Misled by the Morning "Fasting" Plasma Glucose
1Diabetes Care Center, Salinas, CA, USA aking@diabetescarecenter.com.
Journal of Diabetes Science and Technology
|May 15, 2015
Summary
Morning fasting plasma glucose (FPG) is often used to adjust basal insulin, but large evening meals can falsely elevate FPG. This can lead to incorrect insulin dosing, causing hypoglycemia and weight gain in type 2 diabetes patients.
Area of Science:
- Endocrinology
- Metabolic Disorders
- Diabetes Management
Background:
- Morning fasting plasma glucose (FPG) is a common but potentially misleading marker for basal insulin titration.
- Obese patients with type 2 diabetes often consume large evening meals, elevating FPG.
- This elevation can lead to over-basalization of insulin, contributing to hypoglycemia and weight gain.
Purpose of the Study:
- To highlight the limitations of using FPG as the sole marker for basal insulin titration.
- To explain how late evening meals impact FPG and insulin dosing decisions.
- To recommend strategies for more accurate basal insulin adjustment.
Main Methods:
- Review of current practices in basal insulin titration.
- Analysis of the impact of meal timing and composition on FPG.
- Discussion of the pharmacodynamics of once-nightly basal insulins.
Main Results:
- FPG can be an unreliable indicator of basal insulin needs due to post-prandial glucose excursions from late meals.
- Overestimation of basal insulin requirements is common, leading to adverse effects.
- The "peakless" nature of some basal insulins coincides with increased insulin sensitivity during the predawn hours.
Conclusions:
- Limiting evening meal size and timing is crucial during basal insulin titration.
- Monitoring for early morning hypoglycemia is essential, especially during the predawn period.
- A comprehensive approach beyond FPG is needed for optimal basal insulin therapy in type 2 diabetes.
More Related Videos
08:13Study of In Vivo Glucose Metabolism in High-fat Diet-fed Mice Using Oral Glucose Tolerance Test OGTT and Insulin Tolerance Test ITT
Published on: January 7, 2018
72.7K
06:59Characterization of Metabolic Status in Nonhuman Primates with the Intravenous Glucose Tolerance Test
Published on: November 13, 2016
11.5K
Related Concept Videos
01:24Metabolic States of the Body: Fasting and Starvation
3.4K
During the initial hours of fasting, the body uses up its glycogen stores as an energy source. Once these glycogen reserves are depleted, the body begins breaking down stored triglycerides and structural proteins. During this stage, glycerol becomes a key substrate for gluconeogenesis, while free fatty acids undergo beta-oxidation to provide energy for tissues, such as skeletal muscle. In the fasting state, the body spares protein breakdown as much as possible to conserve muscle and structural...
3.4K
01:15Hypoglycemia and Glucagon
1.3K
Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
1.3K
01:02Glucose Homeostasis: Regulation of Blood Glucose
5.5K
Carbohydrates consumed through foods are converted into glucose, a crucial energy source for the body. In the prandial state, high blood glucose levels stimulate the secretion of insulin from the pancreas. Insulin inhibits hepatic glucose production and stimulates glucose uptake and metabolism by muscle and adipose tissue. The excess glucose is converted into glycogen and stored in the liver and muscles.
During fasting, when blood glucose levels are low, the pancreas secretes glucagon. it...
During fasting, when blood glucose levels are low, the pancreas secretes glucagon. it...
5.5K
01:18Metabolic States of the Body: The Postabsorptive State
1.6K
The postabsorptive state usually starts about four hours after a meal and lasts until the next meal is eaten. During this time, the digestive system stops absorbing nutrients, and the body uses stored energy reserves to maintain stable blood glucose levels.
Initially, glycogen stored in the liver is broken down to release glucose into the bloodstream, while glycogen in the muscles is broken down to supply glucose for energy directly within the muscle cells. As glycogen stores diminish,...
Initially, glycogen stored in the liver is broken down to release glucose into the bloodstream, while glycogen in the muscles is broken down to supply glucose for energy directly within the muscle cells. As glycogen stores diminish,...
1.6K
01:16Hormones Regulating Blood Glucose
8.9K
Insulin is released by beta cells of the pancreas when blood glucose levels are high. It facilitates glucose absorption and utilization in insulin-dependent cells with insulin receptors on their plasma membranes. Insulin promotes glucose uptake by increasing the number of glucose transport proteins in the cell membrane, allowing glucose to enter the cell. As a result, glucose utilization and ATP production are enhanced.
In addition to accelerating glucose uptake and utilization, insulin has...
In addition to accelerating glucose uptake and utilization, insulin has...
8.9K
01:15Diabetes: Symptoms, Diagnosis, and Complications
2.9K
For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
2.9K