Too Much Sugar in my blood, but how?
June 13, 2015 8:44 AM   Subscribe

Results from my annual show most things A-OK but one red flag -- a fasting blood sugar level of 108 mg/dl, which I read places me in pre-diabetes territory. This hit me like a sledgehammer because I simply cannot figure out how or why I would have this number considering my generally healthy, low-carb diet and decent weight. Some answers would be most welcome. Read on please.

I would place my diet in the high-fat/high-protein/low carb/loosely Paleo category. Eggs for breakfast almost every day, salad/peanut butter/fruit or chicken/veg soup for lunch, and then meat/fish/chicken for dinner, all simply prepared with olive oil or butter and accompanied by vegetable (brussels, kimchi, broccoli, spinach) or salad. Salad dressing is usually homemade with some mayo, dijon mustard and garlic.

I do not consciously eat carbs -- no rice, no cereal, no potato, no pasta, no bread. I also do not snack on junk -- no soda, no potato chips, no candy, no ice cream and fruit only sparingly. I read labels and I know what I put into my body. My only indulgence is salted almonds and chocolate, the latter typically dark (85%+ cacao) but occasionally flavored with berry. I probably overdo both on a nightly basis and can curb that if I had to, but I do enjoy it.

I track my steps with a pedometer, faithfully registering 10,000 (5 miles approximately) per day and try to get my heart rate up as often as possible. I am in the process of getting back into strength training, after dropping off for about a year.

I am 5'10" and fluctuate in the 180-185 pound range, which makes me about two points over the high range of my ideal weight based on the BMI scale, which says I should be 174 max.

A few more facts:
- quit smoking five years ago after puffing for more than 35 years.
- quit drinking alcohol in August of last year and have not even smelled a drink since then.
- blood pressure under control with medication.
- I admit to a weakness for overeating on the "good" stuff -- meat, chicken veggies -- and would call it two to three portions instead of one, so a bit of portion control is definitely in order.

I am reaching out in hopes of finding an answer/suggestion because on paper this blood sugar reading does not seem to make sense, at least to me. I thought I read somewhere that the body has the ability to convert protein to sugar to compensate for low glucose in the body, but I'm not sure about that. If that is not the case, then where is the sugar coming from?

My doctor does not seem to be worried -- get your weight within BMI, continue on low carb and eat oatmeal in the morning and see me in six months is her advice.

All ideas are most welcome. Thanks.
posted by terrier319 to Health & Fitness (25 answers total) 14 users marked this as a favorite
did they do an a1c measurement? one fasting blood sugar might not be enough to get the whole story.
posted by nadawi at 8:53 AM on June 13, 2015 [2 favorites]

My doctor was more concerned about my A1C levels than my fasting blood sugar. Did you have that tested as well? Fasting glucose can vary depending on what you ate in the days leading up to the test.

I would work on the strength training and make an effort to get your weight down a bit more. Oatmeal just makes me hungry; I started adding ground flaxseed to my breakfast shake and my cholesterol and A1C were both lower at my last bloodwork.
posted by mogget at 8:57 AM on June 13, 2015

Response by poster: nadawi -- no, there was no a1c measurement or suggestion that I do one at this point.

Other current numbers that may be factored in:

LDL - 119
HDL - 69
Triglycerides - 50
posted by terrier319 at 9:00 AM on June 13, 2015

your a1c is a measurement of what your blood sugar has been for three months instead of what it is on a single morning. it's a much more accurate and telling number.

i admit that i also don't understand the advice of changing an eggs breakfast to oatmeal for blood sugar issues.
posted by nadawi at 9:04 AM on June 13, 2015 [8 favorites]

Echoing the comments above - get an a1c blood test. It's the only way to know if you are pre diabetic or not.

No need to wait 6 months and retest with an inconclusive test. That's 6 months you could be on medication, or making dietary/exercise modifications if needed.
posted by charlielxxv at 9:28 AM on June 13, 2015

i admit that i also don't understand the advice of changing an eggs breakfast to oatmeal for blood sugar issues.

Relatively high-carb breakfasts can be good for some Type 2 diabetics; IIRC it basically kickstarts insulin production and you end up with lower blood glucose numbers over the course of the day.

As to the OP... there are a couple of possibilities. One (which seems relatively unlikely given how low overall your number was) is that you have Type 1.5 diabetes (where the body stops producing insulin in adulthood, as opposed to Type 1, where that usually happens in childhood/adolescence). Another is that you're just genetically unlucky; while diet, exercise, and weight are all definitely major contributing factors in blood glucose readings, biochemistry is complicated and the math doesn't always make sense.

But I'll second what everyone else has said and say that a single reading, while it's something to pay attention to, isn't *that* much to worry about. There's a reason the diagnostic criteria for diabetes require two separate tests.
posted by asterix at 9:36 AM on June 13, 2015 [3 favorites]

I had one weird fasting glucose result in the pre-diabetic range, which never repeated.

I talked to someone who works on diabetes in lab animals, and she said that one wonky reading is very common, and can be caused by all kinds of little things (like having a mild illness), so drawing conclusions from one reading isn't warranted.

I would say, if your doctor isn't worried, that's great. See what happens in six months, or, if you're really worried, see if your doctor will order the A1C test to put your mind at ease.
posted by BrashTech at 9:38 AM on June 13, 2015 [3 favorites]

Relatively high-carb breakfasts can be good for some Type 2 diabetics; IIRC it basically kickstarts insulin production and you end up with lower blood glucose numbers over the course of the day.

thank you so much for saying this!! we've been trying to figure out a weird blood sugar trend over here at chez nadawi and this might just be the thing we were missing.
posted by nadawi at 10:00 AM on June 13, 2015 [2 favorites]

Hi, actual Type 2 diabetic here. The posters above are correct in that it's your a1c reading that matters more than a random fasting sugar reading. Those can go wonky for all kinds of reasons- you didn't sleep enough, you had a carby dinner the night before, you were on your period, whatever. I wouldn't worry about it unless you started manifesting other symptoms as well.
posted by Tamanna at 10:00 AM on June 13, 2015 [3 favorites]

Nthing the "I had one weird reading and it meant nothing." My former primary care physician had a freak-out over it and wanted to catastrophically overhaul my life. I took a wait and see attitude instead. It was a weird blip and has not repeated itself. All of my numbers have been dead normal since.
posted by rednikki at 10:16 AM on June 13, 2015

I thought I read somewhere that the body has the ability to convert protein to sugar to compensate for low glucose in the body, but I'm not sure about that. If that is not the case, then where is the sugar coming from?

The body can convert protein to sugar through a process called gluconeogenesis, and the body can convert fat to energy on a low carb diet (rather than using sugars from carbs for energy). The process of converting fat to energy produces acids called ketones, and when your body does it, you go into a state called ketosis. The body usually uses carbs first, then fats, then protein if needed for an energy source.

In order to prompt your body to use alternative pathways for producing energy, you have to not only be eating a low carb diet, you have to be eating a very low carb diet.. about 20 to 50 net carbs per day (net carbs are total carbs minus fiber). Remember that there are carbs in fruit, vegetables, nuts, dairy and chocolate. A cup of almonds alone has 20 grams of carbs in it. If you're overeating both nuts and chocolate every night, then I very much doubt that you're eating a diet low enough in carbs that you're in ketosis, and that means it's also unlikely that your body is burning protein for energy either.

Which is not to say that you need to change anything - your diet sounds fantastic and I recommend you stick with it, the only reason to change it is if you want to lose weight instead of maintain. As the posters above have noted, so many things can cause your blood sugar to fluctuate that it doesn't make sense to fret over one level that fell a little outside normal range.

Also, you might be interested to know that the margin of error on a fasting glucose test is about 16, so your value falls well within the margin of error that your true blood sugar may have been below 100.
posted by treehorn+bunny at 10:17 AM on June 13, 2015 [8 favorites]

It's probably because your body depleted its glycogen stores overnight, so the glucose that was stored in your liver entered the blood stream. I had pre-diabetic readings but a1c was normal. Started eating low carb (like 25g/day) and occasionally my fasting numbers will be like 110 for a couple days, then back down to around 100. I wouldn't be worried until you get the a1c done.
posted by hamsterdam at 10:33 AM on June 13, 2015

your body depleted its glycogen stores overnight, so the glucose that was stored in your liver entered the blood stream.

That shouldn't be the issue, because (unless we are getting up during the night to have some midnight snacks), our bodies use the glucose stored in the liver (as glycogen) every night. So what I'm saying is that if using glycogen stores caused elevated fasting blood sugar readings, pretty much everyone would have elevated fasting blood sugar readings.

Fasting prompts liver glycogen stores to be used within a few hours, thus every morning we wake up with very little glycogen remaining.
posted by treehorn+bunny at 10:57 AM on June 13, 2015

Hi, another type 2 diabetic here. One reading of 108 mg/dl isn't that bad, given the information you supplied, and given that you haven't seemed to manifest other symptoms of diabetes, like blurry vision, constant thirst, and pissing like a racehorse. If it would give you piece of mind, get an a1c test.
posted by Rob Rockets at 11:39 AM on June 13, 2015

According to Wikipedia, 108 mg/dl is pre-diabetic under American Diabetes Association criteria but not under World Health Organization criteria, which defines it as starting at 110 mg/dl.
posted by XMLicious at 11:41 AM on June 13, 2015

Too Much Sugar in my blood, but how?

I am genetically unlucky. My genetic disorder predisposes me to diabetes (not type 1 or 2, something called "cystic fibrosis related diabetes" aka CFRD). I have seen numerous articles linking inflammation to diabetes. My best understanding is that inflammation is also related to infection -- inflammation can promote infection and inflammation can be caused by infection. I worked hard on altering my body chemistry to reduce inflammation as a means to generally get my medical stuff under control. One result has been more stable blood sugar.

So, after agreeing that one reading might not mean anything, I will toss out the possibility that you are too acid and/or have some kind of bug that is impacting your blood sugar. I will suggest you search for articles on diabetes and inflammation.
posted by Michele in California at 12:13 PM on June 13, 2015

Not sure of your location, but if an A1C check will put your mind at ease that this is indeed one wonky reading, CVS minute clinics do them without insurance for $59.
posted by katya.lysander at 1:09 PM on June 13, 2015 [1 favorite]

There is also MyMedLab.
posted by invisible ink at 1:37 PM on June 13, 2015

Blood sugar readings are very fluid. It could be 108 now and take it again a few minutes later and it could be up or down 20 points. Even brushing your teeth can make it go up. Get an inexpensive blood sugar monitor and check it at different times of the day. In the world of diabetes, even pre-diabetes, fasting 108 is pretty much in the normal range. To give you perspective, I've known several people who weren't diagnosed until they were 500 plus. I'm diabetic and my blood sugar is regularly anywhere from 80-150, but my A1c stays at about 5.5.
posted by tamitang at 3:30 PM on June 13, 2015 [1 favorite]

Aside from the fact that this is just one reading, it really doesn't need to mean anything. If you've been eating low carb for a while now, and are close to a healthy weight for your body, you may be experiencing physiological insulin resistance.

Here's a blog post from Free The Animal that discusses it in a pretty understandable way: Physiological Insulin Resistance = Low Carbohydrate Diet Induced Insulin Resistance

And here's the Hyperlipid post referenced in the article above - it goes into a bit more technical detail: Physiological insulin resistance

If you want to hear more personal stories about this kind of response, you can also check out the Keto subreddit.
posted by kythuen at 4:03 PM on June 13, 2015 [1 favorite]

Chiming in with a random thought: you mention blood pressure medication. Is there any chance it is affecting your blood sugar?
posted by fanta_orange at 5:36 PM on June 13, 2015 [1 favorite]

You can buy a blood sugar testing kit for cheap. The special paper strips involved are a little pricey but not bad. Test yourself in the morning on an empty stomach. With your own kit you can test every day or every week and you can average the level over a period of time instead of relying on a single annual test.
posted by conrad53 at 7:19 PM on June 13, 2015

Well, certainly, as you say, protein can be used to create sugar. It's called gluconeogenesis.

Eating a very low-carb diet for long enough can cause impaired glucose tolerance, but I'm not aware of how either of these things would come into play on a fasting blood sugar test.

Continued monitoring is advisable; it's possible to develop type 2 diabetes without many risk factors, simply because genetic factors can stop your beta cells from producing sufficient insulin.
posted by mister pointy at 9:49 PM on June 13, 2015

I just wanted to second kythuen's post on low carb induced insulin resistance. It definitely happened to me when I went very low carb, I started getting fasting numbers in the 120s. (Very frustrating!) Definitely something to consider.
posted by tigeri at 9:52 AM on June 14, 2015

Nthing not to put too much stock in one weird number. I freaked out over a high number like this in a blood test, and my doc said it was probably high because I'd been sick (which was why I had the blood test in the first place). She retested after I was well, and it was back to normal and has been since. If it's freaking you out/causing you stress, definitely ask for a more conclusive test just to see, but otherwise your doc's advice sounds very reasonable.
posted by rainbowbrite at 7:53 AM on June 15, 2015

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