Thank you Elmo

Blood sugars rise naturally during the night while we're asleep but they go down when we get up and start to be active!

The issue with metformin vs kidneys is not that it hurts the kidneys

Metformin stays in our system after we take it, doing it's job, for about 48 hours - so after a couple of days you may have "multiple doses" of the stuff floating around

There is residue after it has done it's job that can build up to toxic levels if the kidneys don't filter it out and pass it in our urine (as many toxins are passed the same way)

If you have reduced kidney function you can't filter out that "leftover"

So the "danger" is in not expelling the leftover metformin which could become toxic in the blood - it's not hurting the kidneys at all

The message got a little messed up - people jumped to the conclusion that metformin "caused" the kidney issue when in fact it was the "kidney issue" caused by "whatever" (high blood sugar destroys kidneys) that forces the discontinuation of the metformin

There are various guidelines based on other factors/diseases, but generally the guidance is when kidney function drops into the eGFR of 45'ish to "reduce the amount of metformin" and discontinue use all together when eGFR hits 30 - because at that point the kidneys, which are dying for "some reason" are no longer functional enough to filter out the leftover metformin (which is doing nothing but protecting the kidneys at this point from high blood sugar)

Thank you Elmo ☺️

Fasting/overnight blood sugar is really a complex thing and it's near impossible to simply "change one thing and it will be fine"

While we are sleeping our body takes care of our blood sugar needs. Hormones tell the Liver if something (generally the brain or one of our organs) needs some fuel and the Liver releases some

But it doesn't know we have diabetes and if it releases too much then we are high in the morning.

There are many ways we can try and effect it

Sometimes a snack before bed will put enough sugar in our system that the Liver doesn't get the call - this helps "some people"

But everything from not getting enough sleep "for you" (whatever your body actually wants/likes) to waking up multiple times a night, the seasons, stress levels, depression, other non-diabetic meds, a cold/flu, an injury, pain, fear and the list goes on all effect our morning blood sugar levels

The prescription if you want to do as much as "you can" to try and regulate it generally means:

Maintain healthy weight
Eat "regular" healthy meals (and if you eat about the same time each day that helps)
Get 6 or 7 hours of restful, unbroken sleep each night
Exercise sometime after your last meal of the day (typically supper)
Relax, particularly before you go to bed
Try a snack later at night (protein is the better choice here)

A couple of supplements "may" help as well - a fiber supplement and/or probiotic can help regulate your digestion which can lead to better hormone (control)

If you are having trouble falling asleep or staying asleep you could try a melatonin supplement with a big BUT - either ask your Doc or a Pharmacist for a recommendation as to dose size and when to take it even though it's an over-the-counter option

Melatonin can jack blood sugars if it's present at the "wrong time" - we need it at night when we are trying to sleep but if there is (extra) after we wake up it will drive up blood sugar, so it could take some fiddling to figure what's enough and when to take it to help

Finally, if your fasting sugars stay high no matter what you do (and current clinical guideline is to aim for "never above 126 or 7.0 mmols" in order to protect the heart (high fasting numbers elevate your risk a lot for heart attack and stroke), then start whining to your Doctor about going on meds (or increasing your dose)

The two "effective" controls for fasting numbers are Metformin and Long Acting Insulin (none of the other "new drugs" specifically target fasting numbers like these two) - so somewhat limited choices but better to medicate then suffer a heart attack

But unless you woke up in the middle of the night and ate a cookie, it is beyond unlikely that what you ate last night is still floating around in your system after a nights sleep