PPBS is less than FBS

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There is a common perception that PPBG level must be higher than FBG level .But repeated investigations yields similar type of result. FBG may be higher than the PPBG in both diabetics and healthy population MECHANISMS - Immediately after food intake, insulin is released from pancreas that maintains blood glucose by activating glycolysis pathway along with suppression of glycogenolysis and gluconeogenesis pathway. The common cause of decreased postprandial glucose level is intake of antidiabetic medication and strenuous activity before sampling. Individuals with lesser PPBG level than FBG should be evaluated for possibility of meal induced hypoglycemia also known as reactive hypoglycemia. Various causes for this are high insulin sensitivity, exaggerated response of glucagon-like peptide-1, defects in counter regulatory hormones like glucagon and massive weight reduction.3-6 Chewing and eating slower can reduce the reactive glucose surge post meal. Other causes of lower PPBG includes gastroparesis seen in diabetic patient which an alter the rate and amount of food passing into small intestine causing erratic changes in blood sugar level. Some people deliberately eat less or eat non-carbohydrate meal before testing for PPBG level.

Yes possible. Either dose taken before breakfast or lunch might be very high than required. Or As sir said, it could be due to dawn or somogyi phenomenon. In dawn, due to inadequate insulin, mid night sugar levels are also high apart from FBS. But in somogyi, mid night patient goes into hypoglycemia due to overdose of insulin and as a result of counter regulatory hormones there is rebound hyperglycemia in morning due to which there is high FBS. So FBS is in higher range which might get normal after morning insulin resulting in normal PPBS. To differentiate this do mid night RBS.

Yes. In Dawn Phenomenon. It is a medical condition characterized by a blood sugar spike that occurs early in the morning . The sugar surge could be related to an inadequate dose of insulin the night before or eating too many carbs before bed. But the spike might also be related to natural body fluctuations that occur during sleep. During the night, newly released hormones might increase your body’s resistance to insulin, which ultimately impacts your body’s ability to absorb sugar into the cells, resulting in high sugar levels in the blood..

In normal individual this is not possible because blood level of sugar is more in PP than fasting But this condition occurred because after inj insulin food is not taken & causes low level of sugar. This is also happened with medicine when food is not eaten. Overdosage of diabetic medicine medicine in psychological patient causes hypoglycemia in PP condition. Not proper prescription of diabetic patient for example medical store & RMP causes hypoglycemia in PP condition

PP blood sugar can be lower than fasting blood sugar, though not very commonly. 1) If Islet cell response to breakfast is very good, and breakfast itself is of low calorie, PP BS may become lower than FBS. 2) If OHA/ Insulin is taken very early before breakfast , this can happen . 3) Post orandial hypoglycemia patients may have this finding. May need adjustment of dose and timings of OHA/ Insulin .

It is found in some cases that postprandial level of blood glucose is remarkably lower than that of fasting level. Being unsatisfied with the laboratory result, patient or sometimes clinician wants to recheck the blood glucose level in next laboratory.

Glucose appears to be a stronger agent than the more natural mixed meal in these individuals in causing post prandial lowering of plasma glucose.

Yes possible with post prandial blood glucose.

Yes in reactive hypoglycemia

Yes, possible.

Thanks Dr Golam Murtaza
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