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Question:
I cannot find any information on the effect of short-term spikes
in blood sugar (i.e., 115 before breakfast, 170 one hour after breakfast).
How dangerous are swings? Currently, I am not on any medication and
I am simply trying to control my blood sugar through diet and exercise.
I am not overweight (6 feet tall, 175 pounds), and I walk four miles
about four to five times a week. Even with all of this, I still cannot
control my blood sugar into the nondiabetic range. Any suggestions?
Dave, Internet
Answer:
Your question brings up two points. The first is whether there
is a long-term hazard in prebreakfast (i.e., fasting) blood sugars
of 115 mg/dl? The American Diabetes Association (ADA) appears to have
answered this when it created a new diagnostic category known as "impaired
fasting blood glucose" for individuals who display fasting values
greater than 110 mg/dl on two occasions.
Your second point relates to transient spikes. I
see many non-diabetic obese people whom I help to lose weight. A number
of these individuals have normal fasting glucose levels (about 90
mg/dl) but HbA1c values that are slightly elevated at around 5.5%.
This corresponds to a four-month average blood sugar of about 120
mg/dl at my lab. I suspect that such mild elevations have been present
for years. Inevitably, I'll find some early diabetic neuropathic complications
on physical examinations. These may include somewhat diminished heart
rate variation on deep breathing (parasympathetic neuropathy), dry
skin on the feet (sympathetic neuropathy), the intrinsic minus foot
deformity with claw toes and high arch (motor neuropathy), diminished
sensation in the feet (sensory neuropathy) and double vision in one
or more directions of gaze (motor neuropathy). Usually, more than
one of these signs is present. I suggest that you have your HbA1c
checked. Normal values are probably below the midpoint of the normal
range of your laboratory, since most labs tend to set their normal
ranges too wide.
For the problem of controlling your blood sugars, I would advise
a low-carbohydrate diet. If you are in shape and exercise, it is likely
that you might be consuming too much carbohydrate. If a low-carbohydrate
diet does not normalize your blood sugars, the next step would be
insulin, which must be administered in a physiologic manner as determined
by blood glucose profiles. Although sulfonylurea oral medications
might work initially, they are not long-term solutions.
My book, Dr. Bernstein's Diabetes Solution, goes into great
detail on all of the above.
Richard Bernstein, M.D., F.A.C.N., F.A.C.E.
New York Diabetes Center
Mamaroneck, New York
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