How to prevent diabetes and heart disease for $16

In the last article we discovered that the blood sugar targets established by the American Diabetes Association are far too high, and do not protect people from developing heart disease, diabetes or other complications. And we looked at what the scientific literature indicates are safer targets for fasting blood sugar, hemoglobin A1c and either OGTT or post-meal blood sugar.

On the other hand, we also discussed the importance of context: why it’s important not to rely on a single blood sugar marker, and how healthy people can sometimes have blood sugar spikes above 140 mg/dL one hour after a meal. Please keep this in mind as you read through the rest of this article.

In this article I’m going to introduce a simple technique that, when used properly, is one of the most effective ways to maintain healthy blood sugar and prevent cardiovascular and metabolic disease – without unnecessary drugs.

I love this technique because it’s:

  • Cheap. You can buy the equipment you need for $16 online.
  • Convenient. You can perform the tests in the comfort of your home, in your car, or wherever else you might be.
  • Personalized. Instead of following some formula for how much carbohydrate you can safely eat, this method will tell you exactly what your carbohydrate tolerance is, and which carbs are “safe” and “unsafe” for you.
  • Safe. Unlike the oral glucose tolerance test (OGTT), which can produce dangerous and horribly uncomfortable spikes in blood sugar, this strategy simply involves testing your blood sugar after your normal meals.

The strategy I’m referring to is using a glucometer to test your post-meal blood sugars. It’s simple, accessible and completely bypasses the medical establishment and pharmaceutical companies by putting the power of knowledge in your hands.

It’s one of the most powerful diagnostic tools available, and I use it with nearly all of my patients. Here’s how to do it.

Step one: buy a glucometer and test strips

A glucometer is a device that measures blood sugar. You’ve probably seen them before – they’re commonly used by diabetics. You prick your finger with a sterilized lancet, and then you apply the drop of blood to a “test strip” that has been inserted into the glucometer, and it measures your blood sugar.

There are literally hundreds of glucometers out there, and their accuracy, quality and price varies considerably. The one I recommend to my patients is called the Relion Prime, which can be found at Walmart.com. (Note: as a rule I don’t like to support Walmart, but I haven’t been able to find this unit anywhere else at a similar price.) Even better, the test strips, which you’ll need on an ongoing basis to monitor your blood sugar, are relatively cheap for the Relion Prime. You can get  50 of them for $9.00 at Walmart.com ($0.18/strip).

If you’d like the option to sync your readings to an iPhone or iPod Touch, the Relion Prime syncs with the Glooko MeterSync Cable. The Glooko cable (with the free app on your iPhone/iPod Touch) allows you to sync all readings, as well as track factors that affect your glucose level, such as carbohydrate intake, activity level, and how you’re feeling. Though the cable costs $39.95 on Amazon, it’s a worthwhile investment if you plan on tracking your glucose levels over a long period of time.

I’m sure there are many other choices that work well, but this is the unit I have the most experience with, and in general it is very reliable. Another good choice is the TrueTrack meter drugstores sell under their own brand name (i.e. Walgreens, Sav-on, etc.). Other models to consider are the One Touch Ultra or one of the Accu-Chek meters. The problem with these, however, is that the test strips tend to be more expensive than the Relion Prime.

Step two: test your blood sugar

  1. Test your blood sugar first thing in the morning after fasting for at least 12 hours. Drink a little bit of water just after rising, but don’t eat anything or exercise before the test. This is your fasting blood sugar level.
  2. Test your blood sugar again just before lunch.
  3. Eat your typical lunch. Do not eat anything for the next three hours.Test your blood sugar one hour after lunch.
  4. Test your blood sugar two hours after lunch.
  5. Test your blood sugar three hours after lunch.

Record the results, along with what you ate for lunch. Do this for two days. This will tell you how the foods you normally eat affect your blood sugar levels.

On the third day, you’re going to do it a little differently. On step 3, instead of eating your typical lunch, you’re going to eat 60 – 70 grams of fast acting carbohydrate. A large (8 oz) boiled potato or a cup of cooked white rice will do. For the purposes of this test only, avoid eating any fat with your rice or potato because it will slow down the absorption of glucose.

Then follow steps 4-6 as described above, and record your results.

Step three: interpret your results

If you recall from the last article, healthy targets for blood sugar according to the scientific literature are as follows:

Marker Ideal*
Fasting blood glucose (mg/dL) <86
OGGT / post-meal (mg/dL after 1 hour) <140
OGGT / post-meal (mg/dL after 2 hours) <120
OGGT / post-meal (mg/dL after 3 hours) Back to baseline
Hemoglobin A1c (%) <5.3

 

*To convert these numbers to mmol/L, use this online calculator.

Hemoglobin A1c doesn’t apply here because you can’t test it using a glucometer. We’re concerned with the fasting blood sugar reading, and more importantly, the 1- and 2-hour post-meal readings.

The goal is to make sure your blood sugar doesn’t consistently rise higher than 140 mg/dL an hour after a meal, but does consistently drop below 120 mg/dL two hours after a meal, and returns to baseline (i.e. what it was before you ate) by three hours after a meal.

There are a few caveats to this kind of testing. First, even reliable glucometers have about a 10% margin of error. You need to take that into account when you interpret your results. A reading of 100 mg/dL could be anything between 90 mg/dL and 110 mg/dL if you had it tested in a lab. This is okay, because what we’re doing here is trying to identify patterns – not nit-pick over specific readings.

Second, if you normally eat low-carb (less than 75g/d), your post-meal readings on the third day following the simple carbohydrate (rice or potato) challenge will be abnormally high. I explained why this occurs in the last article, but in short when you are adapted to burning fat your tolerance for carbohydrates declines. That’s why your doctor would tell you to eat at least 150g/d of carbs for three days before an OGTT if you were having that test done in a lab.

If you’ve been eating low-carb for at least a couple of months before doing the carbohydrate challenge on day three of the test, you can subtract 10 mg/dL from your 1- and 2-hour readings. This will give you a rough estimate of what your results would be like had you eaten more carbohydrates in the days and weeks leading up to the test. It’s not precise, but it is probably accurate enough for this kind of testing.

Third, as I said above, an occasional spike above these targets in the context of other normal blood sugar markers is usually no cause for concern.

Step four: take action (if necessary)

So what if your numbers are higher than the guidelines above? Well, that means you have impaired glucose tolerance. The higher your numbers are, the further along you are on that spectrum. If you are going above 180 mg/dL after one hour, I’d recommend getting some help – especially if you’re already on a carb-restricted diet. It’s possible to bring numbers that high down with dietary changes alone, but other possible causes of such high blood sugar (beta cell destruction, autoimmunity, etc.) should be ruled out.

If your numbers are only moderately elevated, it’s time to make some dietary changes. In particular, eating fewer carbs and more fat. Most people get enough protein and don’t need to adjust that.

And the beauty of the glucometer testing is that you don’t need to rely on someone else’s idea of how much (or what type of) carbohydrate you can eat. The glucometer will tell you. If you eat a bowl of strawberries and it spikes your blood sugar to 160 mg/dL an hour later, sorry to say, no strawberries for you. (Though you should try eating them with full-fat cream before you give up!) Likewise, if you’ve been told you can’t eat sweet potatoes because they have too much carbohydrate, but you eat one with butter and your blood sugar stays below 140 mg/dL after an hour, they’re probably safe for you. Of course if you’re trying to lose weight, you may need to avoid them anyways.

You can continue to periodically test your blood sugar this way to see how you’re progressing. You’ll probably notice that many other factors – like stress, lack of sleep and certain medications – affect your blood sugar. In any case, the glucometer is one of your most powerful tools for preventing degenerative disease and promoting optimal function.

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Comments Join the Conversation

  1. says

    A comparison of my Reli On prime meter with my accu- chek meter showed a 25 pt difference! The difference between normal and pre-diabetic. I am not diabetic and only use a meter to gauge my reaction to food. So glad I compared as I was horrified to see high readings. The accu-chek compares best with my A1c and last fasting glucose, all of which are normal. Very scary. Had I been diabetic, it would be dangerous to rely on the Reli On, it’s not so cheap after all.

  2. Diana says

    Hi Chris, I just discovered your site and I am thrilled to see someone take on health issues, and not just tote the party line. I am in a pickle. I am 48 years old with some Autoimmue thyroid issues, Ulcertive colitis since 20, and now sicca syndrome and UCTD.

    About 2 years ago my endo did a battery of test on me because of symptoms, and one of the tests was a GAD antibody. Also the A1C and Cpeptide, GAD was positive 36, cpep was low at .77, but A1C was 4.6. At the time it was a watch and wait deal. Now my blood sugars when I wake are in the high 80’s to 100, and post meal goes 129 to 180 at 1 hour and then 120 to 84 2 to 3 hours.

    My doctor is not calling me as diabetic yet. He said if anything I would go type 1.5 and I would know because when it happens I will need insulin. He said the tests he done is usually for type 1 and 1.5. Am I destined to get insulin dependent diabetes, or can the test be wrong and my other conditions be the cause? He also said there is no diet that will prevent type 1 or 1.5 that its not a lifestyle induced diabetes, but a autoimmune condition. I am starting to lose hope.

      • Diana says

        Yes Beverly, I am just starting to break away from junk foods and processed microwave dinners. I am active rather sedentary. It odd because I was a runner before getting sick 5 years ago, and did gymnastics growing up.

        I am not really over weight 5’4 127, BMI 22. I just dont have any energy since getting these problems so I pop things in the microwave for convenience. And high carbs are the bulk. I dont live anywhere there is a lot of choice, we have one store for 70 miles, and I dont drive.

  3. Dicky says

    Hi Chris,

    Recently I have become a low-fat raw vegan. I understand that it is quite common for people on this diet to eat a lot of bananas, even 15 to 20 in a day. On a few occasions, I ate 7 medium (about 7″ to 7.5″ long) or 9 small ( 6″ to 7″ long) bananas for lunch. I checked my sugar before and after meal using a Relion glucose meter. Here are my readings:

    Day 1 – meal of kale banana smoothie with 7 bananas (base: 95, 1hr: 156, 2hr: 124, 3hr: 75)
    Day 2 – meal of kale banana smoothie with 9 bananas (base: 98, 1hr: 181, 2hr: 134, 3hr: 115)
    Day 3 – meal of kale banana smoothie with 8 bananas (base: 89, 1hr: 160, 2hr: 127, 3hr: 90)
    Day 4 – breakfast of spinach banana smoothie with 4 bananas (base: 92 (fasting), 1hr: 135, 2hr: 123, 3hr: 84)

    So when I eat more bananas, my post-meal 1st and 2nd hour readings are more than your thresholds of 140 and 120 respectively. But my blood sugar returns to, or quite close to, the base reading within or shortly after 3 hours. Is this fine? Or you think that the blood sugar should ALWAYS be within 140 after 1hr and ALWAYS within 120 after 2hr mark?

    If latter, I will have to eat fewer bananas, say only 4 bananas for a meal. Thus, I will have to split my 8-banana meal into 2 meals of 4 bananas each. I typically eat 3 meals a day. But if I split my banana meal, then on that day, I’ll have 4 meals.

    What do you suggest?

    Thanks,
    Dicky

    • James Kantor says

      Dickey.

      Eat low glycemic index fruit like berries, apples, pears, peaches.

      I would avoid more that 1 banana per meal.
      Flax oil, walnut oil and olive oil are okay to eat. You need some healthy fat in your diet. Too many carbs can be a problem.

      • Dicky says

        James,

        Thanks for your comment. But I would like to stick to high-carb (low-fat) diet for the time being, until I see any adverse effects. I do consume some nuts and seeds but the quantity is very low (say either 2 walnuts or 2 almonds a week). I do eat other fruits as well including those you mentioned. With 3 meals of fruits a day, I have to eat 20 meals of fruits in a week, and so I must eat bananas to get enough calories and stop losing my weight.

        Chris, do you think the temporary blood sugar spike is a problem when I consume 7-8 bananas for a meal and considering that it comes down to base level in 3 hours. Otherwise, I am, in my opinion, an healthy individual.

        Thanks,
        Dicky

  4. Jesse says

    Chris Kresser,

    To clarify are you saying that because of the margin of error with home glucose meters that we should be adding 10 to the result? Or are you saying you adjusted your results comparison chart to take that into account and we don’t have to add 10?

  5. says

    My husband just did this interesting 3-day BG testing experiment, and as we try to interpret his results, I have a question:

    Are you recommending that people whose blood sugar spikes to, say, 170 after a meal, should reduce their carb intake? Or should they _add_ fat? Or has your advice changed in this regard?

    Thanks for an interesting post!

    Regards,
    Sarabeth

    • Jesse says

      Going out on a limb here but I’m guessing Chris would say go see a doctor if your husband isn’t already diagnosed with diabetes.

  6. Dee says

    When I tested my FBG, the figures I got include 74mg, 79mg, 80mg,81mg, 85mg, 90mg and the highest I have reached is 90mg. One hour after meal: 104, 110, 106 and the highest 119. Two and three hours after meal, the figures are always less than 100.

    I’m always on low carbs. I don’t think I’m diabetic but I always experience the symptoms like excessive thirst, pains in my legs and eyes etc could I be diabetic?

    • James S. Kantor says

      Dee,
      I would ask your doctor to do more testing. I would test for serum Calcium and parathyroid Hormone. If you have pains in your eyes you also need to go see a ophthalmologist, and MD eye doctor. Pains in your eyes can be serious. Let us know.

    • Jesse says

      Those are my exact blood sugars and I have diabetes. I eat an extremely low carbohydrate diet (less than 50 grams) and those are exactly the numbers I get when I test my blood glucose.

      Fasting is generally in the 70’s to low 80’s, 1 hour usually peaks at about 115, and then my 2 hour drops below 100 usually in the mid to high 90’s.

      But apples to oranges being that diabetes is an individualized disease. I would talk to a doctor.

  7. Dana says

    I am on the AIP and low FODMAP. What are some other quick-acting carbohydrates that I could try for this test?

  8. James S. Kantor says

    I did the test as you suggested

    I had eaten a last night meal and fasting glucose was 126mg/dl
    I walked for 2.5 miles and my glucose is 121 mg/dl
    I then had a protein shake which included:
    1 cup almond milk
    2 cups Spring Mix Lettuce
    1 scoop protein powder
    1 tablespoon of grape seed oil
    1 teaspoon Maca
    My 1 hour glucose was 131 mg/dl
    My 2 hour glucose was 109 mg/dl
    My 3 hour glucose was 95 mg/ dl

    My glucose after a meal seems to normal, not impaired
    but my fasting overnight blood glucose
    have been 113, 127, 112, 127 mg/dl this week.

    • Jesse says

      Are you diabetic because those look like numbers I’d expect to see from a person with diabetes?

      I know body tolerances are different but when I go for a 2 mile walk my blood glucose usually drops about 10-15 points.

      Your 2 and 3 hour post meal sugars are high, imo. Before I went on a low carb diet those were my numbers.

  9. James S. Kantor says

    I did the test as you suggested

    I had eatten a last night meal and fasting glucose was 126mg/dl
    I walked for 2.5 miles and my glucose is 121 mg/dl
    I tehn had a protein shake which included:
    1 cup almond milk
    2 cups Spring Mix Lettuce
    1 scoop protein powder
    1 tablespoon of grape seed oil
    1 teaspoon Maca
    My 1 hour glucose was 131 mg/dl
    My 2 hour glucose was 109 mg/dl
    My 3 hour glucose was 95 mg/ dl

    My glucose after a meal seems to normal, not impaired
    but my fasting overnight blood glucose
    have been 113, 127, 112, 127 mg/dl this week.

  10. Maria says

    Through trial and error I managed to control it at first. It took me more than a year to get ride of that plague. I have hashimoto’s and was a bit overweight. I decided to diet to lose the excess weight and I did it so well (or bad, since I didnt follow a paleo diet but rather a low fat low carb diet, eating every 3h) that I lost 15kg in 3 months. That might seem like a good idea but it wrecked my metabolism. I became very skinny and with amenorrhea. Didnt had my period for 5 months or so. When I started to increase my carbs around 150g/a day I developed reactive hypoglycemia in the 60’s 1h after eating. The worst part is that the first doctor I went to adviced me to eat carbs every 2h so I was in a vicious cicle where I would pass out several times, with a blood glucose of 35/40. It made everything worse. Even coconut oil would cause my blood sugar to drop. Up until recently If I slept until noon (skip breakfast) I would eat lunch my blood sugar would be 50 1h after. I started eating the way you describe for almost 6 months after reading alot on the matter. But the key for me was eating a high protein breakfast for about a month instead of skipping it. It helped alot and made all the difference. ( I believe chris as an article on that too, im gonna try to find it. ) After that I could eat coconut oil without a problem and followed sort of a ketogenic diet a la paul jaminet. (Read PHD). In fact nowadays I follow his approach – not the ketogenic anymore
    – but on the low side. I’m sorry I couldnt be more helpful remember this was a gradual process and took me over a year. I advice you to contact Paul jaminet. I am sure he will help you.

    • Cinzia says

      Hi Maria,
      Are you on thyroid medication? I’m assuming you are since you have Hashimoto’s disease. Did you go to an endocrinologist who is specialized in blood sugar problems, or did you go to a regular doctor? You must go to a specialist that specializes in high and low blood sugar. Dropping to 30’s and 40’s is insane!! You poor girl!!! When I drop to 60’s, I’m totally freaked out!!!! Pure sugar is the only thing that brings it up. But it will plummet again so you must eat protein at EVERY meal. I eat 5-6 small meals a day. By eating every 3 to 3 and half hours you will keep your blood sugar up. 30-45- grams of carbs for meals, and 15-30 grams of carbs for snacks. If you eat dairy, eat lowfat (2%) Greek yogurt. It has 23 grams of protein in 1 cup. I usually eat more cuz it’s so good. Remember, to lose weight you have to eat. I’m sure your cutting out all the sugar foods and simple carbos, and alcohol. Don’t eat a drop of simple sugars. The only time I will have a simple sugar is if my blood sugar drops to a low 60’s. As you know, the symptoms are frightening. I carry pure glucose tablets with me just in case something happens. I’m not a doctor, but if you eat several small meals a day with a high protein factor, your sugar should stay up longer. Also, fiber is a big thing as well. Beans, lentils are good. I used to be able to eat oatmeal, I can’t anymore..too much carbs for me. Also do ground flaxseeds. It’s high in Omega 6 and fiber and other fab things..look it up online. Fiber will keep your blood sugar up longer. Don’t do non-fat foods, do lowfat (2%) foods. Blood sugar stays satiated longer with good fats and fiber foods. Hope this helped you…like I said, I’m not a doctor, but I’m a certified nutritionist and have researched my condition for so many years. It still is a pain and a hassle to deal with this every single day of my life, but…food is our medicine. Being a hypoglycemic, we have too much insulin, hopefully it will never turned into diabetes. I know that the pancreas can run out of insulin. But I really think if you treat the condition with the proper foods and no sugar, because sugar makes the pancreas crank out the insulin and the body will store excess insulin as fat. Hope this helps..Peace & Love…

      • Cinzia says

        @Maria…correction…Flax Seed is high in Omega 3 fatty acids, not Omega 6….Omega 6 is not as good for you as Omega 3’s..Omega 6 fatty acids is corn oil, safflower oil, soy oil…canola oil..which are not that good for you….Omega 3’s are excellent..you could also get your Omega 3’s from fish oil as well..I prefer the flax seed since I don’t like or eat fish…

  11. Maria says

    Hi Cinzia. Can you tell me more about how and when did your hypoglycemia start? I am not a medical doctor but I have had the same problem. I was hypoglycemic all the time. I think first you should do others tests to exclude rare possibilites, like an insulinoma or addison’s disease (I don’t mean this to scare you). It is very unlikely you have it, that really sounds just plain Reactive Hypoglycemia, but still. Do you have other medical conditions, like hypothyroidism? Are you very thin or overweight? Have any idea how it started? Maybe I can help you, I can’t give you medical advice but I can tell you my experience. I’ve been to several doctors and it was a long process to overcome it.

    • Cinzia says

      Hi Maria,
      Thanks for your fast reply. When I was first diagnosed back in around 1975, I was diagnosed diabetic. I was having diabetic symptoms, was overweight, craving sugar, etc…my doctor put me on a diet to lose the weight and control sugar cravings..I did so well that I became a hypoglycemic and have been one ever since. My doctor at that time did not put me on insulin, I did it all through diet. I was tested for insulinoma a few years ago and do not have it, I wasn’t tested for Addison’s disease because I didn’t have any of the symptoms, I don’t have that. I do have a low thyroid and take 50mcg. of synthroid everyday. I am thin, 118-120 lbs., normal weight for my height which is 5’5″. Diabetes runs in my family. My brother is diabetic and has to take insulin. I was told by one doctor a few years ago that I might return as a diabetic at some point. I don’t even go there, I’ve been hypoglycemic for so long and don’t eat any sugar, a lot of protein, good fats etc…I have a Certificate in Nutrition so I know how to control this, it’s just my mornings as I said that are somewhat difficult after fasting all night long. It does sound like Reactive Hypoglycemia but my doctor never said those words to me. I try to eat every 3-3 and half hours. I rarely eat after 6:00pm. I find if I do have a snack after 6:00 pm. I’ll wake up with my blood sugar really low. It seems to not drop as low if I don’t have a snack, but sometimes it will still be in the 60’s if I don’t. Very frustrating. It was 73 this morning which isn’t too bad.. I feel my best when my blood sugar is in the 80’s and 90’s..I do like tea w/caffeine in the am and I know that caffeine can lower blood sugar, but I put milk in it and that seems to help it not to drop too low. As the day goes on, it seems to get under control because I’ve eaten several times already, but I still eat something every 3-4 hours and stop eating at 6:00pm. Over the years, my hypoglycemia didn’t bother me as much. I was able to even have a glass of wine and some sugar. About 4 years ago it totally went crazy, it started to drop rapidly in the am but I was eating a little differently then. Through trial and error, I figured out what to eat and what not to eat. Today I don’t have any alcohol, desserts, nothing like that. I control my carbs. As I said, my doctor says I’m doing everything right, I just have to live with this, it’s genetic. Anyway…I’m interested to hear your story as well since you said you overcame this? That would be so wonderful if I could do the same… Thanks again for responding and your help…Cinzia

      • Jesse says

        I’ve read from a couple of places that some people that eat low carbohydrate diets and lose massive amounts of weight quickly become hypoglycemic for some reason.

        There’s a user on the Diabetes UK forum that talked about this very thing. He went on an ultra low, carbohydrate free diet to lose weight and control his blood glucose.

        After he was done he became hypoglycemic. The only thing his puzzled doctor had to say about it was maybe it’ll correct itself in a few years.

  12. Cinzia says

    I am hypoglycemic. My fasting sugar in the morning can be as low as 62,66,68,70,73,75, sometimes 80 which is rare. I eat 5 small meals a day, no sugar whatsoever. When it’s in the 60’s in the am, I immediately drink a little of low-fat milk to bring it up quickly. My mornings are my most difficult..it seems my pancreas shoots out too much insulin and my blood sugar goes up and down..it’s very frustrating. I’m doing everything I can correctly but it still makes me crazy!!! It seems to balance itself out by noon. But my mornings are a ritual of anxiety, up and down blood sugar and constant checking my blood sugar levels..I go through a lot of strips at times. Sometimes even after I eat, it can drop to the 60’s and I’m not eating a lot of carbs. I beyond frustrated with this…anyway..if anyone has any thoughts, I welcome them. I’ve been to doctors and they say I’m doing everything possible and correctly. My A1C was on the low side. thanks…

      • Cinzia says

        Hi Melanie,
        I had my A1C tested a year ago. It was 4.9..the flag reference is 4.2 to 6.2. Mine is definitely on the low side. I’m sure there is such a thing as a too low A1C…

        • Melanie says

          Mine was a 4.9 in November and in April it was 5.1, so I am worrying that it is going up and I am becoming diabetic?

          • Cinzia says

            Hi Maria…what did your doctor say since it went up to 5.1? Is she concerned that it went up? As I said, I did mine 1 year ago…I probably should have it retested..do u feel you’ll getting diabetic symptoms? I’m not having any diabetic symptoms… my A1C is still probably low….remember blood sugar goes up and down quite frequently….mine is a yoyo in the am…

            • Melanie says

              No concern from doctor, just me being concerned. I don’t know what diabetic symptoms are, I heard weight loss? Or is that just type 1?

              • Cinzia says

                Hi Melanie,
                You can always google diabetic symptoms and it will tell you. Excessive thirst, peeing all the time, tired, hungry, craving sweets..Type 1 and Type 2 diabetes symptoms I believe are the same. If your doctor isn’t concerned, she or he should know. Also, see a nutritionist. My doctor had me go to one. Basically, don’t eat a lot of carbs, u still need carbs but only 30-45 grams of carbs for meals, 15-30 grams for snacks.
                Too many carbs will spike your blood sugar than plummet it. I find eating lowfat (2%) Greek yogurt for an afternoon snack is great. It as 25 grams of protein in 1 cup. I usually eat more than a cup cuz it’s so good. Eating protein at every meal is the key. Hope this helps..Peace & Love…

  13. Lael says

    Thank you so much for posting this information for us to read for free! I am very grateful for how much you give.

  14. Bobby says

    Hi Chris,
    Steel cut oats are spiking my BG levels really high. Is there anything I can do to blunt the spike so I can still eat my morning bowl of oatmeal? I am pre-diabetic according to my last A1C. Plant based Doctors like John McDougall, Neal Barnard, and Joel Fuhrman say it is the fat in the diet that stops insulin from working thus is the real culprit in Type 2 D, and not carbs. Is this true? Some vegans have even reversed their disease by eating a high complex carb diet by eliminating refined carbs, all meat, and all dairy.

  15. Susan says

    Chris,

    Could you please offer strategies for improving the numbers if one is already eating low carb paleo and results are still not great.

  16. ambreen says

    hello. i am asian and have recently started tracking my sugar level. my numbers are not quite in the diabetic range but are not ideal either. my fasting is in late 80s or early 90s. post prandial after my regular meals is between 120-125 where as if i have had a very high carb meal it goes up to late 130s. but i have not seen it cross 140. ive measured my sugar 1 hr, 1.5 hrs, 2 and even 2.5 hours after a meal. the highest ive seen is at 1.5 hours after a meal. it is less than 120 after 1 hour of a meal.
    last night i saw a very wierd pattern. i had a heavy meal and a large cup of icecream (350-400 ml cup) 1.5 hrs after the meal my blood sugar was 133….. 20 minutes later it was 115. i wanted to see if i reached pre meal at 3 hours. but to my shock it was 125 after 3 hours and 130 half an hour later. this i do not understand.
    i also want to know what to do now to avoid diabetes. my bmi is 22. i do not have any of the indicators that are listed in various sites that state risk of diabetes… except perhaps for stress/depression. i have started brisk walking once a day. my diet is usually very limited except perhaps for occasional eat outs like last night. i do not know how to cut back food because my food is limited (1 proper meal a day and that would not exceed 25-30g carbs) light snacks in between. i am very worried because of my numbers. do i visit a doctor? that thought scares me because doctors usually give a big list of tests without explaining anything and medication. my husband has diabetes or prediabetes as some people would call his numbers. he refused to take the list of medication and is on diet control (his doctor thorougly discouraged him) his numbers have not exceeded nondiabetics numbers since he was diagnosed 18 months ago and his h1ac came back 5.3. needless to say the my trust in doctors had decreased somewhat.

  17. Katrina says

    Please clarify: after the 12 hour fast, measure the blood glucose. CAN I THEN EAT BREAKFAST?
    then test again before lunch and periodically afterward…
    Thank you! :)

    • Bev Carney says

      Sure! I think breakfast was just not entered because you wouldn’t be doing a separate test after it.

  18. Marilyn says

    Does anyone know how to obtain inexpensive test strips in Canada? Relion is not in Canada and the other brands are outrageously expensive.

  19. maria says

    Hi Chris,
    Is it normal for my blood glucose to rise to 150 after a meal only of protein, fat and veggies? I’m not eating VLC, I eat veggies, one/two servings of fruit and one sweet potato. Should I be concerned? My fasting blood sugar is always 70.

  20. Khalid Bin Mohammed says

    I am suffering from blood sugar this is first time 160 to 180 how to control and what type of food i want to take?

  21. Gary says

    I apologize if this question has already been answered in the article or the comments. If anyone could direct me to it or answer the question I’d appreciate it.

    When checking the post meal BG do you start timing (1hr, 2hr, 3hr) at first bite of your meal or when the meal is completed?

    Tks

    • Khalid Bin Mohammed says

      I am suffering from fewer past 1 week so i went to doctor at the time he is taken blood samples then he told me u r Suffering for blood sugar upto 180.

    • James S. Kantor says

      You measure blood sugar from the first bite.
      So if you start eating a meal at 6:00pm and it takes you 20 minutes to eat, the hour mark is 7:00p,

  22. Robert says

    Hello, I’ve read a lot of your information regarding Diabetes, and learned a lot. I had a question for you Chris,
    I eat a lot of fast-food like burgers, fries,(I’m a 28 yr old male, lightwieght,) but lately i checked my Blood Sugar with Accu-check Aviva a couple of times, the results after eating wheat bread and now are:
    1 hour later: 103mg/dl
    3hours later: 100mg/dl
    I have been feeling somewhat thirsty more than usual and using the restroom more often, would i be able to reverse this? I’m not sure if i should go see a doctor? I hope its not T1.
    –>Anyway, thanks for all the information you gathered, It’s amazing work you have done and I read most of these comments, really helpful :)

  23. Maria says

    I’m a bit confused about the effect of carbohydrates on a low carb diet. Do they increase insulin resistance or improve insulin sensivity?
    My experience is that in the beginning, few days after the adaptation period, eating carbs (sweet potato, a piece of fruit, rice) wouldn’t spike my blood sugar… It always remained on the 100-110 range. I decided to stick with it for a couple more weeks to see what happens but now I have blood sugar spikes to 130-150 (just from eating an apple(!), or eating the occasional sweet potato). What does this means and why does this happen? should I be worried?
    thank you for your time and sorry for my english, I’m from Spain.

  24. allison says

    Hey Chris,

    When doing the OGTT at home, you mentioned using an 8 ounce boiled potato. But when I look it up online, it appears that a potato does not have 75 grams of carbs. Also, do I eat the skin, or just the flesh?

    The reason I am wondering is that I have seen creeping FBG over the last few years: 84, 92, then 84, and in January 95, and am wondering about the OGTT. I failed the one hour test when pregnant, but passed the 3 hour OGTT (over four years ago).

    In February this year I did the 3 year OGTT, but they administered 100 grams of glucola, rather than 75 grams. Keep in mind that I am a 90 pound, 36 year old woman. Here were my readings with the 100 grams: fasting 95, 30 min 174, 1 hours 221, 2 hours 191, 3 hours 132.

    Now I am scheduled to have a repeat OGTT on Monday where they will give me the 75 grams.

    I have reduced my carbs to fewer than 50 per meal and seem to have normal readings, never getting above 120 or 130. I ate 50 grams last night, and it went like this: 89 at 1 hour, 134 at 2 hours, and 111 at 3 hours. Fat and protein were part of the meal.

    I also tried 38 grams of carbs of buckwheat hot cereal a few days ago, with coconut oil, rice protein powder, macadamia nuts, and flaxseed meal in it, and I spiked to 166 at 1 hour, but dropped to 99 at 2 hours.

    I am an active, thin, healthy woman, but concerned about the possibility of being pre-diabetic. What are your thoughts? Also, my cholesterol/triglycerides numbers are fantastic, blood pressure 90/58, and have no family history of diabetes.

    Thanks so very, very much,
    Allison

  25. John says

    So basically if the carb challenge is outside the ideal range we must consume less carbs and are considered carb sensitive? My fc has been 75 and on average the 1 hour post meal 105, 2 hour 88, and 3 hour 76. Once I did the carb challenge, my levels were 175, 140, and 115. But I have been eating semi low cabr/primal for the laste 4 months or so and last month has been pretty high in fat. Also, for the carb chllenge I ate a bowel of rice as opposed to a cup!

  26. Kristen says

    Thank you for the great information. I was convinced my blood sugar would show spikes, as I have found the ONLY way I can lose weight is to almost completely cut carbs. Creating a decent calorie deficit, but still including “healthy carbs” yields NO results for me. My results were consistently numbers below your “ideal” scale. Do you have any thoughts as to how carbs could be so detrimental to my ability to lose weight, when they do not seem to abnormally affect my blood sugar levels?

  27. nuttmegs17 says

    Chris,

    what can someone who is having higher than ideal FBG readings do? Mine are now 99 when tested at the hospital and over 100 when tested at home.

    i eat paleo, i eat low card, exercise – don’t eat SAD. If diet and lifestyle changes aren’t helping – what are next steps?

    I suspect that my high FBG is due to some meds i’m on: HC and cytomel. I dont think I’ll ever be able to get off the cytomel, but am starting to wean of HC (i’m only on a low dose 15 mg or less a day…hoping weaning wont be too painful).

    is metformin worth bringing up to my dr? Even if my FBG isnt due to lifestyle if my BG levels continue to be high, I have to assume its having adverse affects in my body.

    I have normal to low testosterone and hear metformin can affect that too.

  28. Nurcan Keskin says

    Dear Chris,

    Thank you for the very informative web site. I had misconception of every overweight people will have Diabeties and slim ones will not.
    I am trying to find an answer to my conditions, your input will be really helpful.

    In september of last year (2012) my a1c came as 5.9 (fasting glucose number was ok)
    and the doctor told me I am pre-diabetic, suggested to control my carb and sugar intake.
    I am 5 3 and 129 pound at the time

    In 3 months (usual time interval to go back for another lab work) ; I have increased my workout intensity (4 times a week, 30min each weight training)
    lost 11 pounds (118 pounds now),
    totally cut down white bread, rice, potato, dessert, juice, soda, any bakery related products (crackers, cookies etc) from my diest
    start watching the G Index and G load food that I am eating.

    In december my a1c number came exactly the same 5.9! I was in shock, and I am getting mixed messages from doctors from the same office, one says 5.9 prediabetic the other says it is not.

    I have the family history, so I know I should take care of that number (it is at the high end), but I am not sure what the next step would be…

    Thank you very much for your time
    Nurcan

  29. Saul says

    Hi Criss for the past week I been monitoring my blood sugar with a glucometer. My fasting blood sugar is always the highest of the day from 96-111 postprandial is 1 hour=106 2hours=88 before i go to bed 80-95, random glucose is never more than 100. If I fast 8 hours after breakfast my sugar is around 80-90. How come if I fast overnight my numbers are higher than fasting after a meal. I work at a hospital I work at night I dont know if the schedule has something to do with this number my doctor told me my Fasting blood sugar is not that high that I should lose weight and excercise but did give me an answer as why my sugar is high in the AM and good all day long

  30. Leigh Burton says

    Hi Chris,
    I did your the baked potato test after following my blood sugar levels for a couple of days. My question is this, at the three hour mark, what if you bs reading is less than what you started out with? For example, my fasting was 90, I ate the potato, at the 1 hour mark it was 137, at the 2 hour mark it was 112 and at the 3 hour mark it was 75(less than my fasting at 90). I have not been diagnosed as a diabetic or a pre-diabetic but I am trying to be proactive because both of my parents have type 2.
    Thanks for your wonderful site

  31. fiona says

    … interesting article.. but the whole science of leptin is missed and even if onces BS is ok after 1, 2 or 3 hours… that ignores the fact that insulin would have spiked and the sugar would have gone somewhere, t might be fine when you are younger but keep spiking your insulin and soon you will become insulin resistant and then when you follow this simple test.. then you will see your bs numbers unable to keep as low as they did when you were not insulin resistant. Would it not be better to just not spike your insulin in the first place and thus not become insulin resistant… and enable you to stay healthy for longer..

  32. says

    Chris,

    I have been experimenting with this over the course of the week and it has been fascinating. I’ve found that my blood sugar is actually highest upon waking in the morning (First thing) usually after a 9-10 hour fast. If I wait roughly 2 more hours it seems to drop a bit.

    What was really interesting is that it stays very low 1, 2, and 3 hours after meals. roughly averaging 95-97. Then around the 4 hour mark dips quit a bit.

    I follow a modified paleo approach based on your Paleo Code (love it!) These results tell me their might be some cortisol issues due to the elevated blood sugar in the morning. I’d love to hear your thoughts if you have any. Or any other body hacks I might be able to play with over the course of the day. I geek out on this stuff

  33. Jo-Anne says

    I had a Fasting Glucose Tolerance Test some years ago and the test came back ok. But…..the thing is the test was just for two hours.

    Fast for 12 hours [by the time they tested me it was 15 because they forgot me]……they took a sample….I drank the drink…..they took samples at half an hour, one hour and two hour [I think] and sent me off home.

    On the way home my blood glucose crashed [I have only felt that way once before after working and only having chocolates for lunch….I know I know….] and I rang the lab and told them what happened……..go to your doctor…….doctor said pre-diabetic so eat like a diabetic……so I got Mum’s books and read up on it…….thank goodness for the internet…….because if I had followed the books I would be diabetic like my Mother and Sister.

    In my readings I found a section that stated that you have to be tested at 2.25 hours and/or at the point of time you have any negative reactions….demand it if you have too.

    I have always been curious about what that reading would have been so when I feel a bit like that now I test and the blood glucose reading is always too low but I have never felt that bad again…..and I am not keen to.

  34. Rachael says

    Can SSRIs raise blood glucose levels? I read and heard that they deplete chromium levels, which in turn cause BS spikes.

  35. Indy M. says

    I started eating and now am quite fond of plain Kefir from Whole Foods(low fat variety: 12gm Carb per cup), after reading Dr Kresser’s writing on Kefir as a therapeutic food item. I take it with a tablespoon of Rice Syrup. After reading this article on monitoring Blood Glucose using a Meter, I measured mine for this item, as part of Lunch(along with other Paleo-esque Lunch items, no other significant Carb sources; total Carb = 5(Veg)+12+18=35gms):

    Pre-Lunch : 92 mg/dl
    1 HR Post Lunch : 92 mg/dl

    So this may be a good find for LC me(may be others as well), for a food choice that does not send my blood glucose sky high(Btw, the fruity versions of Kefir at Whole Foods, with added Sugars, do the opposite, where the 1Hr Post Lunch Blood Sugar goes 125+). I am not diabetic or pre-diabetic but may be beginning to have some Carb tolerance issues. The Glucometer is a big help.

    My 2C.

  36. marie says

    Hi Kris,
    I’ve been on low carb/ketogenic diet for the last 3 months now. I monitored my glucose after meals and it was ok – Fasting 93 – 98, post meals averages: 101 – 108 in 1hour. Recently I wanted to check my glucose during exercise and I was surprised to see the result of 140 after 23min of High Intensity exercise (right before exercising was 89!). Do you think it is normal? Do you know what might be the cause of this? I’ve checked my A1C level recently and it was very high-6,4%. Do you think it might be caused by HIT alone?

  37. Tom says

    Chris, can you comment on low testosterone and insulin sensitivity?

    I was examined by a clinician recently and he was confident that I have hypogonadism (I’m having blood lab work done today to confirm). I was out searching for some causes and effects and I ran into the following article:

    http://care.diabetesjournals.org/content/28/7/1636.full

    Also, I did my first glucose monitor tests yesterday and I had values all over the place (88 after waking, breakfast – 117, 137, 83 (1 hour, 2 hour, and 3 hour), lunch – 104, 121, 100, and dinner – 190, 100, 112. Obviously having the macadamia nut cookie from Subway didn’t help!

    I had a 101 fasting glucose level measured a few years ago and had a follow up HbA1c measurement of 5.1 so I had been basically assuming things were fine.

    I have about 18% body fat so my weight is pretty good but I have ulcerative colitis and apparently it is a secondary cause for hypogonadism. I couldn’t find anything on Jenny Ruhl’s site about low testosterone.

    • Chris Kresser says

      Yes, one of the primary causes of low T in men (which I discussed in my radio show episode on andropause) is insulin resistance leading to excess aromatization of testosterone into estrogen. This can be confirmed by testing your estrogen levels. Optimizing insulin and leptin sensitivity and reducing aromatization is the key to reversing this pattern.

  38. Ellen says

    Hi Bev,

    Thanks for your reply. I just visited the ReliOn website – and while there noticed that a home test for A1c is also available at an affordable price. Something else for my growing “arsenal”. What a great service for people without insurance, etc. I have good insurance so I’ve not given a lot of thought to getting lab work done when whatever is happening with my body started. But, after learning more about various tests – and experiencing what I have recently with doctors – I’m leaning more toward getting my own testing done.

    I’m coming to my own conclusions about what’s best for my health. I feel a bit like that saying about a person who acts as his/her own attorney has a fool for a client. I would have never gone so far out on this limb as I am now if it weren’t for experiencing two approaches from doctors. They either give lip service to the value of lifestyle changes and then pull out a prescription pad – or they just watch the slide further into poor health, like disease is inevitable. My current (newest) doctor actually sees me as “basically healthy” – for my age, I assume. In some ways I really am healthy for my age – for any adult age – but the areas that need work aren’t getting the right stuff – until now that is.

    Geez.

    Whatever happened to medical doctors who actually appreciate patients who are responsible for their own wellness? Have they all died or gone into doing talk shows?

  39. Ellen says

    Thank you so much for your reply. Good to know that the pattern is familiar, even if my measures are extreme.

    I have a hunch about what might be happening. I’m a 59 yo post-menopausal female (no HRT) with recent diagnosis of mild hypothyroidism (not autoimmune) – and what looks (to me) to be metabolic syndrome: Elevated triglycerides, decreasing HDL, and central obesity. I am NOT morbidly obese, however.

    I’ve discussed that possibility with more than one MD but no one wants to give me that diagnosis. The reason given has always been that my blood pressure is excellent, 115/75 (as is my resting heart rate). And, of course the emphasis has always been on TC and LDL-C. The advice has always focused on low fat dieting. Right. You know the drill.

    Well, I tried the low fat route and fairly easily got the LDL returned to normal and the triglycerides also lowered – but not to normal. Great. So, that’s when I decided to give the low carb approach a try – and was immediately captivated by how little I miss the carbs and how much better I feel overall. I’m a solid convert.

    But, I am only a recent convert. Haven’t had any lab work since going low carb. I still have the tummy fat to melt off, the lipids to lower, and its winter so I am not exercising as much /regularly as I do the rest of the year. My bad, I know, but there it is at the moment. Anyway, I wonder if the issue is that I am “melting” adipose fat – depleting lipid stores – right now and that’s causing the extreme measures. Maybe the pattern will remain – but shift into a normal range as I lose the weight, lower the lipids, and increase exercise. As in the way we see even diabetic glucose and lipids improve with weight loss and exercise. While low carb diet may confer immediate benefits, wouldn’t the most benefit be derived over time with total fitness?

    Does my thinking on this subject seem reasonable to you?

  40. Ellen says

    Recently started eating low carb and even more recently started glucose monitoring. Am a bit puzzled by the pattern that is emerging and curious about the physiology involved.

    For context – I am NOT diabetic. I am NOT pre-diabetic. At least, by ADA guidelines. But, I do not regard my recent blood sugar to be behaving normally. I was starting to get creeping elevations in my FSB (104) and A1c (5.8) and wanted to reverse that trend before I got into trouble.

    I haven’t consumed anything even close to 100 grams of carbs (per day) in several weeks. Lately, I stay around 35 grams of carbs (per day). So, here’s a typical daily pattern for my blood sugar now:

    Immediately on waking, FBS 130. (Never seen my blood sugar that high before, btw.)

    I continue to fast, drinking water, and not exercising – while continuing to check glucose every hour.

    Second hour about 116.

    Third hour about 100.

    If I continue fasting, by hour four glucose starts to rise again – usually back to around 110.

    So, I assume that my pre-meal “baseline” is about 100.

    One hour after eating the first meal of the day, glucose about 110.

    Two hours after eating, glucose usually drops below 100 – maybe about 95.

    Basically, eating a low carb meal results in lower blood sugar than the baseline within two hours. Overall, though the numbers run higher than I’d like to see, it seems to me that my blood sugar is pretty stable on a low carb diet. The numbers ~always~ stay below 140. And, I feel fine, sleep well for 8 – 9 hours, and so on. Will be interested to see what the next A1c results look like.

    Meanwhile, I don’t think I need to worry – or do I?

    • Chris Kresser says

      This could be a fairly extreme version of the dawn effect, which is a known phenomenon in low-carb dieting where you become mildly insulin resistant overnight because your cellular energy needs are being met by fat (and they don’t want any glucose). In this pattern you see high fasting glucose in the A.M., but then it drops after eating into normal ranges. However, a FBG of 130 is much higher than I’d expect with the dawn effect. You might want to investigate this further.

      • Ellen says

        You know, another way to think about my higher measures – in light of mustering lipid stores in adipose tissue – is that I may simply be efficient at gluconeogenesis. In animal husbandry there is a term for cows that maintain their weight during the stresses of limited food, gestation, birthing, and lactating. They are called “easy keepers”. In cows, that is a desirable genetic trait :-). Hopefully, when I have fewer stores to muster….

      • Ellen says

        Just wanted to say, once again, thanks Chris – really, for everything that you do. And, no worries – “investigate” is my middle name. Sometimes I worry that the learning curve will do me in! LOL!

        Anyway, I have already started. I read last night that the test strips that I use can be particularly sensitive to cold temps. My house gets quite cold at night – which is how I like it. Last night I left the thermostat up much higher than normal and kept the house warm over night – 65 degrees F. This morning my FBG was 119 – versus 130. Later today I plan to use control solution to check to see if the meter is giving me accurate readings. I’m also going to get a different meter soon – unless I can think of a way to keep the strips warmer overnight.

        Oh, and now that I think about it I wonder if sleeping in a cold house might also trigger my body to produce more glucose at night. At any rate, I am not going to stop until I feel like I understand what is happening, am doing the best that I can for my health, and have found an MD who is supportive of LC and really competent with things like thyroid. I’m also investigating thyroid issues and believe that is a part of the whole package for me along with the elevating lipids and glucose and stubborn weight gain.

        • Bev Carney says

          Ellen,

          We too keep our house cold. The only strips that have a wide temperature range are the ones from Walmart – the Reli-on Brand. They have the added advantage of being cheap. Our house is 58 at night and 59 during the day. I do find that I get a slightly different reading if I keep the strips & meter in my jeans pocket to warm up a bit. The Walmart brand is good to 39 degrees.

          • Ellen says

            Hi Bev,

            I just made a reply to you that may have gotten lost in cyber space. In brief – thanks for you reply. I just visited the ReliOn site and noticed that they also offer an A1c home test. Ordering that test as well as the Ultima meter/supplies.

      • Ellen says

        Hi Chris,

        I wanted to let you know how things are going one month after posting the initial BS measures (above). First of all, I did get the ReliOn meter and feel that I get more valid readings with that system. Since I started testing with the ReliOn, I have been maintaing VLC and added IF. Basically, I don’t eat the first meal of the day until my BS is below 100. Now, I have a FBS immediately on waking below 100 about half the time.

        Overall, my BS is trending down – both FBS and the daily average. My pre and post prandial measures are in a very small range. NO measures above 115, ever – even shortly after a meal that has some fruit. I rarely eat fruit anyway, A typical week of FSB measures looks like this: range from 110 to 96; average FBS 102; 4/7 days below 100. That’s the improvement after one month of consistent VLC and IF and bare minimum exercise. No weight gain nor loss that month BUT waistline measures about 1 inch smaller. Next I will introduce an improved exercise program and I expect to see even more improvement to BS.

        Thanks for all that you do.

  41. Robin says

    In a study presented Oct 10-13, 2002 in Seattle researchers addressing gene activation specifically noted: “…Interestingly once a cell chooses a particular pattern of expression, that pattern becomes fixed in the cell….”
    My question is:
    If the changes in my cells due to Type-2 Diabetes have become, over time, “fixed in the cell” are there techniques, including meditation, that can change or moderate that pattern of expression?

  42. Ray says

    Peter …

    A reading of 200 at 30 minutes is too high. Generally, blood glucose reaches a peak about 45 minutes to 1 hour after eating. You should consider eliminating grains from your diet.

    • Peter says

      Hi Ray,
      Thank you for the response.I did stop eating oatmeal.I had blood work done and my A1C was 5.6%. My 12 hour fasting blood glucose was 94 mg/dl.That was the lowest I had been all week.I was testing at 104 to 125 fasting. My Mean Blood Glucose was 114mg/dl.I told the doctor how oatmeal was affecting me.They thought I was eating the kind in little bags.I told them otherwise.He said “huh,I recommend oatmeal for my diabetic patients because of the steady absorption.”They aren’t doing anything about my blood glucose.They just told me to exercise and watch my diet,of which I am doing both.

      • Ellen says

        Hey, Peter –

        I recently had something similar happen to me with oatmeal. Organic, steel cut whole oatmeal with walnuts and a little dried fruit – no added butter or sugar. You know, the supposedly low GI stuff the MDs love to recommend. What got my attention was being super hungry in under 2 hours after eating. I have eaten oatmeal my whole life and never had that sort of reaction before. Seems like it was mild reactive hypoglycemia – something new for me. And, I have given up grains since. I had already given up gluten sometime before on general principles. Only ate whole oats and brown rice, and very little of the rice. Like you, I get NO real advice from my MD beyond the standard low fat diet and exercise drill. So, here we are.

  43. Michael says

    Hi Chris

    Thanks for all your work and making the knowledge available.
    Ive taken your advise gone out and bought the meter and have been testing for the last 3 days after every meal for 3 hours. I eat using a paleo framework and dont eat dairy, carbs is on about the 50g 70g per day and ive been doing this for most of 2011. Im 6’3″ and weigh in at 277 pounds, i lift heavy 4 days a week with 10 to 15 minutes cardio thrown in 2 or 3 times a wk (crossfit football)

    I still have a good amount of belly fat and think I have have high cortisol and not great testosterone levels. Im 43yrs old.

    My fasting Bg has been between 92 and 99, after breakfast it drops and then at 2 hour mark is between 106 and 112. Over the 3 days the highest my bg went was 112 and lowest was 79. Does this sound normal considering a low carb diet?
    Is this a 2nd stage insulin response?

    Im hoping you can guide me as to what should i be asking my doctor to look at and what test would be appropriate?

    Many thanks for any follow up and time you can give to answer this.

    kind regards
    Michael

  44. Peter says

    Hi Chris,

    I have a question in regards to the 1 hour BG test.Lately I started feeling tired and light headed after eating certain things.I bought a meter.When I would eat oatmeal,not the kind in the little bags,I would feel light headed in about 20 to 30 minutes.I checked my BG and it was over 200.Is 30 minutes too soon to check BG?My BG was 120 2 hours later.

  45. Mike Ellwood says

    If anyone is still looking at these comments, and for anyone worried about non-grass-fed beef: From the PUFA point of view, it may not be as bad as you think. Although non-grass-fed may be less than ideal, according to Ray Peat, all ruminent animals (i.e. cows, sheep and goats) manage to convert most of the PUFAs that they may consume to saturated fats before being stored in their tissues. This is one reason why I now only eat beef or lamb meat (and their organs, cartilage, gelatin, etc). As it happens these tend to be mostly grass-fed where I live anyway, but even if they are not 100% grass-fed, at least the situation is better than it might otherwise be.

  46. Mattias says

    Did the rice test today for late supper (I get home around 20.00).
    FBG 79
    Pre meal 77
    1h 126
    2h 150
    3h 124

    Also, quite often my 2h reading is higher than the 1h, but 3h around the pre meal measure. Is this something unusual and should I be worried? Also, could my psoriasis affect BS?

    • Chris Kresser says

      That can be a sign of a poor first-phase insulin response. I’d say your BS affects psoriasis, not the other way around.

      • Mattias says

        Is there anything special I can do to help that or is it a non-issue as long as I keep to eating “good” carbs in a moderate amount?

  47. says

    Hi Chris, Not sure if you still check this thread or not, but have a question for you. I’ve been testing my blood glucose for about a week now. I’m 28 weeks pregnant, and my midwife is requiring 2 weeks of testing fasting glucose and 1 hr after every meal in place of the oral glucose test. So far, all of my numbers have been great. I’m usually back to baseline or below an hour after meals, though I haven’t tested past that. One thing I haven’t totally been able to figure out: My fasting blood glucose is usually in the 80s, though I’ve had a few in the mid-90s. This is surprising to me since this is higher than my reading after dinner the night before. I’m on a low-carb diet if that makes a difference. I’ve also been getting to bed after midnight each night and seem to remember reading something about stress hormone levels and raised blood glucose in the morning. Overall, I’m not concerned at all since my 1 hr reading is usually back to baseline, but was just curious what causes the higher fasting levels… any ideas?
    Thanks!

  48. Ian says

    Hi Chris,

    I just started testing my BG yesterday. After a meal of chicken curry and rice in equal proportions, along with two beers, my BG after 1 hour was 115 and 2 hours was 68. Today my fasting BG after 3 eggs, spinach and about half a banana and a half a cup of cranberry juice was 91 and my 1 hour was 62. Could this be a digestive issue? I’ve been burping a lot after eating or drinking coffee, though I don’t get the feeling of acid reflux. I do tend to feel pretty full even a few hours after eating. I have a history of GERD, which I alleviated with your GERD guide about a year ago. I just started using DGL again and eating sauerkraut. HCl seems to come out in my stool, which worries me. Is it time to get some bitters?

    Thanks for your blog. The suggestion of the BG monitor has already been more educational than weeks of speculation.

  49. Dale says

    Re diabetes and low thyroid: I’ve just been reading Hypothyroidism: The Unsuspected Illness by Broda Barnes from 1976 (reprinted, available at the public library). I have both type II and low thyroid so I found it particularly interesting since he believed from his medical practice specialty that the two are linked and prediabetes may well be low thyroid. If only I could find a physician with that type of knowledge!

    • Ellen says

      Sounds like a book that I need to read. I second your wish for a physician with that sort of knowledge. I’ve been looking and will continue to.

  50. KW says

    I know this is an old post so perhaps the comments are no longer monitored, but I wanted to share anyway. I checked out this 3-part blog series after Robb Wolf shared the link on Twitter last week, and it couldn’t have been more timely! I was scheduled to have the OGTT today at my OB’s office to screen for gestational diabetes and I was having reservations about the test. I expressed those reservations to my doctor – that it would make me sick because I don’t consume 75 grams of any kind of CHOs in a day, let alone at once, and that it would result in a false positive, which I didn’t want in my medical records. She explained that if the results were questionable, protocol was to follow up with a 4-hour GTT, where I’d consume 100 grams of glucose. Brilliant. (note the sarcasm ;)

    These blog posts gave me not just the information I needed to back up my concerns, but also a viable alternative to the OGTT, to which my doctor readily agreed. As I discussed the testing protocol with her, she outlined the desired ranges for each reading, and I was pleasantly surprised to find them on target with your suggestions! I have ordered my glucometer and will start testing as soon as it arrives. Thank you for posting such easy-to-read and very well-documented information! The information is presented in such a way that it made it easy to present a well-informed argument to my doctor, and I am certain that played a huge role in the lack of opposition to skipping the OGTT. Thank you again!

    • Anna, Sweden says

      I also managed to skip the OGTT test for gestational diabetes with similar arguments. I’ve been on a (liberal) low carb during the entire pregnancy (and also before), but testing BS frequently seems to still have made a positive impact on foetus growth (it slowed down and is now only a few percent above average). Now I dare eat certain foods I avoided before, like fruit in moderate amounts, which gives me more freedom. I’ve learned that I should avoid bread however, especially in the morning. I’m 45 and diabetes type 2 runs in the family so this is hardly surprising.

    • says

      On the odd occasion when I’ve tested my blood glucose (when I’ve been feeling a bit low in BG), I’ve used my ear lobe as I’m a bit of a wuss about pricking my and other people’s fingers. It strikes me as being a bit nasty to prick someone in such a sensitive spot that can be used even to read braille.

  51. Dale says

    In Canada the glucometer is free, the strips are $75 for 100 tests @ Costco and Superstore. I was reluctantly glucose tolerance tested for hypoglycemia (with migraine!) and years later after an uncle’s surgery, tested positive for diabetes type 2 and told the two had no connection, were separate diseases! Luckily the low carb diet recommended by Dr. Richard K. Berstein Diabetes Solution removed the excess weight gain and returned blood sugar to normal. If I had known about glucometers years earlier, perhaps I could have prevented my sugar addict slide.

  52. Steven Miller says

    The journey continues….

    I think I am still a bit insulin resistant as my FBG remains in the high 80’s and today I did a 1 hour post-prandial following my usual high protein, high fat, low carb breakfast (eggs, bacon, avocado, a few small tomatoes). Interestingly, my BG result was 78 which is one of the lowest readings I have seen so far. Anytime my post-prandial is lower than my fasting, I am assuming it is a result of insulin resistance in the morning.

    My general BG level seems to be drifting downwards following the addition of the two carb portions to lunch and dinner…..interesting. I think I will stay with the regime of doing a FBG and a 1-hour post prandial as suggested on one of the Heartscan papers. Its simple and it makes sense to me to be testing real-world eating conditions rather than the “hypothetical” pure glucose/carb tests.

    I plan to get a general idea of how my normal meals are impacting BG before I retire the meter again (there really is a danger of obsession with this BG stuff!)

    • Ellen says

      Steven,

      Thanks for sharing your journey. Its been informative to me since I have a similar pattern and am just starting to get a clue. As you are not overweight and have been waking up in the night hungry, adding more carbs to restore a bit of insulin sensitivity makes sense – for you. For me, however, I wonder about more carbs being a good idea. In the 140 that are what’s really damaging. So, in time I may try a trial of carbs intake >50 but <100 as well as a protein adjustment trial.

      You are right about both things, Steven – the value of real world measures and glucose monitoring having the potential to become obsessive :-).

  53. Steven Miller says

    ” if you have a sweet potato with a meal, for example, and your BG shoots up to 180 mg/dL an hour later, not good. That’s where post-meal measurement comes in – determining carbohydrate tolerance. It’s a moot point if you don’t eat starchy/carby foods at all.”

    Chris….thanks for responding…I haven’t checked this thread for a while.

    Yes, I had been checking my post-prandials which is how I noticed that they were actually dropping after a meal but that was on pretty low-carb. I have since started experimenting with more carbs…specifically a portion of rice or sweet potato with lunch and dinner. I was thinking that perhaps I was too low on carbs given that I had dropped so much weight and, more importantly, I was waking up almost every night in the middle of the night hungry.

    After a few days of this, I checked by FBG which was 87 so maybe my insulin sensitivity is returning.

    Also, I just checked by BG 1 hour post-prandial after eating a lunch of beef, brussels sprouts, and half a large sweet potato mashed with butter and cream. It was 99. Two-hours post-prandial was 98. That may be a trifle on the high range of “normal” but still seems pretty ok.

    So, bottom line, even with the additional carbs my BG is staying in a pretty tight range with no evidence at all of “spikes” remotely close to the 180 mg/dl range. When I started all this, I wanted to see more readings in the 70-85 area but perhaps this is just the way I am (or have become after too many years of thoughtless eating).

    Anyway, I expect to have an A1c test in a couple of weeks and that should complete the picture. I realize I actually have very little reason to go through all this except to try and understand more about my own physiology but it also gives me some small appreciation of what life must be like for diabetics….what a nightmare.

  54. David says

    I used a similar process to try and get my glucose under control (25-year diabetic). There is only one drawback to the method. It is possible to have a “normal” blood sugar reading and still be producing way too much insulin to make that happen. A meter cannot tell you that. In such a case, you would be in between normal metabolic function and frank diabetes, without an idea.

  55. Steven Miller says

    Actually, I have been working on the theory that my BG pattern results from the return of insulin sensitivity, particularly following the morning BREAKfast. By coincidence, I rediscovered this from Peter at Hyperlipid:

    “A LC eater has a FBG of 5.5mmol/l, technically pre diabetic, but blood insulin is 3.5 IU/ml. This is VERY low. Glucose is in very short supply but blood glucose is maintained by physiological insulin resistance, ie the muscles are full of triglycerides assembled from free fatty acids (NEFA) from lipolysis. The LC eater has breakfast, with enough protein from his eggs or particularly casein from his yoghurt to raise insulin from 3.5 IU/ml to 5.0IU/ml. This inhibits lipolysis enough to reduce NEFA in the bloodstream, intramuscular triglycerides fall and muscle insulin sensitivity returns. There’s minimal glucose coming from the gut and so plasma glucose drops to between 4.0 and 5.0mmol/l, probably nearer 4.0mmol/l. It fluctuates between 4.0 and 5.0 after and between each LC meal. In the early hours of the morning there is a growth hormone surge and NEFA from lipolysis peak early morning to give insulin resistant muscles and an elevated FBG. MEAN glucose over 24h will be in 4 point somethingish, HbA1c will be between 4 and 5%. INSULIN will probably average out around 5-10 IU/ml, averaged out over 24h.

    http://high-fat-nutrition.blogspot.com/search/label/Physiological%20insulin%20resistance%20(3);%20Clarification%20of%20FBG

    This is me! So, I am going to retire my BG meter and give my sore old finger a rest for the time being unless somebody convinces me there is osmething wrong with this analysis.

    • Chris Kresser says

      Steven: I’ve also written about LC eaters having high FBG. However, that doesn’t diminish the importance of post-meal blood sugars as a measurement of glucose tolerance. If your FBG is high on an LC diet, but your post-meal numbers are fine, nothing to worry about. But if you have a sweet potato with a meal, for example, and your BG shoots up to 180 mg/dL an hour later, not good. That’s where post-meal measurement comes in – determining carbohydrate tolerance. It’s a moot point if you don’t eat starchy/carby foods at all.

      • Ellen says

        Steven, Chris –

        The “return of insulin sensitivity” makes sense to me. As commented on below, I seem to have a similar reverse pattern – only my numbers tend to run higher and to have a sightly wider range and the drop after meals happens a little slower. Still, I feel fine and not at all like I’m having BS issues. I am new to LC and not as overall fit as you are Steven so I would imagine that its quite possible that my numbers will shift lower as I gain more fitness. Time will tell.

  56. Steven Miller says

    “I’ve seen another strange pattern a few times where the patient’s blood sugar actually decreases after the meal at the 1- and 2-hour mark, and then increases at the 3-hour mark. ”

    This is actually something that seems to be happening with me. I am a “paleo” eater (no grains, low carb) and my FBG usually runs between 95-101 which i attributed to low-carb morning insulin resistance. However, today and yesterday I did a BG text 1/5 hour after breakfast (eggs, bacon, tomatoes, coffee/heavy cream” and my BG dropped both days from a FBG of 105 to 95 yesterday and 80 today. Today I monitored more carefully and at 1 hour it was 90, 2 hours 80, and three hours 104. I hour after lunch it was 95.

    Do I need to worry about this?? Whatever the explanation, and they are all theoretical, my BG seems to be staying in a narrow range (80-105) without any of the post-prandial peaking; in fact no peaking at all nor is it dropping particularly low nor do I have any feeling of low BG.

    I am otherwise healthy with an HDL of 88 and TG of 67 (haven’t had a VAP or NMR yet). I lost about 7/8 pounds since starting paleo/lc and now have a BMI of 20 (5:11/143 pounds). No matter how much I eat, my weight doesn’t budge more than .5 pounds either way. I am probably too thin but I don’t feeling like eating more than the 2500 calories I take in usually.

    So, once again, aside from the reverse pattern I seem to have developed, is there some negative health implication in this that I am missing?

  57. Stan says

    And because posting of personal experience and results is usually encouraged:
    morning FBG – 4.4 mmol/l
    last time, I promise

  58. lynn says

    Hi Stan

    Where does the beef come from? If it comes from Ireland or certain other European countries, it will be grass fed.

  59. Stan says

    Hi Lynn

    Here, Bulgaria, it is mostly pork and chicken meat, beef is very small part and mostly imported. Cows are milk breeds mainly. There are eggs from open raised hens (I eat these), at least twice the price of conventional cell raised. Dairy is not raw.

  60. lynn says

    Hi Stan

    Strange question, but are you SURE you don’t have grassfed meat where you are? The reason I ask is because it’s never advertised on packages here (I live in Ireland); because ALL our beef is grass fed. There is no such thing as factory farmed beef.

    We do not have raw dairy here though.

  61. Stan says

    Thanx for all the comments. This blog is fantastic. I guess some more info is needed.
    I am 170 cm/66 kgs. Started a vegan diet 6 y ago (without packaged junk, sugar) after I was told to take pills for life for high blood pressure (140/90, “your dad had it so it should be genetic”). It helped, I lost 3 kgs (that was never a problem) and was feeling pretty good and “light”. I also did water fasts 1-2 times per year. But since I was reading a lot about nutrition I eventually introduced fish and eggs about 2 y ago, then dropped wheat, grains, legumes, potatoes (reintroduced about 6 months ago). I eat about 2 pieces of fruit during the day (mostly banana, apple, melon and other in season) and main meal in the evening, and lots of nuts (100 gr/day), regular vegetables blend. I use ev olive oil. I do not eat dairy, clarified butter was added recently (I do it at home). My nose is mucus free, I am glad and want to stay like this. Now I also eat chicken liver, vary rarely other meats (no good sources here). I do not have any major health issues. So it is obvious I made a lot of changes to my diet the last several years. Exercise – not much, avoiding elevator twice a day for 6 floors, push-ups, crunches, squats, stationary bike all at home.
    BG tests today:
    FBG morning – 6.2 and 5.1 from same spot
    Before main meal – 4.5 and 5.9 same spot, 5.0 new spot (I will stick to one testing, just these were the last strips from the batch)
    carbs – 200 gr potatoes with butter (half from yesterday), raw vegitables – carrots, zuccini
    new batch of test strips
    1 hr – 6.3
    2 hr – 4.9
    3 hr – 5.2

    I am skeptical about these BG meters. They are essential for people with diabetes, showing major differences low and high. But for normal and pre-diabetes they have too big variance – 100 mg/dl may be 80 or 120. I may limit potatoes and bananas, and fruit to one piece. But my problem is that I have been eliminating foods all the time. We have driven ourselves into the position to produce very few decent foods here in Eastern Europe, people want cheap food and compromise or do not know about quality. We do not have grass-fed free-pastured meat or dairy (or it is not promoted), for example.

    Sorry for the long post.

  62. Chris Kresser says

    Stan: it seems you may have a delayed insulin response. Your triglycerides are quite high, especially in relation to your total cholesterol. Ideally your TG should be less than 1/2 of your TC. How long have you been following this diet?

    Stress, sleep deprivation and cortisol dysregulation can also cause elevations in fasting BG and 3-4 hour post-meal readings.

  63. NoGluten says

    Since you are fairly new to using the meter, are you certain that your hands were clean before each check?

    If you are confident that the testing is correct, then your personal peak for that meal seems to be at the 3 hour mark and it is a little high. Perhaps try sweet potatoes instead of the potatoes? Are the carrots cooked or raw?

  64. Stan says

    Hi Chris

    Following a recent FBG test that showed 6.1 mmol/l (previous test june’10 – 4.5), I decided to invest in a BG meter. The first day I tested – before main meal 4.4, 1hr 5.7, 2hr 5.3, 3hr 7.3, then I decided for a 4hr test 5.3. Meal included potatoes with clarified butter. The next morning two tests 6.2 and 5.3 – one after the other, and that is quite a variations which I understood is normal 20% variance. I do not eat grains, legumes, sugar etc. Major carb food I eat is potatoes 3-4 times/week, nuts, carrots, zuccini.
    Now I am completely confused. I would appreciate any comment. Thanx.
    By the way some more data from the same lab test:
    TC – 170 mg/dl, TG – 130 mg/dl, HDL – 45 mg/dl

  65. Chris Kresser says

    Hay que comer mas grasas saturadas y menos carbohidratos. Carbohidratos aumenta trigliceridos y “small, dense LDL”, y reduce HDL, mientras que grasas saturadas reduce trigliceridos y “small, dense LDL” y aumenta HDL.

  66. bannon says

    Hola, en mi última analítica tengo estos resultados:

    Cho total: 217 mg / dl
    TG: 181 mg / dl
    HDL-Cho: 39 mg / dl
    LDL-Cho: 146 mg / dl

    Tengo 33 años.

    Estoy algo preocupado, por los valores de trigliceridos y hdl.¿Que debo hacer?

  67. Tim says

    Chris,

    At 3 hours, I’m been at or near baseline/FBG. But I’ve only tested 3 hours on starchy meals a couple of times, so I’ll need to verify that after a few more measurements.

  68. Rodney says

    Thanks Chris,

    I guess the crux of my question is whether for someone with fairly normal glucose control is it better to cycle between roughly 85 – 130 a few times during the day, or is it ok to eat more frequently but have your sugars range from say 105-130 except during the longer nightly fast? Is there harm staying a little bit high, or benefit from getting down to 85 several times daily?

    Thanks for the continued education!

    • Chris Kresser says

      If you’re not having any reactive/hypo events (dropping below 70-75) then there’s no need to eat frequently throughout the day, and it’s probably better if you just fast between meals.

  69. Tim says

    Hi Chris,

    I’ve taken up this challenge and found some things I’m a little confused about.

    My FBG and post-meal numbers have been generally good (FBG in mid 80s), with one sticking point. After a starchy meal (white rice or potatoes), I’ll have fine 1hr post-meal numbers (between 105 and 115, though I’ve had a few register in 120s and 130s, never anything over 140). But at 2hrs, the number will be the same, and often a little bit higher. This does not happen with low carb meals, which consistently give me numbers below 100, and baseline at 2hrs.

    Could it be that I have a problem with starches? Is it something to worry about, even though my numbers don’t get all that high?

    For background, I’ve been on a pretty low carb diet for the past couple of years (rarely over 70g/day, with some cheating on weekends). But for the past month or so I’ve reincorporated safe starches back into my diet.

    • Chris Kresser says

      You may have a delayed or compromised phase 2 insulin response, or you may have delayed gastric emptying or slow digestion when you eat starch. When you eat starch, what are your numbers at 3 hours?

  70. raquel says

    Thanks!!!

    I appreciate your words.
    One the other hand I’m very interested in the connection between high insulin and IGF-1 and acne. Do you think drinking milk would increse them? Could other dairy products do the same?
    Maybe, there’s a post about this because I still haven’t read all.

    • Chris Kresser says

      I think the acne/dairy connection, when/if there is one, is more related to food intolerance than IGF-1. The only way to find out is to remove dairy for a period of time, and then add it back in and track what happens.

      • Allan says

        Someone very close to me has been to doctors for years concerning shoulder/back acne. Antibiotics, acids, etc. All worthless. A week or so into a ketogenic diet (for prediabetes) fixed the problem swiftly and completely. We only monitor the person’s bg and ketones so I can’t say anything about IGF-1.

  71. Chris Kresser says

    Rodney: some people with reactive hypoglycemia and adrenal/cortisol issues do better with small meals throughout the day. It doesn’t raise their blood sugar, but rather keeps it from plummeting if they wait too long to eat. The only way to determine your ideal is to try different approaches and test for each.

  72. Rodney says

    Hey Chris,

    What are your thoughts on how “grazing”, or eating small snacks throughout the day between meals affects blood sugar levels? It would seem the levels would always be moderately elevated except between the last meal of the day and breakfast the next day. If so, is this where 16 hour IF’s come to the rescue? Or, is it better not to eat so frequently during regular daytime hours to give sugar levels a chance to recover to baseline?

    All of this assumes no readings would be above the 140 danger threshold.

    I am just wondering what approach to take after I finish your sugar testing as outlined above. Cut the snacks way down in frequency or don’t worry about it?

    Thanks,

    Rodney

  73. Chris Kresser says

    No te preocupes, Raquel. The most important number is the ratio between triglycerides and HDL. If that number is <2, you’re at low risk for heart disease. In your case, it’s not only below 2, it’s below 1 (0.65), so you’re in a good place. A TG/HDL ratio of <2 suggests you have predominantly large, buoyant LDL, which as you know from the video, is not a risk factor for heart disease.

  74. raquel says

    Hi Chris!!!

    I’m Raquel from Spain (woman, 45). I really like your blog and I follow it everyday.
    Recently I have my new cholesterol test results:

    Total Cho: 266 mg/dl
    TG: 51 mg/dl
    HDL-Cho: 79 mg/dl
    LDL-Cho: 177 mg/dl

    I read your post “I have high cholesterol and I don’t care” and I’ve deduced that there isn’t any reason to be worried about because my LDL is in the large buoyant type.
    Since two years ago I follow a diet similar to Zona, but recently (since I dicovered you) I decided eat more saturated fats (though here, we eat and cook with olive oil a lot), eggs, butter, cream, and whole fat foods. I wanted to make an experiment and see what happens, however I wasn’t sure (our whole life we’ve heard about fatty monster and it’s in our collective subconscious) and here in Spain, most doctors also wants reduce your total cholesterol at all costs.
    Finally, as I have your opinion into high consideration, should I have anything to be worried about?? I know what my doctor will say (high total Cho, high LDL)

    Thanks a lot

    Raquel

  75. Plethon says

    Readers should be aware that most pharmacies will give you a meter for free. We’re constantly inundated with coupons to process free glucometers for folks, and happy to give them to anyone interested.

  76. says

    I had to remake that graph because I couldn’t get it to copy. The ones from the paper look far worse.

    http://diabetes.diabetesjournals.org/content/53/3/645.full.pdf

    You can imagine the results of telling a patient to come back in 6 months to a year and you’ll check it again.

    This is the reason I like what you’ve just put out. My blog is a “sick” blog related to a specific, if common, type of diabetes. My audience is limited. Yours is a “health” blog. As you can see from the graph, FBS and A1c won’t protect you from this problem. The meter, however, will work for almost everyone.

  77. Chris Kresser says

    Wow, that’s quite a steep curve! I know Jenny Ruhl has written a lot about the myth that the onset of T2DM is gradual. As often as not, it’s quite sudden as your graph indicates. This does support the idea that repeated post-meal spikes are problematic regardless of what the average (A1c) is. Of course this is supported by the literature, as well.

    • says

      “This does support the idea that repeated post-meal spikes are problematic regardless of what the average (A1c) is. Of course this is supported by the literature, as well.”

      Could you expand on this or link to references?

  78. says

    Given the action of counter regulatory hormones, genetics, environment, and the heterogeneous nature of diabetes, that graph is to be expected. The graph is for two days and tells us nothing about progression or diet. It is said that these people were not diabetic but that is taken from the A1c and we have already talked about problems there.

    Every single one of the people in that graph could, in fact, be a future diabetic. We have no way of knowing since diabetes is inferred from a group of tests. I suffer from abrupt type 2 diabetes onset. This is the graph I wish to show.

    http://1.bp.blogspot.com/_N02EMssBLJU/TJZ4InFu_rI/AAAAAAAAACE/F9LchHIVEAU/s1600/weight+A1c+graphs_26526_image002.gif

    What you see shows no real progression. It stays steady and then takes off. A person with this could pass all manner of tests and still be in the hospital within a year. My little experiment points me to cumulative trauma as the problem here, persistent glycemic excursions breaking down the normal insulin mechanism.

    We really have no idea what “normal” is but we do know what levels cause damage. There might be some who escape damage much like people who only smoke a little a day but the great majority are going to be harmed. The numbers are clearly there and going over them, in general, leads to damage and going over them consistently will lead to cumulative damage.

  79. says

    Hi Chris. Yes, I agree.

    Another strange pattern that I think was discussed on Stephan’s blog was a marked increase in blood glucose several hours after a high-protein meal. This I suspect is also related to a delayed and abnormal glucagon secretion.

    Btw, I think you’ve seen this graph from Christiansen’s research group, which suggests that blood glucose varies chaotically, even in the normoglycemic:

    http://healthcorrelator.blogspot.com/2010/05/blood-glucose-variations-in-normal.html

    Tom Naughton suggested that the folks with the highest peaks of BG would probably develop diabetes later on (the participants were young at the time the measures were taken). I have my doubts, because the highest peaks were not consistently found in the same individuals after meals.

    • Chris Kresser says

      Hi Ned,

      I’ve seen that graph (and entire presentation) and I read your blog post about it too. The question that remains is how “normal” those subjects really were. We know that metabolism can be damaged very early on in life – even in utero. It’s entirely possible in my mind that the people having the greatest blood sugar fluctuations throughout the day were not normal, but metabolically damaged. Perhaps these are the folks that go on to develop diabetes. Perhaps they already had some degree of reactive hypoglycemia, swinging from 170 mg/dL to 50 mg/dL. A1c is just an average. If someone is bouncing around from 170 mg/dL to 50 mg/dL, they may have a normal A1c because that would be an average of very high and very low readings. But that doesn’t mean they have normal BG. There’s also a lot of research, which I mentioned in a recent article, suggesting that post-prandial BG is a much more sensitive marker for predicting future problems than A1c.

      It’s also possible, of course, that spikes up to 170 mg/dL and down to 50 mg/dL are normal and part of a chaotic daily fluctuation even in healthy people. I still wonder why that happens in some healthy people, and not in others. It certainly indicates some difference in glucose tolerance and utilization. Whether that difference is significant or not would be the more important question.

  80. Lynn says

    This article and the comments section is so educational. I thought I knew lots about this issue, but it has been great to learn more about what RH is, and about strange PP numbers.

  81. NoGluten says

    “I’ve seen another strange pattern a few times where the patient’s blood sugar actually decreases after the meal at the 1- and 2-hour mark, ”

    FWIW, Before my spouse went gluten free, he had a similar pattern.

  82. Chris Kresser says

    Karen: thanks! It’s nice to be appreciated.

    Ned: I agree. That’s something I see fairly regularly in practice. Generally appears as a below baseline reading at the 3-hour mark after significantly elevated readings 1- and 2-hours after the meal.

    I’ve seen another strange pattern a few times where the patient’s blood sugar actually decreases after the meal at the 1- and 2-hour mark, and then increases at the 3-hour mark. i.e. it might be 105 before the meal, then 95 one hour later, and 90 two hours later, and then 110 again three hours later. That one definitely has me scratching my head, but I suspect cortisol/glucagon dysregulation.

    • Marg says

      Hi Chris, a friend sent me this article and both of us are trying it. I did mine before dinner, not lunch, so maybe that’s the problem. Before, it was 70mg, after an hour it dropped to 61, 2 hour it went up to 85, then stayed at 85 at the 3 hour mark. This morning, true FBG was 108. I’m so confused. I am eating VLC, about 20g a day for about 2 months. A professional blood test about 2 weeks ago put me at 88 FBG. Not sure if I need to be worried.

      Thanks for the site, I love it!

    • says

      My numbers are all over the place. I have hypothyroidism and in four months I’ve had my medicine adjusted from Synthroid 112mcg to 100mcg to 88mcg. My A1C has gone from 5.8 to 5.3 in four months. During months 1 and 2 , as my meds were being adjusted, my fasting blood sugar readings were 81 and 83 in the doctor’s office. I purchased a glucose monitor a month and a half ago and began closely monitoring my sugar levels. Though I have recorded a few fasting blood readings in the low 80’s earlier on, my fasting readings are routinely in the high 90’s. Oddly, upon eating a low, moderate carb meal or a non restrictive carb meal, my readings are near always within the optimal/normal ranges. For example, I had a 12 oz cup of Mango Lassi, 3/4 of a piece of naan, a serving of curried chicken and about 3/4 cup of white rice. In one hour after my last bite, my reading was 91 ( about 90 minutes from the start of this meal). Another example: I ate a serving of homemade lasagna and had a diet coke. In 1 hour and 35 minutes my reading was 83.
      What is happening here? How can I lower my fasting sugar levels? Most all of my 1 hour -2hour after meal readings are below my fasting. Help!!!

  83. says

    One thing to consider adding to these suggestions is a simple test of reactive hypoglycemia. This would be useful, because reactive hypoglycemia so often precedes a pre-diabetic condition.

    I don’t have the references now, but if I recall correctly, RH usually occurs 2-4 h after a high-carb. meal, and the key piece of evidence is a BG reading that is significantly lower than the baseline.

  84. Karen Koshgarian says

    I’m totally with you Chris, regarding Walmart. I took it upon myself, with the suggestion of a diagnosed diabetic friend, to get the ReliOn Ultima at Walmart. I don’t patronize that store, but made the exception because in his experience, this meter had the least error because each pack of lancets comes with a calibrator for that particular pack.

    Testing my glucose has been eye opening, in that I’ve discovered on my own, that balance in food really works. The feedback loop of having a meter has made all the difference in my life. I can have whatever I want, so long as I control portions, and eat carb fat combos. I didn’t understand why this was working until I read this post. You’re brilliant, helpful, wonderful, and I’m thankful for your work and genuine caring about health. I read you religiously.

  85. Rodney says

    I just made a trip to Wally World and bought the ReLion Ultima for $9. No strips, but 10 lancets come with it. Strips were $20 for 50, or $39 for 100. The WalMart site says that ReLion is a brand made specifically for them, so that is why it can’t be found elswhere, unless it is under a different brand name from the same manufacturer.

    I have a strong family history of diabetes and at age 45 finally checked my sugar while visiting a relative recently. My fasting was around 102, and a 2 hr post pancake binge was around 125 or so. It surprised me because my weight is fine and I do exercise. I also love sugar, and now finally have a “hit home” reason to deny myself all of those frequent guilty pleasures. Clearly now is the time to buckle down on the diet a bit. I will now be able to follow my progress directly with the new monitor.

    Thanks for the outstanding service you provide. The education is priceless!

    • Cynthia says

      The ReliOn Prime has strips for about half the amount than the Ultima. So just wanted to point that out for future purchasers.

  86. Bev Carney says

    The Walmart meter and strips are also the only ones I’ve found that allow storage at temperatures under 59 degrees. We keep a cool house and nighttime temperatures dip into the 40’s upstairs. Most strips won’t tolerate that.

    That said, I do notice a difference with a cold meter and strips (even though within the Reli-on guidelines) and a meter and strips pre-warmed to 80 degrees or thereabouts. Any idea why that happens?

    Thanks

  87. NoGluten says

    Wonderful post! This is where the rubber hits the road – you and your meter can create the right diet for you. The comment about food intolerances is spot on too!

  88. says

    I loved this!
    The one point that I keep reiterating on my site is that people should eat to their meter and that is what they should base their dietary guidelines on.

    I began taking this tack after talking with various diabetics on diet. Invariably, they were given advice on what to eat by their diabetes educators and docs. What I had to say was meaningless to them because of the prevailing wisdom being put out there by people who should know. There is a loop hole, however, and it relates to food allergies. No food, no matter how “healthy” it’s supposed to be, should be eaten if the person has a bad reaction to it. This loophole allowed to me to put this diet information in a form that is allowed by both FDA and ADA so I could get around the credentials issue.

    Testing for food intolerances using a glucometer is something anyone can understand. Healthy becomes what does not push that meter over 140. All the rest of the diet seems to fall in place after that.

    The other way to couch it is through vanity. Tell people that they can use this meter to lose weight and suddenly they will pay the 60 bucks so they can look better on the beach next summer.

    Jenny is a wonderful resource. No matter what arcane piece of research I’m digging in, her site or blog always seems to pop up.

    My most recent post, having to do with self-experimentation, points up the fact that prediabetes is diabetes. My loss of 1st phase insulin response, due to glucose desensitization, in the “prediabetic” range shows there’s nothing “pre” about it.

    Again, good job!

  89. says

    You’re right, Jenny rocks! One comment: her site doesn’t use frames; the URL weirdness is because of the way she’s redirecting one domain to the other.

    You can get to your favorite sections via the following URLs:

    Painless Blood Sugar Testing: http://www.phlaunt.com/diabetes/19774432.php

    Frequently Asked Questions: http://www.phlaunt.com/diabetes/16162265.php

    How to Lower Your Blood Sugar: http://www.phlaunt.com/diabetes/14045524.php

    • Chris Kresser says

      Thanks for the clarification, and for the direct links. I’ve been wanting to be able to do that for a long time.

  90. Lynn says

    What would a compromised phase II insulin response be? How could one fix that? Re: cortisol, would it be high or low cortisol causing issues?

    When you say back to baseline, does that mean the exact figure? Like if the pre meal figure was 85, would the 3 hr PP of 89 be okay?

  91. Chris Kresser says

    Kim: thanks for the tip!

    Lynn: in general it’s suggestive of poor glucose tolerance, but specifically may point to a compromised phase II insulin response or cortisol dysregulation.

  92. lynn says

    Great post! I have done the fasting and one and two hour PP’s, but I never did the 3 hour one. Interesting…

    I will get some new strips and go for it.

    BTW, what does it mean if the 3 hr PP is not back to baseline?

    Thanks.

  93. Kim says

    Hi Chris! Just wanted to tell you a little research will net a FREE glucometer. I got mine last week and it included a free membership to get the test strips@ a discount. It’s a Freestyle Life and uses the smallest blood sample on the market. The offer is probably still available.

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