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Reasons for fasting blood sugar to be higher than the PP blood sugar?

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Practicing since : 2002
Answered : 52 Questions
What are the possible reasons for Fasting Blood Sugar to be higher than the PP Blood Sugar?
Specifics: 33 weeks pregnant with 2nd child (33 years of age). No diabetic history. HbA1C 5.6%
Dinner – 8pm on 12th April followed by walk for 45 mins.
2 Rotis, Cabage dry curry – 1 cup, Rajmah Beans Curry – 1 small cup, Cucumber grated in curd – 1 large cup, 1 small crème wafer
Sample provided at 8 am on 13th. FBS 111

Break Fast – 8:20 am on 13th April followed by 15 mins walk
1 plain parantha, 1 full egg omlet, 1 glass of milk (300 ml) with 1 tsp sugar , 3 almonds
Sample provided at 10:25 am on 13th. PBS 110
Posted Sat, 11 May 2013 in Thyroid Problem and Hormonal Problems
Answered by Dr. Anantharaman 39 hours later
Thanks for writing in. Fasting glucose is primarily determined by liver glucose production .its different in different people .in younger individuals such as yourself fasting glucose tends to be higher commonly . Any high glucose fasting or post meal is not acceptable in pregnancy. By definition you do have gestational diabetes. Please contact your caregiver as you need to be on insulin at night . High fasting glucose in pregnancy is associated with larger babies and low glucose for the baby after delivery.also do check your glucose 1 hr after meal it should be below 140 mg/ dl.
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Follow-up: Reasons for fasting blood sugar to be higher than the PP blood sugar? 2 hours later
Hi Doctor. Thanks for responding!

My primary question however was to understand the possible reasons for fasting glucose to be marginally higher while all other readings are well within limits (Reference to the Glucose Tolerance 1 hour as well as 2 hours, HbA1C average, PBS and various RBS readings through the day). I have obviously shared this information with my OBG and she has not highlighted any specific concerns stating these readings are 'almost normal'. In addition my own weight gain and the estimated baby weight as per my USG scans has been normal as well.

The reason for my question is also to see how and whether I can manage these levels with appropriate adjustments to food intake or exercise and avoid drastic measures for the next 4 to 6 weeks.

I would appreciate if you could share the possible reason for specifically FBS being marginally higher or impaired, even if it suffices for my curiosity. Thanks!
Answered by Dr. Anantharaman 4 days later

I apologize for the delayed response.

Early morning fasting blood sugar is influenced by
- Post dinner sugar levels,
- Insulin resistance and
- Presence of other hormones which stimulate and increase blood sugar level. Glucagon and cortisol are two such hormones. Please note that level of cortisol is highest at around 6-8 AM and it drops gradually to reach the lowest at midnight. Also a good meal inhibits glucagon.

All these factors may be the responsible for higher fasting blood sugar at 8:30 am and a low post prandial blood sugar at 10:25 am.

The bottom line is that I suspect your blood sugar to be high post dinner and the hormone effects after breakfast leading to this phenomenon (high fasting and low post prandial sugar). Therefore my suggestion to start insulin at night. You may verify this by getting your blood sugar checked pre / post dinner blood sugar and discussing with your treating doctor.
I am pleased to know that your last ultrasound scan was normal. And I wish your pregnancy is uneventful.

Let me know if you have other concerns.

Thank you
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