Answer:
Your question brings up two points. The first is whether there is a long-term hazard in prebreakfast (i.e., fasting) blood sugars of 115 mg/dl? The American Diabetes Association (ADA) appears to have answered this when it created a new diagnostic category known as "impaired fasting blood glucose" for individuals who display fasting values greater than 110 mg/dl on two occasions.

Your second point relates to transient spikes. I see many non-diabetic obese people whom I help to lose weight. A number of these individuals have normal fasting glucose levels (about 90 mg/dl) but HgbA_1c values that are slightly elevated at around 5.5%. This corresponds to a four-month average blood sugar of about 120 mg/dl at my lab. I suspect that such mild elevations have been present for years. Inevitably, I'll find some early diabetic neuropathic complications on physical examinations. These may include somewhat diminished heart rate variation on deep breathing (parasympathetic neuropathy), dry skin on the feet (sympathetic neuropathy), the intrinsic minus foot deformity with claw toes and high arch (motor neuropathy and glycoslation of plantar fascia)), diminished sensation in the feet (sensory neuropathy) and double vision in one or more directions of gaze (oculomotor neuropathy). Usually, more than one of these signs is present. I suggest that you have your HgbA_1c checked.  Truly normal values are probably below the midpoint of the normal range of your laboratory, since most labs tend to set their normal ranges too wide.

For the problem of controlling your blood sugars, I would advise a very low-carbohydrate diet. If you are in shape and exercise, it is likely that you might be consuming too much carbohydrate. If a low-carbohydrate diet does not normalize your blood sugars, the next step would likely be insulin, which must be administered in a physiologic manner as determined by blood glucose profiles. Although sulfonylurea oral medications might work initially, they are not long-term solutions because of their propensity to cause beta cell burnout.

 If the diet alone gets your post breakfast blood sugars below 120mg/dl, you might try equi-molar amounts of alpha lipoic acid and evening primrose oil at bedtime----1800 mg of a special timed release water and lipid soluble alpha lipoic plus 2500 mg evening primrose oil.  The goal would be to get all your blood sugars down to 85mg/dl---a non-diabetic value.  This combination increases sensitivity to your own insulin, even if you are not, by virtue of your slim build, insulin resistant.

Richard K. Bernstein, M.D., F.A.C.N., F.A.C.E., C.W.S.