Need help navigating life with diabetes?  Ask D'Mine! That would be our weekly advice column, hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week, Wil takes on the issues of high blood sugars in the mornings and whether us people with diabetes can just use a measuring tape around our waists to gauge our health. What, you say? Keep reading!

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Carol, type 2 from California, writes: Newly diagnosed diabetic here. Watching the grams of carbohydrates and testing blood sugar. The blood sugar is high in the morning — why is this so after approximately 8+ hours of fasting, i.e. sleep?

Wil@Ask D'Mine answers: Because your liver has sprung a leak. Oh, don't worry, it's not as scary as it sounds. But let's talk liver. Now, on a plate with onions, I can't stand liver. I don't think there's a food in the world that I hate more. Hell, to me, would be a place with nothing but liver to eat.

But in a living organism, the liver is frickin' amazing. In humans it's the largest classic organ (your skin, technically an organ, is actually the largest). Your liver takes up quite a bit of space on the right side of your chest, more or less below your bottom rib. It weighs in at three pounds, and is the ultimate multi-tasking organ. I mean, if you think about it, most of your body's sundry parts do one thing, and one thing only. Not the liver. For instance, it makes digestive juices, like bile. It filters nasty stuff like alcohol and Tylenol out of your blood. It produces cholesterol and regulates amino acids. In fact, no shit, the liver does more than 500 different tasks.

But most relevant to those of us with diabetes: the liver is a giant sugar battery. Yep. That stupid bunny with the drum and the pink ears has nothing on the human liver. One of the liver's key functions is to store sugar and then release it later when it's needed. Like, say, between meals. Or when you're sleeping.

All the body's other organs, in fact every one of the 60-90 trillion cells that make up your carcass and hide, eat all the frickin' time. But you can't eat constantly, because, for one thing, you need to sleep. You also need to update your Facebook status and pay attention to your loved ones. So the body's solution to that problem is the liver. It stores extra glucose when you eat, and releases it as needed to keep the fuel coming when you aren't eating.

It's a very elegant system. But as you know, diabetes screws up all the elegant systems of our bodies, and it's very common for type 2s to suffer from an insidious syndrome called LLS, or Leaky Liver Syndrome.

OK. I made that up.

It's really called nocturnal hepatic glucose release. But Leaky Liver sounds so much more fun.

Now, there's really not anything wrong with the LLS liver. It's more like crossed wires than broken gaskets. It's just a hormonal problem that leads to the liver releasing more glucose than the body needs. It shows up most commonly just as you described: you wake up with higher blood sugar than you went to bed with.

(I guess before the flamers burn me at the stake I should point out that less commonly.[W2]   elevated morning sugars can also be caused by sleep disturbances such as sleep apnea, nightmares, sleep walking to 7-11 for a Big Gulp and a burrito, or alien abduction; but the liver thing is the most common cause of elevated morning blood sugar.)

So how to fix it? You gotta see your doc for that, but the two most common treatments are to use either metformin, a pill that fixes the gasket on the leaky faucet; or NPH insulin, an intermediate-acting insulin that mops up the water that's dripping from that leaky faucet, so to speak.

Oh, and the third option, if your doc says it's OK, is to do nothing. If the morning blood sugars are only a tad high, and come back down as soon as you start moving your body with the sunrise, no action may be the best course of action.

So now you know why. It's common. It's part and parcel of type 2 diabetes. And there's no reason to get mad at your liver. After all, it's still doing its other 499 jobs pretty well.


Cheryl, type 1 from Texas, writes: I read that to check your health with diabetes, you should skip the scale and grab a measuring tape: your waist should be less than half your height to keep heart disease at bay. Is there anything to this? Or is it just another media-hyped myth?

 Wil@Ask D'Mine answers: I hadn't heard the waist to height ratio before, but there's truth to the measuring tape and heart stuff. In fact, there's plenty of good evidence that if your waistline exceeds 40 inches for dudes and 35 inches for chicks, you're at higher risk for bad heart stuff. You know, like heart disease, heart attack, stroke, and death. Stuff like that.

How on earth were these numbers chosen? Simply by tracking the health outcomes of people with diabetes and seeing at what point people with increasingly large waist circumferences have increasingly bad outcomes, heart disease-wise.

Now, the more inches above target you are, the higher your risk. It's like that tornado rating scale where an f-4 is a whole hell of a lot more destructive than an f-3. Just ask Dorothy.

So, what if you are a lady with, oh... I dunno...a 57-inch waist? Are you likely to get down to the low-risk 35 inches? Frankly, no. Not very likely at all. But here's the thing. You don't need to have a Barbie Doll waist to lower your risk of heart disease. Remember what I told you about the tornados? Any reduction in waist circumference is a reduction in heart disease risk. Maybe you can't get to 35 inches. But 47 is better than 57. Hell, 55 is better than 57. Every inch counts.

And as diabetes is a HUGE risk factor for heart disease in the first place, it behooves us to fix any other risk factors that are in our power to fix, the so-called modifiable risk factors.

Now, a quick note on how to measure your waist size, because it may not be the same as your pants size: You might be one of those old men who wears the waistline of your pants around your nipples, or one of those street punks who wears your waistline at your knees to show off your stylish boxer shorts. A medical waist circumference is defined as: the measurement from the top of the iliac crest in a horizontal plane around the abdomen. Say what?? In English, this means measure around your middle, being sure to go from the top of your hips around through your belly button. And don't suck your gut in when you're doing this. That's cheating. A cloth tape measure is used because the metal ones kink, bend, snap, or cut your skin and give crappy and inaccurate results.

But wait a cotton pickin' moment. Who has cloth tape measures anymore? I happen to have one 'cause my mom was an avid sewer. But of course, I have a solution for you. Just use a piece of string, yarn, or rope. Or chain, if you're one of those kinky types or have been reading 50 Shades of Grey.

Just wrap the string, or whatever, across the proper part of your body, then measure the string with a ruler, yard stick, or metal tape measure. Ta-da! There's your waist circumference. Easy-peasy, as my son likes to say.

Oh. And since you asked, my waist circumference is 38 inches. Well, OK. 38-and-a-half. Or maybe 39-and-three-quarters. I'm six feet tall and my lying piece of shit bathroom scale says I'm 191 pounds. That gives me a body mass index of 25.9, technically overweight. So the tape measure says I'm OK and the scale says I'm not. Should I kick the scale to the curb?

I don't think so. One thing I like about scales is that problems show up there first. If I've put on five pounds, Mr. Scale will tell me if I ask. If I put on five pounds my clothes won't tell me. For one thing, I'll probably stretch them out as I pack on the pounds. For another thing, weight is distributed all over your body. Not just on your waistline.

Like all things in diabetes, scales and tape measures are just different arrows in our quivers. And if I need to defend myself from diabetes with a metaphorical bow and arrow, I want as many frickin' arrows in my quiver as I can get.



This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.


Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.