Endocrinology-Diabetes Questions Diabetes

Why does my mother have fluctuating diabetes levels?

My mother is 65 years old and has extremely fluctuating diabetes levels. In the morning her sugar levels go low to 50 and by noon rise upto 267. What could be the cause of this fluctuation?

8 Answers

Major cause of sugar fluctuations include medications and food. If your mother is taking insulin before bed that causes her sugars to drop too low in the mornings, the insulin dose needs to be changed.
Since when he sugars are low, she is likely eating something sweet or drinking juice, then her sugars rebound into high numbers. It is imperative she sees her Endo and brings them her glucose meter or glucose log to discuss medication adjustments.
Wide fluctuations in blood glucose suggest that she is experiencing low blood glucose (hypoglycemia) on a frequent basis causing a "bounce" in her blood glucose to high levels. Her medications should be adjusted to first eradicate hypoglycemia, and then to deal with the high blood glucose values.
AM sugars reflect overnight production of sugar by the liver, which is dependent on the degree of insulin resistance present in the patient. AM sugars also reflect the quantity of carbs eaten for dinner as well as the time dinner was eaten, and it also reflects medications taken to control sugars. It is a complex problem that requires careful analysis and treatment.
Several reasons: If she’s taking insulin, she needs to see her endocrinologist to likely adjust the dosing; too much insulin at bedtime; she may be having highs at lunch because she’s afraid to take diabetic medication in the AM as a result of the fasting low; she may be miss-administering her dm medication, especially insulin; she may be taking a short acting insulin at bedtime, resulting in some lows fasting.
This is more likely related to her medication, but, of course, it could be her eating pattern also.
Most cases of fluctuating blood sugar are related to poor diet or a need to change medication timing. Low blood sugar can be very dangerous and you should report this to your healthcare provider.
This is an insightful question! Nicely done!

First: Is she taking any medications for diabetes? The most common reason for waking up in the middle of the night or early morning is TOO much basal insulin (long lasting insulin like Lantus / Toujeo / Levemir / Tresiba / etc).

For diabetic patients, it is important to first get them stable through the night. This means checking a sugar BEFORE BED and then when waking in AM. The goal is to keep it steady overnight (i.e.: bedtime sugar of 150 to AM sugar of 150).

I personally do not like people going to bed hyperglycemic and drifting down ~100 points overnight (ie sugar of 200 to 100). This is because should we go to bed one night with a sugar of ~150 it may drift down 100 points to ~50, a low.

In short, take a close look at the insulins or medications on board and make sure we have not given too much long-lasting basal insulin.

The elevated sugars at noon are likely related to not enough insulin (or medication) given at breakfast to cover for the sugar / carbohydrate / glucose influx with breakfast.

I hope this gives you some guidance and feel free to post another message should you continue to run into issues!

Reassess her medications and diet.
It is impossible to answer this question without more information. There are many reasons for wide fluctuations of BG. She may be on the wrong medicine, or the wrong doses, or she may not be getting the medicines at the right time to coincide with the food or activity. Without knowing what medicine or medicines she is on & doses & timing between meds & food & her activity patterns and most important the pattern of her BG over several days or weeks, I cannot give you a better answer. Talk to her physician. Take him or her at least 2 weeks of BG measures done 4x/d and look for patterns that may show the cause.