Since most of the day’s cortisol is produced within 30 to 45 minutes of waking, do you counsel patients who are tracking blood you’re going to check fasting values after this window of time has passed, or is it important to see how high they get at that time?

Okay. What I think Jessica is referring to here is sort of that cortisol awakening response. I don’t know of the majority of cortisol is actually produced within the first 30 to 45 minutes in terms of the total percentage of cortisol that’s produced over the 24 hours, but you’re right in that we do get a spike of cortisol in the morning. We do get a peak cortisol level pretty early in the morning. We don’t specifically tell patients to check their fasting glucose within the first hour of waking up because what we’re generally looking at is— so when we ask patients to monitor their cortisol, we suggest taking it before a meal so we get a baseline, and then we take it about 15 minutes after finishing the meal so you’re looking at the peak because you never want that glucose level to get above about 140. In some of our patients, we even maybe don’t want it to go about 120, so you have to decide what your target is but at least conventionally never really above 140 at that 15 minutes. Then, we check in an hour after eating and two hours after eating because by two hours after eating, you want to be back at baseline. That’s why you need that premeal blood glucose level. That’s how we’re asking patients to track it right now, before eating and then three different measurements after eating because we want to see how does the blood sugar recover.

I don’t think it’s essential to look at blood sugars specifically during that sort of cortisol awakening time when you’re getting peak cortisol because my question isn’t so much does this patient have a high blood sugar at that time. My question is what is the average? How is this blood sugar responding throughout the day? Are there ways that we can improve it? I’m much more concerned what blood sugar is looking like throughout the day and how it’s responding to and recovering from diet in the foods that we’re eating that are specifically triggering it.

Hopefully that makes sense. So no, I wouldn’t check it necessarily within the first 30 and 45 minutes of waking.