I am 55 years old. I was diagnosed with Diabetes five year ago. Since the last few times, my blood test reports have shown my fasting blood sugar level higher than my postprandial sugar level. Could you please explain to me why this is happening and what do I need to do further? .The normal fasting blood sugar value is 70-110 mg/dL. High fasting blood sugar level may occur due to many reasons, most commonly due to non-compliance to medications, taking high carbohydrate snack at bedtime or due to some hormonal changes that occur naturally in our body.The dawn phenomenonThis is caused by an exaggeration of the normal hormonal process that occurs overnight. During the night, the human body witnesses increased levels of several hormones, most commonly the growth hormone and catecholamines (these hormones help the body to respond to emotional or physical stress). These lead to increased glucose production andrelease from the liver. These hormones also inhibit the effects of insulin, leading to an overall increase in sugar levels in the bloodstream. This increase in the blood sugar levels takes place early in the morning between 2 and 8 a.m. To prevent this effect, one should reduce overall carbohydrate intake, eat dinner earlier in the evening, eat a lighter breakfast, take a walk after dinner and take insulin dose at bedtime instead of earlier in the evening.Somogyi phenomenonIt is rebound hyperglycaemia (high blood sugar levels) or hyperglycaemia after a period of low blood sugar levels. When the blood sugar level falls below normal, the body responds by releasing the endocrine hormone glucagon as well as the stresshormones epinephrine, cortisol and growth hormone. The elevated blood sugar in the morning is a stress response to low blood sugar in the early morning hours.This can be avoided by decreasing the dose of anti-diabetic medications and adding a snack at bedtime that includes carbohydrates. It is important to monitor blood sugar levels around 3 a.m. to detect these hormonal changes and accordingly the measures to avoid fasting high blood sugar levels can be taken. Continuous blood sugar monitoring using sensors can help find out this blood sugar fluctuation.It is necessary to address the change in diet, exercise timings and to consult the physician for modification of diabetic medications to prevent such episodes.Dr Gourish KarandeConsultant Physician .I am 28 years old. I have been diagnosed with Type 1 Diabetes at the age of 17. I have no other complications. I work in the night shift in an IT company. Please advise how I could manage my insulin and meals while working in the night shift.Night shifts can be challenging for people with Diabetes, particularly Type 1 Diabetes, due to a change in the time of eating, type of food eaten and increase in stress, thereby impacting the circadian rhythm, i.e. the internal body clock. The regular meal timings can be impacted by a change in time of sleep. Night shift work causes many people to feel hungry at different periods during the day, compared to a person who works in day shift. This is likely to make meal planning more difficult.Following are some tips on Diabetes management for shift workers:Meal adjustments for night shift• Irrespective of the hours of your work, havelunch around noon and dinner around 7:00 p.m.• During your night shift, have healthy snacks instead of fried items/food.• Don't stay hungry for a long time and also avoid having large meals for dinner.• For snacks, have low-glycemic index carbohydrates and avoid spicy and fried foods.• Avoid beverages that are high in sugar.• Whenever possible, go for a walk or at least stretch out during your shift.• Talk to your diabetologist and dietician to know how to better manage your meal while working in shifts.Insulin aqjustments for night shift• Always check your blood sugar levels before bedtime and as directed for basal-bolus insulin therapy.• After a night shift, if you are planning to sleep through the day then you may have to adjust the insulin doses properly to prevent hypoglycemia while you are sleeping.• In case if you are planning to sleep in the afternoon till early evening, after your night shift then you can continue with your normalbasal-bolus regimen as you can take the desired pre-breakfast dose of insulin, although you may have to adjust pre-lunch.• It's easier to use a basal-bolus regimen of insulin administration in such scenario rather than taking mixed insulin or any other regimen.• Also, there is always an option of the insulin pump, which is more convenient.• Consider a CGM (continuous glucose monitoring) device to see real-time blood sugar readings and trends, which helps to detect unnoticeable low or high blood sugar levels.• You may have to check your blood sugar levels more often if your job has some night and some morning shifts and thus requires fine-tuning of your insulin dose.• Keep your co-workers informed about your health as they can help you if you develop hypoglycemia and need a fast-acting glucose source or a glucagon injection.Always follow the advice of your diabetologist regarding how often to check your blood sugar levels, the best time to eat meals and snacks and when to take your medications, etc. It's important to be aware of the things that might occur during thenight shift, such as hypoglycaemia or hyperglycaemia and to keep a watch on its signs and symptoms.Whenever such problems arise, be sure to consult your diabetologist and to get your insulin dose adjusted accordingly.Dr Ashutosk PakaleConsultant Physician
I am 55 years old. I was diagnosed with Diabetes five year ago. Since the last few times, my blood test reports have shown my fasting blood sugar level higher than my postprandial sugar level. Could you please explain to me why this is happening and what do I need to do further? .The normal fasting blood sugar value is 70-110 mg/dL. High fasting blood sugar level may occur due to many reasons, most commonly due to non-compliance to medications, taking high carbohydrate snack at bedtime or due to some hormonal changes that occur naturally in our body.The dawn phenomenonThis is caused by an exaggeration of the normal hormonal process that occurs overnight. During the night, the human body witnesses increased levels of several hormones, most commonly the growth hormone and catecholamines (these hormones help the body to respond to emotional or physical stress). These lead to increased glucose production andrelease from the liver. These hormones also inhibit the effects of insulin, leading to an overall increase in sugar levels in the bloodstream. This increase in the blood sugar levels takes place early in the morning between 2 and 8 a.m. To prevent this effect, one should reduce overall carbohydrate intake, eat dinner earlier in the evening, eat a lighter breakfast, take a walk after dinner and take insulin dose at bedtime instead of earlier in the evening.Somogyi phenomenonIt is rebound hyperglycaemia (high blood sugar levels) or hyperglycaemia after a period of low blood sugar levels. When the blood sugar level falls below normal, the body responds by releasing the endocrine hormone glucagon as well as the stresshormones epinephrine, cortisol and growth hormone. The elevated blood sugar in the morning is a stress response to low blood sugar in the early morning hours.This can be avoided by decreasing the dose of anti-diabetic medications and adding a snack at bedtime that includes carbohydrates. It is important to monitor blood sugar levels around 3 a.m. to detect these hormonal changes and accordingly the measures to avoid fasting high blood sugar levels can be taken. Continuous blood sugar monitoring using sensors can help find out this blood sugar fluctuation.It is necessary to address the change in diet, exercise timings and to consult the physician for modification of diabetic medications to prevent such episodes.Dr Gourish KarandeConsultant Physician .I am 28 years old. I have been diagnosed with Type 1 Diabetes at the age of 17. I have no other complications. I work in the night shift in an IT company. Please advise how I could manage my insulin and meals while working in the night shift.Night shifts can be challenging for people with Diabetes, particularly Type 1 Diabetes, due to a change in the time of eating, type of food eaten and increase in stress, thereby impacting the circadian rhythm, i.e. the internal body clock. The regular meal timings can be impacted by a change in time of sleep. Night shift work causes many people to feel hungry at different periods during the day, compared to a person who works in day shift. This is likely to make meal planning more difficult.Following are some tips on Diabetes management for shift workers:Meal adjustments for night shift• Irrespective of the hours of your work, havelunch around noon and dinner around 7:00 p.m.• During your night shift, have healthy snacks instead of fried items/food.• Don't stay hungry for a long time and also avoid having large meals for dinner.• For snacks, have low-glycemic index carbohydrates and avoid spicy and fried foods.• Avoid beverages that are high in sugar.• Whenever possible, go for a walk or at least stretch out during your shift.• Talk to your diabetologist and dietician to know how to better manage your meal while working in shifts.Insulin aqjustments for night shift• Always check your blood sugar levels before bedtime and as directed for basal-bolus insulin therapy.• After a night shift, if you are planning to sleep through the day then you may have to adjust the insulin doses properly to prevent hypoglycemia while you are sleeping.• In case if you are planning to sleep in the afternoon till early evening, after your night shift then you can continue with your normalbasal-bolus regimen as you can take the desired pre-breakfast dose of insulin, although you may have to adjust pre-lunch.• It's easier to use a basal-bolus regimen of insulin administration in such scenario rather than taking mixed insulin or any other regimen.• Also, there is always an option of the insulin pump, which is more convenient.• Consider a CGM (continuous glucose monitoring) device to see real-time blood sugar readings and trends, which helps to detect unnoticeable low or high blood sugar levels.• You may have to check your blood sugar levels more often if your job has some night and some morning shifts and thus requires fine-tuning of your insulin dose.• Keep your co-workers informed about your health as they can help you if you develop hypoglycemia and need a fast-acting glucose source or a glucagon injection.Always follow the advice of your diabetologist regarding how often to check your blood sugar levels, the best time to eat meals and snacks and when to take your medications, etc. It's important to be aware of the things that might occur during thenight shift, such as hypoglycaemia or hyperglycaemia and to keep a watch on its signs and symptoms.Whenever such problems arise, be sure to consult your diabetologist and to get your insulin dose adjusted accordingly.Dr Ashutosk PakaleConsultant Physician
