose it will stop producing it (this is not immediate, like flipping a switch, so it can continue to rise for a bit after you eat). This is why your blood glucose will continue to rise when you are fasting for blood work; it's producing the glucose needed to feed your brain and body in the absence of food.

    Another cause of high blood glucose in the morning is the somogyi effect. This happens when one has a low blood glucose overnight (typically about 2-3 AM) and the body responds to the low by causing an increase in blood glucose. The cause of an overnight low can be late day exercise, the content and timing of food (and/or alcohol if you imbibe) intake in the evening, or the need for medication adjustment. While many people will awaken with a low glucose overnight, others will sleep through the low and then awaken with an elevated blood glucose that is puzzling to them. If you think this is the cause of an excessively high morning blood glucose (typically over 200) then set your alarm for between 2-3 AM and check your blood glucose; if you are lower than 70 mg/dl overnight then discuss the results with your health care provider. Kind regards, Laurie

    Laurie J Anderson, MSN, RNP, CDOE
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    mhall6252 responded:
    Barb - I work with my doctor's office to get the earliest possible appointment for labs. That helps, too. I would definitely have a snack around midnight and be sure you are well-hydrated before your appointment.

    arealgijoe replied to mhall6252's response:
    I don't worry about labs on Dr apt day.... seems a waste to me.

    What I do is have my labs drawn a week or so BEFORE my reg Dr. apt. That was the lab results are AVAILABLE when I see him, plus they are fresh and reavent, not months old before I see him.

    Decades ago when I was getting my diabetes care at the VA, we came in, had labs drawn first thing in the morning, given our insulin shot then sent to breakfast. The problem with that was often the labs were not available yet when we saw the doc. Often the latest labs were months old, and a lot can change in that amount of time. Heck things can change overnite, with em anyway.

    DavidHueben responded:

    I have always had my lab work done one or two days before my PCP appointment. The tests are completed that day and the results are transmitted electronically to my doctor.

    When I see him, we have something to discuss. Any dietary advice or medication adjustments can be done right then and there. He or his nurse give me a printed copy and they also send me a copy via e-mail.

    And when I leave, he gives me lab orders for the next appointment.

    "We sleep soundly in our beds because rough men stand ready in the night to visit violence on those who would do us harm." - Winston S. Churchill
    soapster1949 responded:
    Barb - If you're on meds you might consider taking them later at night to prepare for your doctor's appointment. I also see a rise when I need to fast, but I have found that after a while, I start going back down again. You can test to see where you peak and when you start to come back down to normal levels. For me, it's about 3 hours. Check hourly to see how long it takes for your bs to come back down. I have my labs done at a local lab a week before my appointment.

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