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What causes fasting hyperglycemia

The alarm sounds, you roll out of bed and take your sugar reading…………………it’s high.

You didn’t raid the fridge in the middle of the night, so why do you have fasting hyperglycemia ?

Because…..

You’re diabetic

High fasting glucose, IS how diabetes is diagnosed.

Since this IS THE PROBLEM…………one would think, THE ANSWER might be important.

The short answer, they don’t REALLY know, what causes fasting hyperglycemia – insulin resistance is usually blamed.  The reason, the insulin resistant liver, never switches off glucose production.  Why not ?

I recently came across this article, which offers an explanation for the cause of fasting hyperglycemia, based on the what had been observed in patients undergoing bariatric surgery.

Bariatric surgery “cures” type 2 diabetes

Amazingly,  a week after the re-arrangement to the GUT, in someone undergoing Roux-en-Y gastric bypass surgery, sugar levels have improved significantly.   Since, a week after surgery, the patient is still SERIOUSLY FAT, it actually takes months for them to lose the excess fat,  this improvement has nothing to do with decreased fat levels.

So what does change ?

After bypass surgery

Well, they’re eating less.  They’re forced to.

Biochemically speaking, their insulin levels drop dramatically.  So do their lactate and alanine levels, these are among the chemicals, the liver uses to make SUGAR.

So what is the story with lactate ?

Sore muscles

Lactate, or more specifically lactic acid, is associated with sore muscles and you losing your get up and go, following an exercise session.

So what happens……

The exercising muscle takes up glucose,  as the glucose slips into the cell, a phosphate group is thrown on it, creating glucose-6-phosphate.

With the phosphate attached, the glucose is effectively trapped in the muscle.

It MUST be used….

The fate of that glucose molecule

Most of the time, a smidgeon of the energy tied up in the glucose molecule is immediately released, as the glucose is converted to pyruvate.    What happens to this pyruvate, depends on what the muscle is up to and how “hungry” the muscle is :

• If the muscle is busy, busy and there is enough oxygen around, the pyruvate gets burned up in the mitochondria, creating lots of energy.
• If there is not enough oxygen, which often happens if you’re not so fit or you’re exercising like a mad man, then it cannot be burned. “Burning” is oxygen dependent.

If you’re not able to burn it or you just plain don’t need it i.e. you’re full, it starts to accumulate.

Pyruvate accumulates

Now this might sound like a good thing, the cell has a ready to use fuel supply, should the situation change.  But, there is a catch,  this build up of pyruvate, impacts the redox status of the cell, because the cell’s supply of NAD + has been used up.

This situation that cannot be ignored – so, the cell makes a plan.

Shipping the fuel out of the cell

To recycle the “electrons” and restore the NAD + supply, electrons are pulled off,  as the pyruvate is converted to lactate.

Lactate has legs.

It  is able to leave the cell, re-entering the blood stream, eventually landing back in the liver.

Recycling the “glucose”

The liver’s mission is TO FEED the body.

The arrival of the lactate, signals the liver to whip up a batch of glucose.

Quick as a flash, the lactate becomes pyruvate, which then whizzes through the “gluconeogenesis pathway” and whalla……… a glucose molecule is made.

And released into the circulation, to feed the hungry.

Cells that have been exercising ARE hungry, but in the middle of the night………

No one is hungry

Muscles aren’t busy and they’re pretty full !

In the type 2 diabetic, they’re REALLY FULL.  Remember, insulin helps cells to gather supplies and since insulin levels ARE ALWAYS high, in the type 2 diabetic, cells tend to be REALLY FULL. This is why they become insulin resistant.

The other BIG glucose guzzler, the brain, is also taking it easy in the middle of the night, so it’s glucose needs are less.

So…

Fasting hyperglycemia

The glucose hangs around, accumulating in the circulation.

Doing damage !

And you wake up, with an unbelievably high glucose reading, even though you haven’t eaten for hours.

Hungry muscles

Making your muscles “HUNGRY”,  should help you lower fasting glucose levels.  Of course, metabolic imbalances, make this is easier said than done.

One thing, that can help make muscles hungry……. is exercise, especially exercise later in the day and you don’t want to be eating, shortly before bed.

Further reading