Variations of blood sugar values

Question

Dear CF team,
I have no proven diabetes in case of CF. The regularly performed OGTT (oral gulcose tolerance test) has been borderline for years, never unambiguously too high.
The fasting blood sugar values are between 105 and 138. Insulin donation for the night has been discussed, however the topic was finished quite fast, after my doctor checked the daily variations in the protocol. Nearly continously they are between 60 and 220. Slip-up values around 40 are repeatedly among them. Then the nightly administration of insulin had been abandonned quickly, as the staff of the center feared a nightly hypoglycemia.
With bananas and high-calory smoothies I go to sport. However even with this I do not come along very well, as the hypoglycemia gets me after 2 km of running.
Do you have any idea for me, what else I could do? Do the high fasten blood sugar values cause damage?
Many thanks for your efforts!

Answer

Hello,
variations of blood sugar values in case of CF are often a sign that the pancreas is not able to relase insulin into the blood "in time" anymore. That means, that indeed during food intake the signal is given to the pancreas "produce more insulin", however, the produced insulin comes too late into the blood due to scarring of the pancreas. There, the sugar has already decreased due to alternative mechanisms, and then the Insulin finally arrives. By this, the very uncomfortable phases of hypoglycemia occur, as the insulin further decreases the already decreased blood sugar value.
What can be done about this?
It is important to avoid if possible "fast" carbohydrates like gummi bears, fructose or cola but rather to fall back on "slow" carbohydrates like muesli. It is also important, to get to know the phases with hypoglycemia and to face the hypoglycemia already in advance with anew intake of food (e.g. when running, eating a cereal bar on the first kilometer).
The by you mentioned bananas and smoothies just do not help here, as they first increase the sugar value before running, then via running decrease the sugar and then the insulin comes even too late. Here it would probably be better, to eat only small pieces during running, e.g. muesli bar.
An alternative would also be longlasting Insulin preparations, that are administered with one dosage of 4-8 untis once a day and that help to diminish the variations of the blood sugar. This has to be tried together with the diabetes specialists and at the beginning the sugar has to be measured regularly.
Yours sincerely,
PD DR. Rainald Fischer

29.04.2014