Fluctuations in Blood Sugar and Cholesterol Levels

High blood sugar and high cholesterol?

Hello doctor, in 2017 during my company's health check, my fasting blood glucose was 103 and total cholesterol was 214.
Therefore, on January 28 of this year, I went to Taipei Medical University Hospital for a blood test for glucose and cholesterol.
The results showed fasting blood glucose at 92, HbA1c at 5.3, total cholesterol at 202, and low-density lipoprotein (LDL) at 109.
The doctor said these results were normal.
However, one and a half months later, on March 18, during another company health check, my fasting blood glucose was 108, total cholesterol was 234, and LDL was 147.
I was shocked by these results, so I used my father's glucose meter to check my fasting blood glucose, which was 107.
I also tested my postprandial blood glucose for two days, which were 125 and 123, respectively.
I would like to ask why there is such a significant difference in the values (blood glucose and cholesterol) between the tests at Taipei Medical University Hospital and the company health check, considering it was only a short span of one and a half months? Am I considered to be in the prediabetic stage?

Lai En, 30~39 year old female. Ask Date: 2019/04/10

Dr. Xiao Yongxun reply Family Medicine

1.
According to the diagnostic criteria for diabetes set by the American Diabetes Association: a.
Fasting plasma glucose level ≥126 mg/dL after fasting for more than 8 hours, b.
Plasma glucose level ≥200 mg/dL during a 2-hour oral glucose tolerance test, c.
HbA1c ≥6.5% (must not have any disproportionate hyperglycemia, and the testing method must comply with the international certification standards of NGSP and DCCT).
The above criteria a, b, and c must be confirmed on two separate occasions.
d.
If there are clinical symptoms of diabetes (such as polyuria, polydipsia, polyphagia, weight loss, etc.), and any plasma glucose level ≥200 mg/dL (this condition only needs to be confirmed once).

2.
If the postprandial plasma glucose level is between 140 mg/dL and 199 mg/dL, it may indicate impaired glucose tolerance, currently referred to as [increased risk of diabetes], which is what was termed prediabetes in 2010.
To make this diagnosis, a standard oral glucose tolerance test must be conducted, rather than a general postprandial glucose check.
3.
Generally, a normal fasting plasma glucose level is less than 100 mg/dL.
If it is between 100 mg/dL and 126 mg/dL, it can be considered prediabetes or impaired fasting glucose.
Of course, if the postprandial glucose is greater than or equal to 126 mg/dL, diabetes should be suspected.
4.
Clinically, when postprandial glucose levels are elevated, attention should be paid to whether the risk of developing diabetes is increased; often, this is more sensitive than measuring fasting glucose levels.
5.
Based on the above, the blood glucose levels you described do not confirm a diagnosis of diabetes; sometimes, clinicians may use the term prediabetes to indicate the need for vigilance in diabetes prevention.
6.
Your fasting glucose level is 107 mg/dL; however, with normal HbA1c levels, this may indicate mild impaired fasting glucose.
It could be due to overeating recently or lack of exercise.
In fact, individuals with a family history of diabetes, obesity, a history of gestational diabetes, women who have given birth to infants weighing over 4 kg, hyperlipidemia, hypertension, unexplained weight loss, or wounds that heal poorly, are all at risk for diabetes.
If none of these apply, there is no need to panic.
Increasing physical activity, reducing intake of refined foods, especially avoiding overeating and high glycemic index foods, ensuring adequate sleep, and moderate weight loss can all improve blood glucose levels.
Mild diabetes can improve to impaired glucose tolerance, and impaired glucose tolerance can improve to normal.
This means that the development of diabetes is not an all-or-nothing or sudden occurrence; it is a gradual process.
Therefore, it is essential to consistently change lifestyle habits, dietary practices, and maintain regular exercise.
7.
If cholesterol levels are elevated, dietary and exercise control should be prioritized.
It is recommended to reduce the intake of high-cholesterol and trans fats (often found in creamers, butter, ghee, instant coffee, milk tea, etc.) and high fructose corn syrup (commonly found in commercial beverages, desserts, cola, pastries, etc.).
These types of foods may be more difficult for the body to metabolize, or they may be high in calories without providing a feeling of fullness, which can also lead to increased blood glucose levels.
Additionally, increased physical activity can help lower cholesterol levels.
8.
Blood glucose and cholesterol levels naturally fluctuate with diet, exercise, and lifestyle; as long as the changes are not extreme, it is generally acceptable.
If there are further concerns, it is advisable to discuss them with your family physician or seek care at a metabolic clinic.

Reply Date: 2019/04/10

More Info

Understanding fluctuations in blood sugar and cholesterol levels can be quite complex, as various factors can influence these measurements. Based on your provided information, it appears that you have experienced notable variations in your fasting blood sugar and cholesterol levels over a relatively short period. Let's break down the potential reasons for these fluctuations and what they might mean for your health.

Blood Sugar Levels
1. Fasting Blood Sugar Variability: Your fasting blood sugar levels have ranged from 92 mg/dL to 108 mg/dL. According to the American Diabetes Association, a fasting blood sugar level of 100-125 mg/dL is considered prediabetes, while levels of 126 mg/dL or higher indicate diabetes. Your readings suggest that you are on the borderline of prediabetes, especially with the 108 mg/dL reading from your company health check.

2. Postprandial Blood Sugar: The post-meal blood sugar readings of 125 mg/dL and 123 mg/dL indicate that your body may be struggling to manage glucose effectively after eating. Ideally, postprandial blood sugar levels should be below 140 mg/dL two hours after eating. Your readings are within the acceptable range but are on the higher side, which could suggest insulin resistance.

3. Factors Influencing Blood Sugar: Several factors can cause fluctuations in blood sugar levels, including:
- Diet: The types of food you consume, especially carbohydrates, can significantly impact your blood sugar levels. High-sugar and high-carbohydrate meals can lead to spikes in blood sugar.

- Physical Activity: Regular exercise helps improve insulin sensitivity and can lower blood sugar levels. A sedentary lifestyle may contribute to higher readings.

- Stress: Stress hormones can increase blood sugar levels, so emotional or physical stress can play a role.

- Sleep: Poor sleep quality or sleep disorders can also affect blood sugar regulation.

Cholesterol Levels
1. Total Cholesterol Fluctuations: Your total cholesterol levels have varied from 202 mg/dL to 234 mg/dL. The American Heart Association considers total cholesterol levels below 200 mg/dL as desirable, while levels between 200-239 mg/dL are borderline high, and levels of 240 mg/dL and above are high.

2. Low-Density Lipoprotein (LDL) Cholesterol: Your LDL cholesterol levels have also fluctuated, with a notable increase from 109 mg/dL to 147 mg/dL. Elevated LDL levels are associated with an increased risk of cardiovascular disease.

3. Factors Influencing Cholesterol: Similar to blood sugar, cholesterol levels can be influenced by:
- Diet: Saturated fats, trans fats, and dietary cholesterol can raise LDL levels. Conversely, healthy fats (like those from fish and nuts) can help improve cholesterol profiles.

- Weight: Being overweight can negatively impact cholesterol levels.

- Physical Activity: Regular exercise can help raise high-density lipoprotein (HDL) cholesterol, which is considered "good" cholesterol.

- Genetics: Family history can play a significant role in cholesterol levels.

Conclusion and Recommendations
Given your fluctuating blood sugar and cholesterol levels, it is advisable to take proactive steps to monitor and manage your health:
1. Regular Monitoring: Continue to monitor your blood sugar levels regularly, especially if you notice any symptoms such as increased thirst, frequent urination, or fatigue.

2. Consult a Healthcare Provider: Discuss your concerns with a healthcare provider, who may recommend further testing, such as an oral glucose tolerance test or a lipid panel, to better assess your risk for diabetes and cardiovascular disease.

3. Lifestyle Modifications: Focus on a balanced diet rich in whole grains, lean proteins, healthy fats, and plenty of fruits and vegetables. Regular physical activity, aiming for at least 150 minutes of moderate exercise per week, can also help improve both blood sugar and cholesterol levels.

4. Stress Management: Incorporate stress-reducing techniques such as mindfulness, yoga, or meditation into your routine.

5. Follow-Up Testing: Schedule follow-up appointments to monitor your blood sugar and cholesterol levels over time, as this will help you and your healthcare provider make informed decisions about your health.

By understanding the factors that influence your blood sugar and cholesterol levels, you can take steps to improve your overall health and reduce the risk of developing diabetes or cardiovascular disease.

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