Why your “normal” blood sugar isn’t normal (Part 2)

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In the last article I explained the three primary markers we use to track blood sugar: fasting blood glucose (FBG), oral glucose tolerance test (OGTT) and hemoglobin A1c (A1c). We also looked at what the medical establishment considers as “normal” for these markers. The table below summarizes those values.

Marker Normal Pre-diabetes Diabetes
Fasting blood glucose (mg/dL) <99 100-125 >126
OGGT / post-meal (mg/dL after 2 hours) <140 140-199 >200
Hemoglobin A1c (%) <6 6-6.4 >6.4

 

In this article, we’re going to look at just how “normal” those normal levels are – according to the scientific literature. We’ll also consider which of these three markers is most important in preventing diabetes and cardiovascular disease. But before we do that, I’d like to make an important point: context is everything.

In my work with patients, I never use any single marker alone to determine whether someone has a blood sugar issue. I run a full blood panel that includes fasting glucose, A1c, fructosamine, uric acid and triglycerides (along with other lipids), and I also have them do post-meal testing at home over a period of 3 days with a range of foods.

If they have a few post-meal spikes and all other markers or normal, I’m not concerned. If their fasting BG, A1c and fructosamine are all elevated, and they’re having spikes, then I’m concerned and I will investigate further.

On a similar note, I’ve written that A1c is not a reliable marker for individuals because of context: there are many non-blood sugar-related conditions that can make A1c appear high or low. So if someone is normal on all of the other blood sugar markers, but has high A1c, I’m usually not concerned.

With all of that said, let’s take a look at some of the research.

Fasting blood sugar

According to continuous glucose monitoring studies of healthy people, a normal fasting blood sugar is 83 mg/dL or less. Many normal people have fasting blood sugar in the mid-to-high 70s.

While most doctors will tell you that anything under 100 mg/dL is normal, it may not be. In this study, people with FBG levels above 95 had more than 3x the risk of developing future diabetes than people with FBG levels below 90. This study showed progressively increasing risk of heart disease in men with FBG levels above 85 mg/dL, as compared to those with FBG levels of 81 mg/dL or lower.

What’s even more important to understand about FBG is that it’s the least sensitive marker for predicting future diabetes and heart disease. Several studies show that a “normal” FBG level in the mid-90s predicts diabetes diagnosed a decade later.

Far more important than a single fasting blood glucose reading is the number of hours a day our blood sugar spends elevated over the level known to cause complications, which is roughly 140 mg/dl (7.7 mmol/L). I’ll discuss this in more detail in the OGGT section.

One caveat here is that very low-carb diets will produce elevated fasting blood glucose levels. Why? Because low-carb diets induce insulin resistance. Restricting carbohydrates produces a natural drop in insulin levels, which in turn activates hormone sensitive lipase. Fat tissue is then broken down, and non-esterified fatty acids (a.k.a. “free fatty acids” or NEFA) are released into the bloodstream. These NEFA are taken up by the muscles, which use them as fuel. And since the muscle’s needs for fuel has been met, it decreases sensitivity to insulin. You can read more about this at Hyperlipid.

So, if you eat a low-carb diet and have borderline high FBG (i.e. 90-105), it may not be cause for concern. Your post-meal blood sugars and A1c levels are more important.

Hemoglobin A1c

In spite of what the American Diabetes Association (ADA) tells us, a truly normal A1c is between 4.6% and 5.3%.

But while A1c is a good way to measure blood sugar in large population studies, it’s not as accurate for individuals. An A1c of 5.1% maps to an average blood sugar of about 100 mg/dL. But some people’s A1c results are always a little higher than their FBG and OGTT numbers would predict, and other people’s are always a little lower.

This is probably due to the fact that several factors can influence red blood cells. Remember, A1c is a measure of how much hemoglobin in red blood cells is bonded (glycated) to glucose. Anything that affects red blood cells and hemoglobin – such as anemia, dehydration and genetic disorders – will skew A1c results.

A number of studies show that A1c levels below the diabetic range are associated with cardiovascular disease. This study showed that A1c levels lower than 5% had the lowest rates of cardiovascular disease (CVD) and that a 1% increase (to 6%) significantly increased CVD risk. Another study showed an even tighter correlation between A1c and CVD, indicating a linear increase in CVD as A1c rose above 4.6% – a level that corresponds to a fasting blood glucose of just 86 mg/dL. Finally, this study showed that the risk of heart disease in people without diabetes doubles for every percentage point increase above 4.6%.

Studies also consistently show that A1c levels considered “normal” by the ADA fail to predict future diabetes. This study found that using the ADA criteria of an A1c of 6% as normal missed 70% of individuals with diabetes, 71-84% with dysglycemia, and 82-94% with pre-diabetes. How’s that for accuracy?

What we’ve learned so far, then, is that the fasting blood glucose and A1c levels recommended by the ADA are not reliable cut-offs for predicting or preventing future diabetes and heart disease. This is problematic, to say the least, because the A1c and FBG are the only glucose tests the vast majority of people get from their doctors.

OGTT / post-meal blood sugars

If you recall, the oral glucose tolerance test (OGTT) measures how our blood sugar responds to drinking a challenge solution of 75 grams of glucose. I don’t recommend this test, because A) it’s not realistic (no one ever drinks 75 grams of pure glucose), and B) it can produce horrible side effects for people with poor glucose control.

However, there’s another more realistic and convenient way to achieve a similar measurement, and that is simply using a glucometer to test your blood sugar one and two hours after you eat a meal. This is called post-prandial (post-meal) blood sugar testing. As we go through this section, the numbers I use apply to both OGTT and post-meal testing.

As the table at the beginning of this article indicates, the ADA considers OGTT of between 140 – 199 two hours after the challenge to be pre-diabetic, and levels above 200 to be diabetic.

But once again, continuous glucose monitoring studies suggest that the ADA levels are far too high. Most people’s blood sugar drops below 120 mg/dL two hours after a meal, and many healthy people drop below 100 mg/dL or return to baseline.

This study showed that even after a high-carb meal, normal people’s blood sugar rises to about 125 mg/dL for a brief period, with the peak blood sugar being measured at 45 minutes after eating, and then drops back under 100 mg/dL by the two hour mark.

Another continuous glucose monitoring study confirmed these results. Sensor glucose concentrations were between 71 – 120 mg/dL for 91% of the day. Sensor values were less than or equal to 60 or 140 mg/dL for only 0.2% and 0.4% of the day, respectively.

On the other hand, some studies suggest that even healthy people with no known blood sugar problems can experience post-meal spikes above 140 mg/dL at one hour. As I said in the beginning of the article, context is everything and all of the markers for blood sugar must be interpreted together.

If post-meal blood sugars do rise above 140 mg/dL and stay there for a significant period of time, the consequences are severe. Prolonged exposure to blood sugars above 140 mg/dL causes irreversible beta cell loss (the beta cells produce insulin) and nerve damage. 1 in 2 “pre-diabetics” get retinopathy, a serious diabetic complication. Cancer rates increase as post-meal blood sugars rise above 160 mg/dL. This study showed stroke risk increased by 25% for every 18 mg/dL rise in post-meal blood sugars. Finally, 1-hour OGTT readings above 155 mg/dL correlate strongly with increased CVD risk.

What does it all mean?

Let’s take a look again at what the ADA thinks is “normal” blood sugar:

Marker Normal Pre-diabetes Diabetes
Fasting blood glucose (mg/dL) <99 100-125 >126
OGGT / post-meal (mg/dL after 2 hours) <140 140-199 >200
Hemoglobin A1c (%) <6 6-6.4 >6.4

 

But as we’ve seen in this article, these levels depend highly on context and whether all markers are elevated, or just a few of them.

If you’re interested in health and longevity – instead of just slowing the onset of serious disease by a few years – you might consider shooting for these targets. But remember to interpret the numbers together, and also remember that blood sugar is highly variable. If you wake up one morning and have a fasting blood sugar of 95, but your A1c and post-meal numbers are still normal, that’s usually no cause for concern. Likewise, if you see a one-hour post-meal spike of 145 mg/dL, but all of your other numbers are normal, that is also usually no cause for concern.

Marker Ideal
Fasting blood glucose (mg/dL) <86*
OGGT / post-meal (mg/dL after 2 hours) <120
Hemoglobin A1c (%) <5.3

 

*If you’re following a low-carb diet, fasting blood sugars in the 90s and even low 100s may not be a problem, provided your A1c and post-meal blood sugars are within the normal range.

Another key takeaway from this article is that fasting blood glucose and A1 are not often reliable for predicting diabetes or CVD risk. Post-meal blood sugars are a more accurate marker for this purpose. And the good news is that this can be done cheaply, safely and conveniently at home, without a doctor’s order and without subjecting yourself to the brutality of an OGTT.

I’ll describe exactly how to do this in the next article.

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Comments Join the Conversation

  1. Marianne Toledano says

    I have been under a doctor’s care continuously but have recently lost my doctor. Within the past month or so, I experienced a couple of blood pressure spikes that sent me to the ER. I had blood profiles taken there and no one mentioned diabetes or kidney disease. I began seeing a new doctor who told me I had diabetes and prescribed Metformin 500mg. My fasting glucose level was 107 and the HbAic averaged at 137. The doctor said I had “uncontrolled diabetes” but neglected to mention I also had kidney disease and low potassium. A specialist I was seeing for another condition noticed both and ordered another metabolic panel without HbAic–and the glucose level was at 97. This was about 4 hours after lunch. My question is this: If within the past three months I have been consuming way too much sugar and too many carbs [chocoholic and Pepsi drinker] would that affect the outcome of the HbAic as opposed to being tested again after being on a far more careful diet? I have certainly altered my eating habits! I don’t want to be on diabetes medication indefinitely when some graphs indicate I am only in pre-diabetes.

    • Andrew says

      Presumably the HbA1c figure of 137 is after the conversion to average glucose and represents a reading of 6.4%-just below the cut off for diabetes of 6.5% whereas the fbg of 97 (normal) and 107 (slightly high) are non -diabetic. I think you would notice a fall in HbA1C after dietary/exercise changes.
      The description of your condition as “uncontrolled diabetes” looks at bit excessive !

      • Marianne Toledano says

        I am having difficulty with the concept of pre-diabetes versus diabetes. If persons classified as being at the pre-diabetes stage, why are they given Metformin the same as a diabetic? Doesn’t that effectively mean “diabetic anyway”?

        • Eva says

          Marianne, the simplest of explanations is that big Pharma loves to make money and they also fund the physicians, who put profit in front of humanity and personal patient care. We managed to reverse my husband’s type 2 diabetes with lifestyle changes, much to the demise of his primary care physician, who gladly plied him with more and more drugs whenever he went for a check-up. Try a number of different physicians before making the decision to take medications. There are those like Chris, who care for their patients more than the profit they make.

  2. Susie~Q says

    I just posted about my sugars lately after exercise, which is walking for me, due to bad back, etc, I cannot do any other strenuous exercises.

    Today, I had a sandwich, and then got carried away and ate several spoonful’s of Nutella chocolate butter, well, in the past, I never have gone too high. Today, I took a walk, it took an hour, so the reading was one hour after my meal and walking, it was 121, that was fine. Then, I checked again at the two hour mark, it was 178!!!!!!! I was stunned, I had exercised, it should be low!!!!!. I checked again at the hour and half mark, it was 161, then at 2 hours, 127, and at three, 110. As I said, I do not stay high for too long.

    This happened to me yesterday as well, I took a three hour walk, it was elevated when I got back, but I bottomed out at 80 after 6 hours. Hours 3 through 6 were getting lower and lower.

    Also, I noticed that if I eat two high carbs at once, I go high, but, if I only eat one high carb, I do not go up at all. I can eat a large spaghetti, it hardly raises my numbers at all, but, if I add ice cream to it, wham, up it goes.

    I am under such stress, it is unbelievable, and the depression is off the scales. I am miserable, I am so homesick for the states, I do not like New Zealand, my marriage is not good, we have been married two years, and they have not been good. My best friend died last year, and I lost both of my parents, my dad in 2012 and my mom 2005. I have no friends to speak of and am very lonely.

    Oh, one more question, I read that you start the timing that you start your two hours for testing at the first bite, that is ridiculous, I take it from the minute I stop. You see, what if the meal takes over an hour or so, I mean, how can that be accurate?? Sounds dumb to me. Oh well.

    • Andrew says

      Just revisited this site & looked at interesting posts-especially from Susie Q. I don’t think the diagnosis of reactive hypoglycemia done in the 80’s was right-it’s quite normal to have low readings at the end of an OGTT, but the high 2 hour reading is almost diagnostic of diabetes whereas your recent results are more indicative of impaired glucose tolerance (IGT)- a pre-diabetic condition. When you should start timing your post meal readings is debatable – probably better to do it after a quick 20-30 minute meal when it won’t make much difference when you start the clock. Points to note are:

      -stress can elevate glucose readings
      – IGT does not necessarily lead to diabetes
      – Diabetes in middle aged adults only slightly reduces life expectancy if cholesterol and B.P. are controlled.
      -It looks as if you’re testing yourself far too often and creating an anxiety spiral -better to get a diagnosis from a doctor and follow the advice on B.P./cholesterol etc.

      • Susie~Q says

        The 6 hours OGGT was done in 1980, and that was the one where the doc said I had reactive hypoglycaemia, mainly because I dropped to 50 at one point. I have no idea what the test numbers were in 2000, just that I had IGT.

        My blood pressure is outstanding, actually, on the low side. I admit, however, that my cholesterol is high, but my HDL is over 50, my naturopaths back home in the states are not worried about my blood fats, as I have always had great High Sensitivity CRP levels, low homeocysteine and no other inflammation markers. I had a very sophisticated carotid scan done on me before I left the states, two years ago, it showed clean arteries and no inflammation, I wish they did that test here.

        You are right, I have terrible health anxiety now over all this. One night, when I had an episode of high blood glucose after eating, I was so scared, I kept checking every 15 minutes until it went down, luckily, it went down in 2 hours, but I was shaking from fear, I am sure this did not help the readings any either. I wish I had support here, the husband just does not seem to really get it.

        I can not get the doctors in New Zealand to run the tests I had done back home, they do not even know about some of them. I feel so unsafe. The doctors have even said that even though the medical system is good here, since we only have around 4 or 5 million in the entire country, they are not as “in-tune” to all the issues I have and that if possible, maybe I should go back home. Well, that is more stress, I have no money for that.

        My last A1C was in January, it was 6.0, all I was told was to watch what I eat, and to exercise more, well, I have been doing that, for the most part, but, I can tell you, the docs I had back home, whom were very experienced and went to great schools, even had hard times with me on occasions.

        I am scared.

        • Andrew says

          I’m not sure what tests the NZ doctors are saying are unavailable but would be very surprised if a carotid ultrasound can’t be done there -in the UK (& I think the USA) there’s lots of private companies doing them all over the country for about £100 -it only takes about 15 minutes. However, I don’t think it’s necessary.
          The A1C reading of 6% strongly indicates IGT
          Best plan now is to check glucose, cholesterol and B.P. annually, stick to the diet/exercise regime and get a prescription for metformin (or similar) if you do become diabetic. If you develop diabetes but other risk factors are under control, you should avoid major problems.
          Have you considered cognitive behavioural therapy for anxiety ?

    • says

      Susie, I would just be consistent in when you start recording. The best way to do that is to start timing at the end of the meal. Bear in mind that high stress levels will also affect the readings at times. The effect of stress may also vary from day to day. The key is to keep low carb. If you do this and stay below 140 all day then you should not worry too much. The odd day where you get 180 after a blow out (say 1/fortnight) is indicative of poor glucose handling. It doesn’t mean you are going to suffer diabetic complications if you stay under 140 on the other 13 days. There is more information on my website at: http://www.drdobbin.co.uk/diabetes-t2

      • Susie~Q says

        Thank you for your info and website, I bookmarked it.

        I am curious about Berberine. Dr. Jonathon Wright, (who use to be my doctor many years ago) of the Tacoma clinic in Seattle says it is better than Metformin, yet, when I use to take it, I got horrible acid reflux and my glucose levels rose. Same with Aloe Vera Juice, I have read nothing but praise on how it lowers sugar levels, well not mine, again, it raises them, as does anything that I take to lower them. I thought exercise was good, but now, I am finding out for me, it is raising it the second hour after I am finished with the walk. I feel like a freak of nature.

        I do know my cortisol levels are sky high, I never sleep, I am lucky if I get 3 or 4 hours a night, and I never feel fresh when I wake up.

        So far, my best control has been the low carb diet, so, at least I can stick to that, it is just depressing when nothing seems to work. I hate this stress.

  3. Alavida says

    Thank you for part 1 & part 2. I am searching for the next article where you discuss how to monitor one’s own post-prandial blood glucose levels. THANK YOU!

  4. says

    Hi Eva, It could be that if you are on a low carbohydrate diet that your fasting blood sugar levels are naturally higher as Chris has said in his paragraph starting “one caveat here”. The key is that your levels don’t go above 140mg/dl for extended periods, so it may be something not to get too hung up about, depending on your exact numbers.

    • Anya says

      Low-carb made me insulin resistant with very high sugars. Never again. I’m back to moderate carb and my fasting glucose is 79.

  5. Eva says

    Aloha Chris, thank you so much for this absolutely great article, I am much obliged. I have a question which has been bugging me for the last few days, I am trying to find out what it means if someone has high fasting glucose readings but normal OGTT? HbA1c just under 7 (which according to your article is high) but this is after nutrition treatment from being diagnosed with diabetes last year. In a year we went form HbA1c of 12 to 6.9 and on the way down. Blood pressure is normalized but LDL is still somewhat high. We are working on reducing all this without taking copious amounts of drugs much to the dismay of the medical profession. Therefore, I would be very grateful if you’d advise on how to solve the quandary of the hepatic malfunction.

  6. Andrew Roxburgh says

    The doctor refers to diabetes and impaired glucose tolerance but these are separate conditions. A random reading of 200 wouldn’t necessarily diagnose diabetes unless there were symptoms. The diagnosis would be a fasting reading over 126, HbA1C over 6.5% or more than 200 2 hours after glucose ingestion .
    However, a reading of 200 would cause a strong suspicion of diabetes unless it was about an hour after a high carb. meal, even then impaired glucose tolerance would be possible.
    Stress/other illnesses can elevate glucose-there is a non-diabetic condition known as “stress hyperglycemia” sometimes seen in hospital admissions.

    • Knowledge Sponge says

      Agreed. There are other conditions that can cause high glucose readings. Diabetes and insulin resistance are most certainly two separate conditions, In my case I first received a diagnosis of diabetes, got a second opinion from another doc and was told it was insulin resistance. Got a third and final opinion and was told it was diabetes again. The only thing that was consistent was the plan of treatment. Metformin, improve diet, exercise, see you three to four months for blood work. I guess I should say that the plan of treatment is similar for the two conditions.

    • Quayle says

      A one-time fasting glucose over 126 does not automatically make one a diabetic. I went through a period of high cortisol and hyperthyroidism and woke up one morning with a fasting reading of 146. Freaked me out but it was a one-time thing and no doctor has ever diagnosed my as diabetic. My HBA1c is 4.9-5.1.

      • Andrew says

        Agreed Quayle-but in the UK the reading only has to be confirmed once for a diagnosis to be made. Which makes me think there will be several cases of misdiagnosis or reversed diagnosis – e.g. two FBG readings of 127 due to stress/other illness but subsequently much lower.

  7. Knowledge Sponge says

    Susie-Q I had readings very similar to yours. I did have A1cs that would run slightly higher. Like you I never experienced a reading over 200 “at home”. I questioned the results of GTT and decided to talk to my doctor about my concerns. ” I was told that if you ever at anytime have a reading of 200 or more that it is an indication of Diabetes”. One day I got a reading over 200 at home! It is pretty frightening when you test yourself and get a 200+ result for the first time. According to my doctor it doesn’t have to be a consistent reading. I was told that people who don’t have impaired glucose never get readings that high. It doesn’t matter how many carbs they eat their insulin will work effectively to handle the carb load. I decided put this information to the test. One day I tested my husband (who has normal glucose) after he had eaten a full plate of pasta. Pasta is a carb that will raise my levels quickly. My husband’s reading didn’t even go over 110 after one hour. It is also true that stress, depression and anxiety can affect your levels. Being ill can also have an effect on your levels. I saw evidence of that once when I caught a cold. Drs. advice can vary so be sure to do some homework on your own. Some doctors bounce between the terms “insulin resistant” and diabetes. What I’ve discovered is basically it’s not a whole lot of difference between the two. Both disorders result from having impaired insulin and both have to be controlled with diet, exercise, and/or medication.

    • Susie~Q says

      One night, I went pretty high, we had a high carb meal, well, I talked my husband into letting me take his sugar reading, he was only 70!!!! I was close to 165. He goes very low. I spike at times, but do not stay there for long, by the end of the 3rd hour, I am always back to “normal”

      If I really watch my diet, I will always be in the 90’s to low 100’s after I eat, unless I am super stressed.

    • Susie~Q says

      One night, when we ate a high carb meal, I went up to around 160, I think, it was high, that much I know. Anyway, I talked my husband into letting me take his sugar too, it was 70, he always runs low. I went back to normal after 2 hours, which is “normal” for me. I do not stay high for long.

      If I eat low carb meals, I never go above the 90’s or low 100’s after the meal.

  8. Stephen says

    TYPO: THE WORD EVERY SHOULD BE EVER
    I like your site and wanted to show you this….. thanks

    OGTT / post-meal blood sugars

    If you recall, the oral glucose tolerance test (OGTT) measures how our blood sugar responds to drinking a challenge solution of 75 grams of glucose. I don’t recommend this test, because A) it’s not realistic (no one EVERY drinks 75 grams of pure glucose), and B) it can produce horrible side effects for people with poor glucose control.

    • Andrew Roxburgh says

      Yes,I think I agree-but many doctors regard the OGTT as the gold standard and may recommend it in this case. It certainly shouldn’t be used when FPG is high or diabetes has already been diagnosed since the sudden ingestion of glucose could be quite traumatic. The HbA1C test could be a good alternative.

  9. Susie~Q says

    My fasting levels are between 80 and 100, for me, those numbers are great. (These are plasma readings). My blood pressure is stellar.

    At times, I will spike to 160 to 180, depending in what I eat, but normally, when I eat no carb meals, I stay in the 90’s.

    I had a horrible scare last night. I had eaten no carb all day; well, that evening I commuted the mortal sin of eating a Quarter Pounder and fries with ketchup. I have done it in the past without a dangerous spike, and I thought since I had been no carb all day, I would not spike once. Well, I checked my B/S at 2 hours,, it read 204!!!!. I did it right away again, and it was 187, sill too high, but not 200. Well, in two hours it went down to 110, I am happy with that. I do not know what happened, I have never had those high readings before. I have been crying all day, it scared me. It seems the lack of carbs all day caused this. This morning I was back to n low fasting level, and I have eaten no carb all day, my readings have been in the 90’s, which is great for me.

    This is also strange, some days I can eat tons of carbs and sugar but my readings are great!? Other times, I eat lots better or the same meal and my readings go high. It is depressing.

    As far back as I can remember, my A1c has been between 5.5 to 6.0. I take herbs like Berberine, this is the same as Metormin, however, it gives me horrible heart burn. I walk daily for 45 minutes to an hour. I usually watch what I eat.

    I am under lots of stress, depression and anxiety, I guess all this can affect the reading as well.

    Anyway, just wanted to share, my numbers can be so odd at times, but I am working in if.

    • Andrew Roxburgh says

      Susie -Q -your slightly high A1C and postprandial readings
      indicate a possibility of Impaired Glucose Tolerance and an increased risk of developing diabetes in future. An oral glucose tolerance test could be used to make a diagnosis.

      • Susie~Q says

        I had one in the early 80’s and one in the early 2000. I got bad hives from the one in 2000, I was told I was insulin resistant, but how could it be accurate when I had hives?

        The one in the 1980’s was all over the place. Started at fasting 98, half hour, 198, hour one, 217, second hour, 166 third hour, 113, fourth hour 55, fifth hour 76, and sixth hour, 79. I was diagnosed back then with reactive hypoglycemia. That was 30 years ago. I went from feeling dizzy to having bad anxiety attacks while it was dropping.

        The one that gave me hives in 2000, was only 2 hours, I was not told the numbers, just that I was insulin resistant, like I said, how can it be accurate if it gave me hives? I was told to take liquid chromium. I have never had an A1C lower than 5.6.

        I noticed that lately, I spike at the two hour mark, but at the three, I am “normal”. Also, I will go to normal if I exercise after a high carb meal the first hour, but the next hour ( one hour after exercise) I go very high. Again, it goes down the next hour.

        I never stay elevated for very long.

      • Susie~Q says

        It is called “true results” I had to order it from the states, I could not find any in New Zealand. I am from the USA and do not understand the readings here.

    • Alyson Archambeau says

      Susie-Q, the overwhelming message I get from your comments is that you’re laboring under an enormous amount of stress. Have you looked into the possibility of suffering from adrenal fatigue? It’s something I just discovered, and sounds a lot like me. I suspect you would fit the profile as well. I’ve been looking at a book by Dr James L Wilson, Adrenal Fatigue: The 21st Century Stress Syndrome. (Interesting bit of info for you, since you’ve seen Dr Johnathan Wright-he wrote the foreward!) I think it’s a great book. Part 1 is an overview, Part 3 is full of what to do to recover from adrenal fatigue. Things to do, and things to avoid because they stimulate already overburdened adrenals.

      Dr Wilson has a website at adrenalfatigue.org. Here is a link to a questionnaire. http://www.adrenalfatigue.org/take-the-adrenal-fatigue-quiz
      I’m just beginning to learn about adrenal fatigue, and there is so much to absorb. I’m hoping that maybe it will help you!
      By the way, I do a lot of reading at this site, and others, but this is my first comment ever. Your distress moved me to respond.

      • Susie~Q says

        Thank you so much for your comment and concern.

        I went to that site and did the test, mercy, I scored way over 100, almost every question I answered I had to score “3”. I have always suspected adrenal mal function in my issues, but now that I am over here in New Zealand, I definitely can not get help, they just do not understand problems like mine. I feel totally helpless, I spend most days crying, I am crying now in fact. I am so, totally and helplessly miserable and there is not a thing I can do to change it. The money I came over with is gone due to the damn high prices here, my marriage is not good, I really have no support system, folks are nice, but they sure do not understand where I am coming from. The only little relief I get is when I walk with my two, sweet Shetland Sheepdogs. I so wish I was back in the states, but then, I would still have no one, my dear folks are dead, my best friend is dead, I do not have enough money to really get re-established, I really messed my life up when I came over here.

        My memory has gone bye-bye, it use to be stellar, now, it is awful, I fear Alzheimer’s, to be honest. I am 57, and falling apart at an alarming rate.

        I do have some good news. Yesterday, I ate the same as I did before (the day I got the higher numbers) well, this time, I only ate half of what I did that day, and my numbers stayed in the 90’s to low 100’s, that is wonderful for me.

  10. Anna says

    Hi!

    I have just got some testresults back after going to my doctor to check out my blood sugar levels. I can’t really make sense of the results by myself so I hope someone can help me understand them better.

    The reason why I went to my doctor was because my FBG (tested at home) showed 90 mg/dl. I have never tested myself before so I could have had these numbers forever. The FBG from the doctor showed 93 mg/dl, so quite close. My HbA1c showed 5,2 %. My BP is 105/70 and my Hb is normal. My post meal values are always at 120mg/dl at the highest and goes down to 100 about 2-3 hours after.

    The only number that I don’t get is the FBG that according to this article is borderline high. My other numbers are ok so I don’t get why the FBG is high. I am underweight and have always been. I’m 26 years old and my BMI is 17,2. I have always had a hard time putting on weight (so has the rest of my family). I eat around 130g carbs a day. Can my high FBG have something to do with me being underweight? Maybe my liver doesn’t have so much glucose in storage because everything I eat gets used up during the day? So when fasting my body has to break down fat resulting in high FBG?

    Thank you for commenting on this!!

    /Anna

    • Andrew Roxburgh says

      Anna your doctor can give you an expert opinion but to me your blood glucose & blood pressure figures look fine. If the glucose figures are in plasma or plasma equivalent (nearly always the case these days) the fasting BG is very much in the normal range. If it’s whole blood it’s borderline high but well below the diabetic threshold. My earlier post referred to an article highlighting health risks of LOW blood glucose, so we should not aim for “the lower the better” . However,I would aim for a BMI of at least 18.5 because,similarly, being in the normal range is better than underweight but you would only need a small increase to achieve this.

    • Susie~Q says

      I am totally over-joyed when my FBS is in the 90’s, it is seldom in the 80’s or lower, but for me, this is “normal” I am thankful that my FBS rarely goes into the 100’s, when it does, it is always under 110, and if I re-check a few times, I am obsessed with it, I usually can get a number in the 90’s.

  11. Diana says

    Hi Chris. Just stumbled upon this and I am very impressed by all the information. I have recently been diagnosed with diabetes (1 month ago) My FBS was 124 and A1c 6.7. I have complex regional pain syndrome that prevents me from getting a good nights sleep, I average 1-2 hours straight sleep then wake to the pain. I have revamped my diet to low carb around 100g/day. I have started exercising, but am very limited to exercise as tolerated due to the CRPS. I have lost 5 pounds since diagnosis. My doctor has me checking my BS only first thing in the am. It has been running from 110-138. I just checked my BS tonight after 2 hours eating and it was 104. Is my lack of sleep causing/contributing to diabetes and what can I do about it? I have had CRPS for 3 going on 4 years now. I was started on Metformin, but immediately had dark green, grainy stools. Now off it with stools returned to normal. I take more than enough meds for the CRPS and do not want any more added. Any suggestions and help would be appreciated.

  12. Prem says

    Chris, kudos on this very informative article. I have just been diagnosed as Type 2 diabetic. With medications, diet and exercise, I am maintaining my BG (Fasting, PP, random) in good control. How long does it take for my A1C to reflect my new average levels? When should I go for my next A1C tests?
    Thanks,
    Prem

  13. Andrew Roxburgh says

    I suggest you google “Low fasting plasma glucose level as a predictor of cardiovascular disease and all-cause mortality”. It’s a U shaped risk curve with the healthiest in the range 80-109 mg/dl.(4.4-6.1 mmol/l.) -below this range was higher risk as well as above it.

  14. Wing says

    Chris, my A1c is 6.3, FBG is 94. I am thin (age 60, 5′ 10″, 138 lbs). I have lost about 8 lbs in the past 8 months and would like to gain it back. How do I do that without increasing my sugar levels?

  15. Shawn says

    Very interesting read!
    My FBG: 96-120
    My A1C: 5.3
    Post meal: 110-125
    I have had spikes high up to 183.
    Have a weight loss problem, dry skin. Thirsty a lot.
    Doctor says I’m not diabetic.

  16. Kari says

    Hi Chris. I know this is an older article and I’m hoping that you still check these comments as I really need your advice. I have been checking my blood sugar lately and it has had a very odd pattern that I hope you can figure out :). Yesterday for example went like this and this is a typical day.
    Fbg 99
    I do intermittent fasting and workout before my first meal
    Pre workout bg (roughly 3 hours later) 85
    Post workout/pre 1st meal 118!!
    45 min after meal 87
    2 hours after meal 93
    Approximately 5 hours after 1st meal I have 2nd meal bg 84
    45 min after 99
    2 hours after 99
    3 hours after 95
    Pre dinner 95
    45 min after 117
    2 hours after 110

    I recently had a lipid profile done and the results are as follows:
    Total cholesterol 175
    Hdl 67
    LDL 99
    Trig 55

    I eat mostly paleo but I do have Gouda cheese (for k2) and kefir Everyday. I also eat moderate carbs since I am breastfeeding and all my starchy carbs are at dinner. Typically potatoes sweet potatoes or rice. I have a history or unexplained chest pains and MVP so the study that shows bg above 86 correlating to heart disease scares me. I tried adding a meal this morning to see if it would help with my readings and it made no difference. Any insight you could provide would be greatly appreciated.

  17. mary says

    Hi Susie:

    I tried to answer you twice now and each time my stupid tablet lost the message and dropped me offline, so I moved to my PC. ;-) Easier in the long run anyway.

    Metformin is a real wonder drug! It is a first line drug against diabetes and is a very old tried and true drug. It has been used over 50 years with little to no side effects. The main and really only side effect is that it can cause gastrointestinal problems when you are first adjusting to it. So they start you with 500 mg and gradually raise the amount so your body can adjust. I take 2000mg a day split into 2 doses of 1000mg each. They are learning new and good things about Metformin. Lots of recent and new research going on about it because they have discovered it helps other things besides diabetes. It reduces the risk of cancer by 50%. It has been found to regrow brain cells and it might be used in the fight against Alzheimers, to repair damaged and older brains. Canada has a new study going on right now to see if it will help children who have suffered from brain cancer, and lost a lot of brain, to recover some of the brain. They have used it for years for PCOS.

    Here is what the Physician’s Desk Reference says about the dose… “… anything less than 1500mg a day is not clinically significant…” Give this quote to your doctor if he seems unwilling to up your dosage. He can check it with his copy (usually online anymore, but some doctors still have the hardback books)

    You know that high blood pressure in diabetics is tied into high blood sugars too so keeping the BG down in normal ranges helps keep the blood pressure down too. They are connected… It also helps with weight loss for most. So I sure would recommend you ask for higher doses as soon as you are adjusted to it. Don’t want a bunch of gas and the runs, but once you can tolerate more, you should ask for more. I love what my metformin has done for my health! I hate prescription drugs as a rule, but not my Metformin! Love the stuff. The maximum recommended dose of Regular (not extended release) Metformin is 2750mg a day. I am considering whether I might not want to up mine to that amount as I am taking the generic stuff and it is not as strong as Glucophage. I had to change to a weaker generic and it caused me to gain 10 pounds over a few months, so I think I will try to get mine upped to the maximum. Generics are NOT the same where metformin is concerned… but Glucophage is so expensive.

    • Liz says

      The number one diabetes drug in the world (metformin) just so happens to be drug mugger of a few nutrients such as CoQ10 and vitamin B12. Low levels of these nutrients can affect the brain causing memory impairment, confusion and depression. Also, the nerves could start to hurt, and neuropathy may develop because B12 protects the myelin which is a coating that protects nerve fibers. If you require metformin for your blood sugar, just “marry” this medication with the two nutrients so you can avoid or minimize the side effect. As to forms of vitamin B12, the best type is called “methylcobalamin” and is widely available by dozens of makers. The CoQ10 can be found easily as well in both health food stores and pharmacies nationwide.

      just an fyi. :D

      • mary says

        I take sublingual B12 and have never heard it causes a coq10 problem. Statins cause a coq10 problem but not metformin. A once a year b12 shot or sublingual B12 drops (around $4 at walmart for 6months supply) solves any possible b12 problem. Again, metformin is a true wonder!

  18. mary says

    Hi Susie:

    Metformin is a real wonder drug and much research is and has been done on it. They have found it reduces cancer by 50% and recently research has shown it rebuilds brains by causing new cellula growth. They have been using it for over 50 years with little to n side effects. The only real side effect is gastro problems when first adjusting to it. So they start newbies with 500mg a day and slowly increase it. I take 2000mg a day split into 2 doses of 1000mg per dose. The Physicians Desk Reference says “…anything less than 1500 mg a day is not clinically significant…” So yes, you should ask for more. I dislike and distrust drugs with the exception of metformin, but I love what it has done for me.

  19. mary says

    Hi susie!

    A couple of thoughts… age is not a disease and if anything you should keep a tighter rein on the blood sugar cause you do not likely heal a well as a kid, at least I don’t and I am 63. I think you are headed right with your new diet. Any A1C over 5 is known and proven to cause complications, minor at around 5 but the higher it goes the worse the complications become. Minor nerve damage at 5.0 but with high numbers you can start to find things like kidney damage, etc. So I disagree with your doctor on that point.

    Regarding the cholesterol, I had that problem too. HAD that problem… I will warn you the doctor will try to put you on statins and they are really bad, the brain is made of cholesterol you know and when you use statins to reduce it you get brain fog which is another name for brain damage. You can lose memory etc. too. Really bad stuff. If you will begin getting sun on a daily basis, I think you will find yourLDL and total will drop. That is what I did and it worked. Any drug that lowers my lipids also raises my blood sugar, by the way.

    The body makes vitamin D from sunshine AND uses cholesterol as the raw fuel to do it! My lipid went from over 250 to 130 and my LDL dropped to 9 all from daily UVB rays of the sun. I am considering getting a UVB lamp for this winter. Do a web search on sunshine, cholesterol and blood pressure. Both cholesterol and blood pressure drop in the average person in the summer… that is what keyed me in to start reading about it. Do a bit of personal research before taking any statins though… that is just my opinion, I AM NOT A DOCTOR and I don’t even play one on television ;-D but I have personal experience about your problem cause I am a T2 with the same problems. I tried statins, so i know what they do to everyone, not just a few. I tried the diet my doctor gave me fr 2 years and all that happened was i gained 4 pounds and my a1c was just below 7. I went on a very low carb diet, dropped 40 pounds from it while having cream, instead of creamerand butter instead of margarine. I ate better foods for my body and my taste buds. I quit being hungry too. Cravings disappeared. You are going the correct direction in my opinion. My doctor got real excited when he saw my numbers and at one point exclaimed that my labs were that of a 20 year old! Then when I told him I was eating low carb, he said oh no! That will kill you. Mind you he was holding my good labs in his hand when he said that, and I mean full labs covering 2 pages of results! So I take my dctors advice with a grain of salt and do not argue with him but remind myself it is i who will suffer complications from my diabetes, not him. Hope this helps you and please pardon any typos as I am not on a computer and do not have a keyboard writting this…no delete key either so for a typo I have to backup and retype everything. This thing also puts in wrong letters etc. sometimes.

    • Susie says

      Hi, Mary,

      Thanks so much for your thoughtful and detailed response! I really appreciate the time you spent sharing here. You did marvelously well with the typing….much better than I’d most likely do without a keyboard, for sure. I will look into the sunshine info you shared and have recently been getting some walks outside pretty regularly. I’ll also check into the lamp idea you mentioned for the upcoming shorter winter time. I am determined not to start on statins and appreciate your info regarding them, too. Perhaps I’ll consider asking my doctor to up my metformin from 500 mg to 750 mg per day if eating a more paleo diet doesn’t yield the results I’m seeking.

  20. Susie says

    It’s been 10 months since I was diagnosed as Type II. At the time of diagnosis my A1C was 9.5. After 3 months of diet changes, exercise and 500 mg of metformin daily my A1C dropped to 6.4. I am a 71 year old female my doctor was very satisfied. After reading through this thread and learning that the ADA guidelines are not the best to follow I am wondering about my next step. For a week now I have eliminated grain, legumes and dairy but also added a green tea supplement and drinking green tea and making a breakfast “biscuit” with flax meal, coconut flour, egg, baking powder and coconut oil. I have also ordered “Your Personal Paleo Code” and await it’s arrival. My doctor’s reasoning that 6.4 was good for me was my age….if I were in my 30s or 40s she would want it to be lower. She’s also wanting me to start on cholesterol lowering medication but we’ll recheck labs in January. I am not wanting to go in that direction. I also have what the dietician called “the dawn phenomenon” in which my fasting blood sugar is elevated. Any advice or comments would be very much appreciated. I just discovered this web site yesterday and am learning a lot! Thanks.

  21. Mary says

    Hi Jackie. My suggestion is to actually run a full glucose curve. Test before you eat, then every 15 minutes after for 3 hours. The lab is more accurate as home meters are allowed to be as much as 20% off, though most of the time they are no more than 10% off, if that. What are the soap ingreidents you use? Some soaps have unseen sugars in them, such as glycerine (the gly gives it away) check your protecals to be certain there is no problem there. I do use the relion PRIME meter and strips myself and find them to be accurate and very cheap at $9.00 per 50 strips. This allows for as many tests a day as I want cause it is only .18 per strip. Good luck and do that glucose curve.

  22. Jackie says

    Thanks Mary
    I did do some testing last night. I ate a bunch of potato chips and my numbers stayed between 99 and 105, then shot up to 129 about 2 hours in. This morning my fasting was 109. When the lab does the testing, they say my fasting is 126. I have an Aviva tester, but going to get the Relion like mentioned here and see if it’s any different. That’s what I find so confusing. My numbers are all over the place. I sometimes feel like I’m having symptoms, like fatigue and a headache, but my readings are between 101 and 105. Any thoughts on that?

  23. Mary says

    Hi jackie. I too think you are diabetic. Have you heard of doing a glucose curve? A simple do it yourself home test that is fairly inexpensive. It tells the real story of what you blood sugar is doing. You see, often you have spikes that you do not see if you are only testing two or three hours after eating.

    To do a glucose curve, take your blood sugar before eating and write it down. After eating, the clock starts ticking! Take your blood sugar every 15 minutes for the next three hours. This will pin down where your personal high point is located.

    I thought my PP was wonderful and could not understand why my fasting and A1C was high, till after I did a glucose curve. I was spiking HIGH at the 45 minute mark but by two hours was back down, so i simply did not see the blood sugars going up in excess of 200. This simple do it yourself test will give you some really good information. Do use a timer though, as you can easily miss a test or two and not get as good of information as possible.

  24. Jackie says

    So curious after reading comments here. I’m 52 years old, with a fasting blood sugar reading of 126 and an a1c of 6.1. I’ve tested my blood both before and after meals many times and the highest I have ever seen it is the 126. My triglycerides and cholesterol and both ideal. All my other blood tests are also fine. I do have some ketones in my urine. I do not eat ‘low-carb.’My NP says I am diabetic, but I don’t understand how all my numbers tie together. They don’t match what I’m reading here. I’ve certainly never seen my blood sugar at 140 or higher! Any feedback would be appreciated. Thanks

  25. Ronnie says

    Hi, been having BS issues for a number of years now and no-one seems to have any idea what is going on or worse, doctors don’t listen or care.
    I’m 61yr female, bmi 18, active, been LCHF & gluten free for the last 18 months. A1c was 6.3% now down to 5.8% so coming down albeit slowly. FBG 4.1-4.3 mmol/l

    The issue is this, I can do an OGTT and not get any rise above 6.3 mmol/l and no reactive hypo – so I think very normal.

    Food, however, if I eat more than 30g absolute max carbs at any one time I will go to 10-13 mmol/l, sometimes staying there for a very short time or for a long time, depending on the type of starch or sugar component – fruit short time, rice or grains a long time.

    Why can I take a massive 75g glucose with no effect, but ‘normal’ carbs have a bad effect on me. What is the difference in the mechanism for signally that insulin needs to be produced in the two examples. Because it seems that with food no signal for first phase insulin is either made or received, hence the big spikes, but glucose obviously triggers insulin release absolutely normally.

  26. Danial says

    Hi, my fasting (not eating for at least 8 hours during the day) blood sugar is normally around the 83 mg/dl mark. But my blood sugar after waking up in the morning is sometimes over 100 mg/dl. How do I interpret these blood sugar levels? Thx.

    • mary says

      Hi Daniel.

      This is normal and true of everyone. When you sleep you have “sleep” hormones in your system, such as melatonin, for example. When you wake your body goes through a sort of flushing to rid the body of the night hormones, part of why wepee so much when we first wake. However, when these sleep hormones are flushed from the system,other hormones go with them, such as insulin. This is normal and as soon as the flushing process is over the body puts out new insulin and the Bg falls back into normal ranges, though 100 is technically normal anyway. A diabetic cant make insulin quickly and has no stored insulin to quickly replace it. That is why it is best to wait 3 hours before exercisg after arising for a non-insulin dependent diabetic. It is also why breakfast should be the smallest meal of the day. Even people with normal metabolisims have their highest blood sugar readings with breakfast. Also why the worse meal one could eat is a high carb meal in the am. A light breakfast containing protein is the best breakfast for a good metabolisim. NOT cereal, with sugar water (milk) or a doughnut etc. and OJ, the typical continental breakfast is a terrible idea! Really almost all sugars.

  27. sara says

    I’ve used 3 different glucometers to test my blood sugar and the results were drastically different. one was 67, another 95, and another one is 115. This is my fasting blood sugar. Not sure which is the correct one. Then I went to the doctor a few days later to get tested and it was only 85, when it was 124 when I tested at home before going there. I like to monitor my blood sugar at home, but is a bit nervous when the results are so different. BTW, the glucometers I use to test my blood sugar are
    TRUEtrack, TRUEdraw, and Gluccocard Vital. Just curious if I should take any of these results seriously. Can anyone recommend a more reliable meter?

    • Christina says

      Freestyle Freedom light has tested 96% accurate at all levels of blood sugar. However it is on the expensive side.

  28. says

    When I stay strict paleo, I see my post prandial and fasting numbers are in the ideal range for the most part. When I deviate by having say a piece of pizza and pineapple my post prandial shoots up to 150-170.. So how do I find the medium ground in terms of how many carbs I should target in a day?

  29. Susan says

    I have posted as “Susie~Q” and “Susan”. I have a question. A lot of times my blood sugar will not spike until the second hour, it fools me on the first making me think all is well, then WHAM, it can be anywhere from 139 to 150, by 3 or 3 1/2 hours, I am pretty close to my starting level.

    I am taking all kinds of lowering herbs, I guess they help some, but sometimes, when I do not take them, my blood sugar is lowering, like the herbs are working opposite of what they should do.

  30. Carol Minniespearl says

    I’d rather estimate lower, unlike another had posted. I am inclined to agree that these numbers are closer to normal. We should be trying to meet the levels of healthy people, not the numbers of known diabetics using insulin. I, for one, totally appreciate the information published here.

  31. says

    …… just another quick question, why are old posts shown at the top? Would it not be better to sort them with the newest at the top so that people can see the latest news?

    Steve

  32. says

    Hi Chris
    For the most part we are told that having elevated BSL causes heart problems, kidney problems etc; etc. My friend who is 76 has never taken any type of medicine (insulin, metformin) due to lack of trust in the Pharma companies and has had this for over 45 years without any type of side effect. The few times he has taken his morning levels they were always between 240 and 320.
    I was diagnosed with chronic pancreatitis at the beginnig of the year at age 62 with diabetes as a side effect. Metformin made me really ill so I was put on 26 units of insulin (Lantus) at night and 6 units of rapid (Humalog) before every meal. 2 months after taking the insulin, my average fasting levels were 169 (anything between 130 and 250). Like my friend, I distrust the Pharma companies. So I Googled it and came up with gymnema sylvestre as an alternative. After 1 month of this my levels had dropped and I needed to stop the Humalog because of hypoglycemia (down to 60ish fasting). After 3 months of taking this supplement I have been able to cut the Lantus down to 10 units.
    Now my average fasting levels are 112 (for a 2 month period).
    Firstly, how come my friend isn’t either dead or seriously ill with complications of high levels? Secondly what do you know about gymnema sylvestre?
    All I can tell you is it works for me.
    It also works for my friend as I told him about it and now his fasting levels are down to a pretty stable 130 – 140. Not brilliant but much improved on before (he still eats what he likes).
    I wish everybody on this site good luck with their quest for normal levels.

    Steve

  33. Susan Thackston says

    Hello, I have just discovered your site and am very glad I did! I just finished reading this article and cannot seem to find the next one where you talk about to accurately take post prandial blood sugar readings, can you or someone else here direct me to it? Thanks!

    Suz…

  34. Anna says

    Hi!

    Are the measurements in whole blood or plasma? I have heard that there is a difference between them.

  35. Susie says

    Your numbers sound great to me. Why do you keep checking? I am always in the 90’s to 100, fasting, have ALWAYS been that way for me this us normal everyone is different, we can’t all be text book perfect.

    I do spike at times, I come down after 2 1/2 hours, again, this is normal for me. I have been this way since I was 26, I am now 57 and in great health.

  36. Anna W says

    Hello! (I’m from Sweden so I apologize in advance for my spelling!)

    I have a question that I don´t seem to find an answer to anywhere. My FBG is all over the place. I can test 10 times at home within 15 minutes and I get numbers from 76 to 109. If I take the middle value of all the readings I get 89 which is borderline high and indicate diabetes within a decade. My postprandial values are always good. I don´t ever spike and don´t get a number over 120 ever. I can go under 100 after 45 minutes sometimes. My HbA1c levels are also good and within a normal range according to the article. I can´t understand why my FBG differs. I am underweight and have been my whole life which is genetic. My BMI is 17,3 and I rarely eat more than 1300-1500 kcal a day. I counted my carbs and I guess I eat less than 130 a day. I don´t strive to be low carb I just eat little of everything. Can my BMI and diet be the reason why my FBG are borderline high? Should I do something about this?

    Thankful for any answer!

    • Lena says

      Have you considered your meter at home may be inaccurate? I was convinced for 3 months I was diabetic until I started having my doctor test me and always got normal results.

  37. Kit says

    How does all this fit with porphyria, where a high carb diet is vital – HIGH carb: 300 minimum, 400-500 during attacks?

  38. deb b says

    RE: Posting of blood sugar and A1c numbers. I find myself unable to comment with the information given. It would be useful to post more specifics like BMI, number of carbs per day (and an idea of their sources), and amount/type of exercise, etc. What changes have you made and what was the impact (if any) seen via your experimentation? What have you done to confirm the accuracy of your meter? Any experimentation done with avoidance of key allergens and the observed impact (grains, dairy, soy, corn, etc)? Are you attempting to optimize cell membrane function (paying attention to )3-6 ratios and environmental toxins?
    Yes, I agree with the comment about not getting too stressed about it. There is no ‘failure’ only feedback and the information IS useful as long as you are not discouraged about it. It may spur you to find answers in areas you hadn’t thought to explore (e.g. gut biome configuration). Even if you never are able to lower the overall numbers, you will likely get info on individual foods YOU need to avoid that will spike you.

  39. lucy says

    This article is very frustrating. No matter what I do, my blood sugar is always over 100, and my A1C is usually around 5.4. There is simply no way for me to achieve the numbers in this article.(I never in my life had blood sugar numbers this low even when I was like 12 year old) BTW I have no family history of diabetes, I am normal weight and exercise every day and eat a diabetic diet. It all makes no difference at all.

    • Susie~q says

      I agree, for me, those numbers are an impossible, I will never be in the 80’s when fasting, oh maybe sometimes I am 86, but my “Norma” is in the 90’s.

      I take tons of herbs to keep it down, such as Berberine, which consistently rates better than Metformin, I have no family history of diabetes, am normal weight and exercise most days, and watch my diet. For me, a good A1C is 5.7. Folks can say what they want, but that is my best. My blood pressure is low, and when I had an ultra sound on my carotid arteries a couple years back, the results were “stellar” to quote my doctor.

      So, bottom line, I am not like others, and the numbers I have are good for me. I will add that I have been in these numbers since I was 25, I am now 56. I say stop worrying about what other folks are, worry adds high cortisol, high cortisol equals higher blood sugar. Accept the readings, especially if you are in good health and have always had such numbers. You are not diabetic, neither am I. We just do not fit the bill of others, but hey, that is fine.

      Here!s to individuallity, and good health.

  40. Melanie says

    I would like to know what is considered an “ideal” hba1c? A few months ago, mine was a 4.9 and now it’s a 5.1. My doctor said not to worry, but are we trying to get it as low as possible? My fasting glucose is 85. I eat about 150 grams of carbs a day. Not low carb but not exactly high carb either.

  41. Luann says

    Chris, I would love to read Part 3 of this article – what is the title please so that I can find it. And thank you so much for your invaluable information!

  42. Neenu says

    Hi Chris,
    My FBG is in 80ss and post meal after an hour is usually 120-130 and 2 hour is between 90-110 but my A1c is always 5.9. I have changed my diet to low carb diet, no sugary sweets or drinks but still my a1c is not moving down even a bit. Is it a concern?.?

    • deb b says

      Hi, I dont think Chris comments on posts much, so I hope you dont mind my thoughts, as I have a similar situation. One possible explanation is long-lived red blood cells , this would explain the higher A1Cs despite lower fasting and non-spiking post prandial numbers. A1C can be like BMI – a general (but not personally specific) screening. 2) You may have a latent reaction that you haven’t ‘caught’ yet (numbers are spiking later than anticipated). This was what was discovered about the ‘low-carb’ Dreamfield pasta – the spike was as high as regular carb pasta, but it was happening later. 3). I am experimenting with a little higher carb diet to see if it actually lowers blood sugar. You may have read that if you are following a low carb diet, you will fail an oral glucose tolerance test, but that eating 100-150 carbs per day for 3 day prior to the test will reverse the physiological insulin resistance (this is a term you can google search for more ideas). 4) I am getting ready to evaluate berberine (‘herbal metformin’) to see what happens and am trying to eat a few more starchy carbs a la Jaminet PHD, as my 23and SNPs suggest I am genetically disposed to higher blood glucose numbers.

      • Margaret says

        Which begs the question, why would you want to go on a low carb diet if it’s going to make you insulin resistant….

  43. Voula says

    When i was pregnant i developed gestational diabetes and it never went away. Up until last year my fasting bs levels would be between 115-130 but i was able to keep my numbers under control for the rest of the day i.e. Under 120 after 2 hrs. I have to tell you i am overweight. I weighed 228 pounds. This past year i have been under extreme amounts of stress being a restauranteur so im sure my cortisol levels are totally out of control and in one year i have gained more weight bringing me up to 245 lbs with fasting numbers at 160-180 and i can no longer control my numbers throughout the day. The low carb atkins diet in which ive done before and lost alot of weight rather easily, is not working at all and my reading 2hrs after a meal is still at 140. Im having a hard time understanding first, why i cannot loose weight on atkins, and second why my numbers are so out of whack even when im not taking in the carbs. Cholesterol at last check wasnt too bad at 184 but they did say triglycerides where a bit high and good cholesterol was low. I am not on any meds and never have been except through pregnancy. Please tell me your thoughts. I know i need to lose weight and im trying but all diets seem to be failing.

  44. Deb B says

    Just an FYI and N=1 follow up to the whole BS discussion. I hope it will be enlightening to the discussion:
    I have taken my Bayer Contour to the lab when I had my blood drawn in the past and it was very close to their results (i.e. therefore I presume it is accurate). I have been testing/comparing the NovaMax Plus meter (for glucose) because the same meter will do blood ketones and the sticks are reasonable priced vs. what they used to cost and competitors. However, there has been big discrepancies between the 2 meters so this morning I called the company. Overnight fasted glucose. Bayer meter read 82 and NovaMax read 145 (same blood drop). Based on my diet and past testing history, the 82 should be (I hope) correct! They had me do a control solution test on the NovaMax strips which read 119 (so this iswithin their ‘acceptable’ limits which are printed on the meter vial and are about the range of 82-127 I believe). They had me re-test my blood x 2. The first reading was 140 and 2nd was 137. By their standards, this is acceptable. I like this company and they are sending me replacement test strips just in case it was something about this batch (this lot is not from their ‘bad’ strips recall). This is just an example of why it helps to do repeat N-1 testing. I am going to add a 3rd meter to the mix. I believe Dr. Bernstein says Freestyle and Freestyle lite currently the most accurate.

  45. Joanne says

    I am a newly diagnosed Type 2 and am trying to control my blood sugar with diet and exercise. So far, I’ve been very successful, but I have a question: Why, when I eat the exact same breakfast two days in a row, does my postprandial glucose fluctuate so much? Yesterday it was 115, today it was 130.

    • Deb B says

      Sounds like margin of error in the meter. What you eat up to 24 hours before can also impact the amount of insulin that is ‘stored’ in your pancreas – so that could have a minor effect as well. Have always been grateful I can check BS out of interest (not medication dosing). Think the device manufacturers should be held to a much tighter standard than they are. See Jenny Ruhl’s Blood Sugar 101 book and great on-line info and there is an interesting section in Tim Ferriss 4-hour body where he tests blood sugar (varied by finger, etc). I wouldn’t purchase the book but maybe stop by the library and have a look at that section.

    • Knowledge Sponge says

      Results can also depend on what your fasting blood sugars are. My results vary depending on where my blood sugar are before I start my meals. You can eat the same exact meals and get different results depending on stress levels, time of day, before meal readings, if you are ill. There are so many things that can effect results.

  46. Ruth says

    Like ‘veryconfused’, I too, have been looking for the third article to be written as part of the series, ‘Why your “normal” blood sugar isn’t normal’ but don’t see one and can’t find it via the search option. Chris references it at the end of Part 2. Was it ever written? If so, can you provide a link to it, please? Thank you.

  47. veryconfused says

    I thought there was suppose to be a follow up article for the
    Why your “normal” blood sugar isn’t normal (Part 2) but I can not find it? Help

  48. SG says

    Hi Folks, I want to ask a question. I have been monitoring my FBS for last couple of years and it remained between 85-87 mg/dl except for once 97 mg/dl (when I was stressed). The more recent FBS was 87 mg/dl which was done in January 2014. My A1C was 4.4 in June 2013. Yesterday I had high pulse ~120 BPM and feeling lightheaded so I went to clinic where these checked my sugar level, it was 153 mg/dl 1 hour after meal and 159 mg/dl 2 hours after meal. Today morning my FBS was 109 mg/dl. I am very surprised and concerned seeing these relatively high number of my readings. Can someone here tell me what is going on with me, or it just might be a temporary thing? To add into a bit more, this week has been extremely stressful and increased my heart beat over 100. Could this is due to this? I would highly appreciate any insight or comment. Thank.

  49. Dhara says

    You wrote “If you’re following a low-carb diet, fasting blood sugars in the 90s and even low 100s may not be a problem, provided your A1c and post-meal blood sugars are within the normal range.”

    Does the same rule apply for the A1c levels (6%) for a 25 year old female who exercises five days a week and eats a low-carb diet? In other words, could a high A1c level and a normal fasting blood glucose level be a result of being on a low-carb diet?

  50. Susan says

    I have a question. How come on one day I can eat a spaghetti dinner and never go above 80 and maybe a week later eat the same exact meal and I can go as high as 175 and it takes forever to go down. This happens frequently. My doc is running some saliva tests for cortisol, can this be a culprit?

  51. Susan says

    Thanks Deb G for the info. I will check that book out on the net.

    Yes, my diet has been more or less the American Standard, however, I have also done the Atkins diet with great success regarding blood sugar control. In New Zealand, so many of the foods do NOT have chemicals, so, I am forced to eat better. LOL, it all tastes weird to me, guess I am use to chemicals and not REAL food.

    I can believe that pizza raises the sugar, it sure did mine, that was one of the times it went so high, it took all night to get back to normal, the next day, even though the FBS was OK, it still wanted to go high after I ate. Last night, I had a small Lasagne, I took tow 500 mg of my herbal Berberine and 2 of my herbal sugar control, both help to keep levels lower, and they sure do, at least with me, The first hour, of course, it went to 137, then the 2nd hour, 154, the third, 117, I ate some cashews before the 4th hour and went to bed, not planning on checking the sugar, but, I started to feel very “weird” and my tummy hurt badly, so, I checked it, it was 68. This morning, it was back to 89,

    Mike, I would love to have your readings after I ate, to me, they are outstanding, but, everyone’s body is different. I was told that it is not hypoglycaemia until the readings are in the 50’s.

  52. Susan says

    UGH, I accidentally typed the wrong email address for replies, I had to re-do it. I am not awake yet, LOL

  53. Susan says

    Hi Deb B

    Thanks for your info. I have not heard of those book before, I will look for them on the “net”. My diet, has been the standard American diet, not as much though over here in New Zealand,. LOL, the food here taste so different, I have been told that is because they do not use as many chemicals. It is actually forcing me to eat better. I did have a pizza on one of those days that my BG went so high, and you are right, it took all night to get it back to normal and the next day, even though the fasting was OK, my BG was still very prome to going higher,.

    Last night, I had some Lasagne, before I ate it, however, I took 2 of my 500 mg berberine caps and another herbal that controls BG with Gymnema Sylvestria. Well, an hour after eating, my BG was 137, the second hour, 154, the third hour 117 and then the 4 th hour 68, I was not going to check the fourth hour as I had eaten some Cashews before bed, but, as I was trying to relax in bed, I got very sick to my tummy and felt weak, so, I decided to check the BG, sure enough, it was 68. This morning, after 7 hours of sleep, my FBS was 89. So, I know for a fact that the herbal products work, I will continue to take them, I had been before, but stopped for a few days and that is when it started to climb.

    I did not know that the BG machines were not too accurate for non-fasting BG’s, I often wondered.

    Mike, I would have been happy with all of your readings, so would my doctor. I would not say it was hypoglycaemia, I have been told it is not that until you reach readings in the 50’s, everyone’s body is different however.

  54. Mike says

    I’ve been feeling ‘off’ for years now. I’ve complained to my doctor who has run the usual blood tests to tell me I’m OK and just need some anti-depressants. I feel I know my body pretty well and I know something is up. I have multiple food allergies which i suspect are throwing my body out of whack in many subtle ways. I’m trying to eliminate foods I’m allergic to like wheat, gluten, rye, barley, eggs, etc. The carb cravings have been overwhelming and I’ve been eating more and more sugar.

    I picked up a glucose meter to see what my blood sugar is doing when I feel good and when I feel bad. Out of curiosity I did my own little OGTT. My blood sugar was 87 before the test and within 15 minutes after I started ingesting my carbs it was 149. I retested in 15 minute increments for the next three hours. The readings were 139, 116, 83 (1 hour mark), 93, 95, 93, 74 (2-hour mark), 77, 75, 77, 77 (3 hour mark). I tested again after 4 and 5 hours and got 78 and 78. I was drinking water during the test, but not large amounts.

    At the 2-hour mark (reading of 74) I started feeling ill, shaky, tired, and hungry. After that I started getting a headache and just felt crummy.

    I guess my question is this, is it normal for blood sugar to peak and drop that quickly within an hour?

    • Liz says

      I am not a doctor, but it sounds like hypoglycemia.
      my doc told me after sufficient testing to eat protein (a slice or two of turkey/chicken/beef etc.) every 2-3 hours and just before bedtime until your FBG is fairly consistent. She doesn’t like to see FBG in the 70’s and really doesn’t mind FBG in the 90’s as long as there is a consistent number and not a pattern of huge spikes. She is also ok with moderate carbs, if it is not a problem.

  55. Susan says

    Hi, I just found this site and would like to participate. I will give my numbers, etc.

    First, my last A1c was 6.1, the doc said it was Pre-diabetes in January of 2014, OK, I get it that part, but what confuses me is that at home, on my glucometer, all my fastings were “Normal” however, back then, I had not checked after meals, so maybe they were the culprits. Now, I am checking all the time and driving myself crazy. In the morning sometimes fasting is 95 and other times 85, it varies day to day. Usually, after a low carb meal, it drops to the 80’s the first hour and lower the second. On some days, when I am naughty and eat wrong, my b/s sugar is still low, and on other days, I can eat the same thing, and it goes sky high, again, not consistent. Normally, however, since February, my fbs is 90, 1 hour after, 120, 2nd hour, back to 90, but, that changes as well. In February, of 2014, on the 5th, it was horrible. I think I had eaten Lasagne, well, before, my sugars did not change much, but that night, WHAM-O I started at 80 before the meal, I forgot to take it at the one and two hour mark, but did at the 3 hour mark, it was 175, then at four hours, down to 160, then at 5 hours, back to 175. I went to bed, because by that time, it was 2 AM, but when I woke up at 8:00 and took it, it was back to 89!!!! This horrible ordeal has only happened once, but, I have gone up to 178 since, but come down to normal in 2 hours. I don’t know if I was extra stressed that day or what, I am under tons of it, my marriage is not good, my dear dad died 2 years ago and my very best friend died 7 months ago, I live in a strange country, I am from America, but moved to New Zealand last year, and I am soooo unhappy. Anyway, what does confuse me is why the daily differences, even though I may eat the same thing on two different days, my sugars will register differently as well.

    I will say, when I was 24 (I am now 56) I had the horrible 6 hour OGTT done by a Naturopath, my fasting was 94, the first half hour, I sky rocketed up to 198, the hour mark, to 212, the two hour mark, 155, the three hour mark, 113, the four hour mark, 55, and the fifth and sixth hour, 76. I was told I was hypoglycemic. I tried another test 6 years later, but I broke out in hives due to fear and the readings were wrong, this one, however, was only insulin level and again, was told I was Insulin Resistent.

    Most of my A1c’s have been around 5.5, 5.7, and 6.0, I have not had that many however.

    I do know that in the past, I have never drank much water, so maybe this accounts for some of the higher levels, also, when I exercise, it goes lower. But, I have another question, when I exercise, it goes to “normal,” but then, about a half hour later, rises again, but then goes down, why would this be? UGH.

    Anyway, that is my story, I am sure my stress is off the charts, I have just sent in the “all day saliva” tests to see where my cortisol levels are as well as other hormones as I am post-menopausal. I am doing this long distance as I do not trust the doctors here in NZ, it is tedious doing the mailing, but well worth having my same Naturopath of 7 years.

    A positive note, I am now exercising daily, either via taking 45 minute walks with my dogs, or doing the vigorous, 45 minute indoor walking with my Leslie Sansone DVD, I feel so good afterwards and my bs sure shows it. I am trying to eat better as well, I need to lower my cholersterol and LDL as well. My blood pressure is outstanding, it is always 110/75.

    • Deb B says

      Hello Susan, My heart goes out to you in your isolation, but I applaud your bravery in taking the steps to tackle this issue. Nor sure what your ‘past’ eating history is (Standard American Diet?). If you haven’t already, I would highly recommend Jenny Ruhl’s Blood Sugar 101 book. It will explain many of the vagaries of BS monitoring. Much of the information is also available on her web site (the book is just a bit more logical in its lay out). Tim Ferriss actually did some interesting experiments with his glucometer in 4-hour body. Basically showed the huge variations based on finger used, many things you would not expect. Bottom line, be glad you don’t have to use these devices to administer insulin, they have a very high ‘legally’ allowable accuracy range. Yes, stress, infections, what you ate 24 hours previous can all impact your BS. It is more a matter of generally tracking and seeing patterns and making correlations with what is going on in your life. BTW – have have seen it anecdotally reported that pizza will elevate BG highest and keep it there longest. The components of lasagna (gluten/wheat flour, cheese and tomato sauce) would perhaps be very similar. Good luck!

  56. Lori says

    Thanks Chris for the great information. I just started testing my fasting blood glucose and it was high (97) but for past few weeks I have been eating very low carb and felt slight relief after reading this post. So, if and when I eat carbs, my FBG would go down? As your post states, I don’t value what is considered “normal”, I too subscribe to the importance of optimal health.
    I haven’t had my Hemoglobin A1C tested in awhile, so I can’t comment about that number right now.

    I am still confused as to whether or not low carb creating insulin resistance is good or not? Can please you clarify this for me? Don’t I want to increase my insulin sensitivity? and am I preventing my body from burning fat?

    Also, I just listened to a podcast from Kiefer about carb re-loading and it makes sense about eating carbs at the right time, what are your thoughts about low GI not being as important or conventional wisdom says?
    Thank you.

  57. Alison says

    Hi Chris. I have been reading your stuff for years now, but rarely tried to pose any questions to you because I appreciate how massively busy you are.

    But now, I have a problem that is really freaking me out and I have tried to read all I can from the smarter nutritional thinkers about it and still feel like something has happened which I don’t understand. I think you might be the most likely person to have some insight.

    I have suddenly started to see big postprandial blood glucose spikes (138, when 88 is more my usual) that hang around for several hours even when I have only eaten some fish and green veggies cooked in coconut oil. I am also seeing much bigger spikes after exercising.

    My fasting glucose is also sitting much higher than usual (100 compared to my usual 64-72). I am still generating ketone bodies in the low nutritional ketosis range ( I measure this with a blood ketone device).

    I read your views and those of hyperlipid about temporary insulin resistance on low carb diets, and decided I would try introducing more carbs in the form of sweet potato to see whether that regulated things again and kickstarted my insulin sensitivity. But it has not, and after a few days on sweet potatoes in the evenings, I have had rubbish sleep and feel high as a kite, and have higher glucose readings than I have ever seen in my life, even compared to when I was a big grain and sugar treat consumer. I am starting to feel a bit scared.

    I am 42, fit and highly active, not overweight at all, otherwise healthy, eat ancestrally all the time and have done for several years, and for the past year on the low carb side of things because I find my brain tends to work better and that it tends to keep my energy more stable. Suddenly everything has changed….

    I am not sure which way to go, up the carbs even more, or stay right off them? My instincts and appetite seem to be telling me to fast on fat, but this seems risky if the problem has been caused in the first place by being too low carb.

    The only thing that has really changed in the last week is that I increased my heavy weight lifting, going from once to twice a week.

    Any suggestions?
    Alison

    • Margaret says

      I destroyed my insulin sensitivity going low carb. After 6 months on a low carb diet with refeeds I started seeing fasting glucose above 110 and post-prandial 160. I quit testing after and hba1c test came back 4.9, but it was still very scary and I don’t even know what my numbers are now.

    • deb says

      Hi Alison. Have you seen any changes since this last post? I wonder about this as well (my story is similar). I read/listen to MANY nutrition sources and from what I can tell – we are still keeping insulin low (key to anti-aging and many other health metrics). So measuring blood sugar is a ‘proxy’ for insulin. Have you had your insulin measured via lab test ever? That said, some of the strategies I have read are: once a week carb day (SAFE starches, not junk food) and do not combine with fat. This would also achieve a protein fast, which is also an anti-aging/autophagy strategy. Some members of the Calorie Restriction Society have excellent blood sugar success with high carb diets (high fiber, low glycemic carbs like fibrous veg, barley). They are able to be in ketosis a large part of the day, but it is through ‘narrow eating window’ and being in a fasted state for many hours through the night (I do not recall their insulin numbers, tho – but blood sugars are fantastically low). Have you read the writings of Dr. Ron Rosedale? May help give you comfort/additional insight. Keeping blood sugar low should work for the majority, however, we are all biochemically unique. Biggest question: how do you feel? I have been experimenting with resistant starch (unmodified potato), but need to get serious about tracking blood sugar impact (it is reported to lower it), also there are some plant based compounds that may help (I have one brand ordered). I want to test/track in an n=1 manner that I can positively say what works for me (and therefore what might work for someone else), but right now I can’t. Hope that gives you a few other areas to consider that maybe you hadn’t. D

  58. margaret says

    It sounds like cortisol. Cortisol will raise your glucose, and strenuous workouts can raise your cortisol. I would look at your intensity and scale back a bit.

  59. Ken Husband says

    I’ve recently started working out. With a very low carb diet, (+/- 35/day) I have my FBS between 82-95 and rarely are the posts above 115. 1 hour after workout, and still fasting, it will raise to 150. Current A1c = 5.6, 1000mg Metformin 2X daily. Any suggestions to moderate this?

  60. Laura says

    Hi, my son is 5 and recently had some tests done (all fasting.) His glucose was 73 (range 65-99), A1C 5.4 (range 4.8-5.6), BUT what concerns me is that his insulin was 0.9 (range 2.6-24.9), and C-peptide 0.5 (range 1.1-4.4). We’ve always noticed that he has extreme mood swings related to food. I did a couple of prick tests on his finger when he was having these episodes and his glucose level was 50 once and also low the other time. I haven’t measured his glucose levels any other time, but his pediatrician said it’s normal because he doesn’t have elevated fasting glucose levels. Do you think the levels are normal or I should seek a second opinion? Thanks for your help!

    • Allie says

      Hi Laura.

      CK is no longer posting on this thread.

      50 is hypoglycemic territory. keeping protein in your son’s diet every 2-3 hours will help keep it more stable and not dip so low.
      This is what my practictioner told me, when I was having drops, but not as low as 50, it did stable me quite a bit.
      Also, eating a bit of protein just before bedtime.

      Can anyone else offer some thoughts?

      • Margaret says

        What causes a person to go hypoglycemic? I’ve had numbers in the high 40s and low 50s and I thought the meter was malfunctioning.

        • allie says

          Margaret – I don’t know the scientific cause, but not eating often and diet contributes to it, try keeping protein in your system every 2-3 hours and right before bedtime.
          This may help the drops.

  61. Maria says

    I used to be hypoglycemic and eating a paleo diet improved my symptoms. I used to have nocturnal hypoglycemia eating the SAD, like 40 the whole night.
    Now I’ve been checking at every single night I have numbers like 100 at 2am. Every single night. But when I wake up it’s always 70 or in the low 70′s.
    It seems like there is a dysregulation but I don’t know why or what can I do to improve it. Can you help me and give me your opinion on why this happens?
    Thank you very much and keep up the good work.
    Greetings from Spain

    • says

      as someone else mentioned in the comments, your liver may need some help. Perhaps you could try drinking lemon water throughout the day (1/2 lemon squeezed into a glass of water upon waking up and more throughout the day) or taking a liver supporting herbal supplement such as milk thistle, dandelion or burdock root (get these in pill or tincture form at your local health store or online).

      try these for a few weeks and see if your numbers improve.

  62. Ken Orland says

    My fasting blood glucose is 110, last year it was 120. My A1C is totally in the normal range. My doctor said my anxiety can raise my FBG levels. I am slightly overweight and enjoy a drink or two every night. I have gone back on the treadmill and stopped the drinks. Also, watching my diet very carefully. Do you think I have taken the proper steps?

  63. Antonia says

    My over 12 hours fasting glucose results are almost always rather high, mostly 97, 98 or even 99.
    But my post meal glucose readings barely go up, doesn’t matter if tested 45 minutes, 1 hour or 2 h after a meal, my post meal glucose readings are almost always just a few points higher than the fasting readings, so mostly only 100 or 101.
    Do I need to worry about my rather high fasting glucose results?
    Isn’t 81 or less the optimal fasting glucose reading?
    Or don’t I need to worry about higher fasting glucose results because my post meal glucose readings are well below 120?
    I follow a low carb vegan diet since years (I never eat junkfood), can low carb dieting cause higher fasting glucose results?

    FYI: I’m not a diabetic and I don’t take any medications

  64. jake says

    My fasting glucose is always in the 70’s or low 80’s and I eat mostly carbs lol. I guess being male, running and 145 pounds helps.

  65. Lulu says

    Well, don,t know if this will help someone, but just in case. I am not diabetic, neither pre-diabetic, my husband is diabetic and I use his glucose meter to monitor myself too. Well, like 2 years ago I bought iodine pills because I read that iodine will low the risk for breast cancer. I started to take 1 pill daily of 150mcg iodine each, a few days after I started to develop hypoglycemia, no matter what I eat or in what amount, hypoglycemia didn,t improve I remember I was eating 3 bars of cookies n, cream chocolate from hershey with no avail, I was eating bread, french fries, candies with no avail, dizzyness what still there and my glucose didn,t went up of 68 doing this but it didn,t went down of 60 either, my FBG was always below 70 but never below 60, the only thing that worked was eating 2 full spoon of white sugar. I didn,t know why that happened to me, but after I quit taking those iodine pills hypoglycemia episodes also stopped. I read recently that iodine increase sensivity for insulin and some doctors are using it in type 2 diabetic ppl so this way those ppl don,t need to use medication.

  66. Scott Scarborough says

    My A1c is 5.9. The doctor says my fasting Blood sugar was 98 one year and 110 mg/dl the next. But I bought a Contour glucometer and measured my blood sugar after meals. Spaghetti dinner was a peak of 122. After 1 hr. it was 111. So my meal spikes are real low but my Fasting is sort of high and my A1C is high. Could both my fasting and A1C be due to other factors?

  67. kristi says

    Hello,
    I’m hoping someone can help me understand if I’m testing within normal range for my diet. I eat mostly dark greens, nuts, seeds and chicken, I use good fats liberally like coconut oil and I consumer flaxseed and take 2 PB8 a day. My BS was 114 a few hours after a meal, 152 an hour after a meal and 114 fasting. Chris says very low carb can bring higher results that could still be considered normal. The only sugar in my diet is Stevia w/coffee.

  68. Evelyn says

    Lynne I have the same phenomenon happening and I think he said it is likely a cortisol issue. Perhaps he can expound upon that?

  69. Lynne says

    Hi Chris,

    Is it possible for my 1 hour post dinner reading to be lower than my 2 hour? For example, i ate around 100g of carbs for dinner and a protein. My 1 hour post eating was 97 and 2 hours later 109! Why would the second figure be much higher than the 1 hour figure? Does this mean I have imparied glucose tolerance?

    • Dash says

      The 2 hr reading being higher than the first can simply mean that it took a long time to digest. Most likely to happen when you eat a high fat meal. Look up the ‘pizza effect’. The numbers you listed though could very well be within the margin of error for the meter anyways.

    • Scott Scarborough says

      Yes, The meter can vary. To determine the amount of variation. Take several readings, say 4 in a row, when your blood sugar is stable like before breakfast. This will give you an idea of the variability of the meter. I can get a 10 mg/dl difference by taking a sample on the opposite hand!

      • Margaret says

        I think these meters cannot be trusted. I tested myself before a fasting test at the lab. At home it was 100. Went to the lab, had the blood drawn, then tested with my meter 2 minutes later, and it was 110. When I got my results, it was only 84.

        • Lynne says

          Hi Margaret,

          May I know what glucose meter decide you are using? I am using the Aviva Accuchek one and it is pretty close. My fasting one day was 61mg/dL at home and when I tested it at the lab it was 66md/dL. So not too bad a difference I think and I am pretty happy with the accuracy so far.

  70. Lyn Hacker says

    Almost 15 years ago I had Graves Disease and they nuked my thyroid. Since then my TSH levels swing from hyper to hypo-thyroidism on a regular basis making it nearly impossible to maintain a stable metabolism. I have had a single breath calorimetry which measured me at 1700 kcal/day although my weight is 360 lbs. With every bout of hypothyroidism (over the 3 months between testing), I will gain weight. I have managed to lose 60 pounds, but it has taken a great deal of hard work over a long period of time. My lipids are generally good, mostly normal, a little high in triglycerides but not scary. My blood sugar is getting worse and worse and does not seem to have anything to do with the foods I eat. Over the past 9 months I have been hypothyroid, hyperthyroid and hypothyroid again. The diabetes meds I am taking are antagonistic to the thyroid medications I’m taking. I feel these two diseases are at odds with each other. I really need some help and some advice, especially as to what kinds of food I should eat. Currently I focus on green vegetables, colorful starches (red potatoes), and lean meats. I don’t know what more I can do. Thanks.

  71. DW says

    I am Type 2, although I’ve never been obese and my endocrinologist thinks I may be a Monogenic (MODY) diabetic. I have become resistant to pills so am on insulin for both basal and bolus injections.

    I learned a long time ago that my HA1C doesn’t equate to my Fructasomine which also doesn’t equate to my average blood sugar readings. My blood sugars before and after meals & insulin can be quite high and my daily sugars can vary wildly. I am insulin resistant. Even the fastest acting insulin can take three hours to take effect.

    But my latest HA1C is 5.1. LDL is a low 42. Triglicerides 71, HDL 53 and overall cholesterol 109. Alt 19 and very, very slightly anemic.

    I’ve given up on the usefulness of the HA1C test, as when I test my sugars 6 times a day at various times those numbers always average 140 or higher. Since it takes so long for insulin to kick in, I try to inject very early before meals, but also can’t risk hypoglycemia at work or driving. When I’m hypOglycemic, it’s usually at bedtime.

    Any thoughts?

  72. Syed Amir says

    Hi Chris, Thanks for the informative article, My wife was diagnosed GDM (Gestational Diabetes Mellitus) during third pregnancy (completed March-2013). After that fasting and random blood sugar comes to normal levels.She had OGTT test done after 3 months and the reading were in normal ranges specified. Two month ago, she checked fasting blood sugar at home using one of handheld glucometer and had readings in range of 120-135 mg/dl. along with random test readings (2 hours) always comes lesser than fasting test results. She started a very strict diet plan but fasting readings fluctuates in the same range with random once again comes lesser than fasting results. She just had glucose fasting, random and HBA1C test done at a reputed laboratory and readings are as under
    Fasting (approx. 12 hours) = 125 mg/dl
    Random (two hours) = 105 mg/dl.
    HBA1C = 5.2 %.

    We haven’t see any Doctor yet and I want to have your opinion on these readings i.e. is she is diabetic or what? also comment why fating sugar levels are higher than random sugar levels. My wife is 33 years old and very active.

  73. Susie Collins says

    Dear Chris,
    I am wondering if you can help me. At 44, I delivered my first baby and developed gestational diabetes with my pregnancy. I was on bed rest towards the end and had to take quick and long lasting insulin. After my C section, they checked my sugars and told me they were back to normal.
    However, 6 months later, I am still checking as my first a1c at 2 months was 5.6. It then came down to 5.2. I am very thin, 108 at 5″4, and exercise by walking every day, usually 45 minutes to an hour at a fast pace and pushing a stroller. My waking sugars range from high 80’s to sometimes high 90’s. Two hours after meals, usually below 100, but sometimes in the low 100’s or teens.

    I do not have diabetes in my family, and try very hard to watch my carb intake. I do not enjoy animal protein, but find that chicken especially keeps the sugars low. I often find myself very hungry mid morning and mid afternoon.

    I tested my a1c today, 6 months after delivery, and was disappointed to see 5.9!

    Any thoughts as to my chances of now having type 2? The clinic I see here told me to stop checking and come back in a few months.

    Thank you

    • Knowledge Sponge says

      Hi Susie, Like you I also developed gestational diabetes. I developed it in two pregnancies. I was somewhat surprised by my diagnosis since I’d never had any major issues with my weight. My blood sugars returned to normal after delivery but later became elevated. I couldn’t understand because I simply did not fit what I thought was the criteria for diabetes. I researched “thin diabetics” and found a well of information on diabetic “myths”. Thin people can and do develop diabetes. Also research insulin resistance. I also was told to stop checking my blood sugars so frequently but I still check because it gives me an idea as how different foods effect my blood sugars. I hope this helps.

      • susie collins says

        Thank you so much for writing back. I am truly confused by the numbers I am seeing. This morning my fasting was 100, where as yesterday it was 86. I have now starting checking my one hour sugars after meals, and so far, they are in the low 100’s. However, I have not really tried to carb overload to really test it. I notice that an hour after rising, the numbers go back down to the 80’s. It’s the first one of the morning that seems high.
        My greatest fear is that I am already doing damage to my heart, eyes, and nerves. My baby girl already has an “old” mom, I just want to stay so healthy for her sake as well as my own.

        Do you take anything? What foods seem to elevate your numbers?
        Thanks again!

        • Knowledge Sponge says

          Yep, I take 500mg of metformin twice a day. During my pregnancies I managed my blood sugars really well with diet and exercise without any meds. I would suggest seeing a Endocrinologist and having a Glucose Tolerance Test done. This is a good way to find out if your insulin is impaired. If you’ve ever had a GTT done then you already know that it is no day at the beach consuming such a sweet liquid substance that can bring you to your knees. The GTT was the way I learned that I had developed type 2 diabetes. After one hour my blood sugars went to 205. The foods that I’ve found to have the biggest effect on my blood sugars are starches. White rice, potatoes, bread. I’ve switched to brown rice which I don’t particularly care for but it has less impact on my blood sugars. I tried the whole wheat bread, but I just couldn’t eat it, so I now eat honeywheat. I love fruit but I also have to eat it in moderation. I’ve learned that for me portion size, types of carbs and timing is key to managing my blood sugars. I need a small snack before bed or my morning fasting blood sugars will be elevated. According to my doctor going too long without food can sometimes cause your body to think it is starving and thus causing the liver to produce more glucose resulting in high morning fasting glucose. When your insulin is impaired it may not be able to handle the extra glucose produced by the liver. I try not to eat my snack after 10:00 because I want a true fasting (8-10 hours after a meal) in the morning. Take your time and choose a good Endocrinologist, bring a list of questions with all your concerns. Bring your monitor with you. Be prepared to go through a battery of test including having your thyroid checked. If meds are suggested ask if they are necessary to manage your blood sugars and make sure you are satisfied with the medical advice. I hope this is helpful

    • Just me says

      Susie, Knowledge Sponge is right, thin people do get diabetes. Besides, there are many obese people without diabetes.

      I’ve read it may take about 10-15 years for women with gestational diabetes to develop full blown diabetes, after their pregnancy. It may also manifest itself with the onset of menopause.

      I’d advise you to test 1 hour after meals if you want to find out whether your glucose/carb metabolism is impaired. In early diabetes, when fasting and 2-hour levels are still normal, the 1st hour reading may reveal the problem. For more detail, you may read about the two phases of insulin release after meals. If the 1st phase is broken, you will have a high 1-hour reading, like above 140. In fact, the “fully normal” people’s glucose rarely goes over 120 even an hour after carbohydrate-rich meals.

      Take care :)

      • susie collins says

        Thanks so much for your response. I started checking yesterday the sugar levels one hour after meals, and they were in the low 100’s to teens. That said, I did not really carb overload, just a normal meal.

        I do understand that thin people get diabetes, I was just surprised, as I do not really fit the profile…no family history, and always a normal weight…very healthy. I have read and understand that 50 % of gestational diabetes patients go on to develop Type 2 within a few years. I guess was just hoping to prevent or keep it at bay as long as possible. I really miss being able to eat normally and with more spontaneity. I have also been a vegetarian most of my adult life. But I am finding that the grains, rice, beans, etc, seem to elevate my sugars, where chicken and cheese, eggs, beef, do not. I also have a terrible sweet tooth.

        Any thoughts on medication, or maybe switching doctors? I feel that an A1C jump from 5.2 to 5.9 in a month is a red flag. Do you think the at home tests are truly accurate? I am also experiencing a great deal of stress at home.

        For the most par, my sugars seemed to be under control, with the exception of the waking/fastings, which lately have been in the 90’s…sometime low, sometimes close to or at 100.

        Thank you for your time!!

        • Just me says

          Dear Susie, I agree with you that a 0.7% jump in your A1c is not something to be ignored.

          I’m not sure you can prevent diabetes, but you can control it. As you’ve rightly found out, carbohydrates elevate your blood sugar levels, while proteins and/or fat do not (though they may, a little bit).

          Was your A1c tested with a home test kit? As far as I know, at home A1c tests are not too off, while glucose meters are allowed to be up to 20% off.

          Susie, with the numbers you’ve posted, I highly doubt you’re doing any damage to your heart, eyes, and nerves. I’m not a doctor, but my opinion is you need no medication, at least as long as your readings are as great as you’ve reported them to be. Now to find out why your A1c has jumped to 5.9%… Stress may have contributed to it, especially if you tend to snack often, when stressed. Just an idea.

  74. mk says

    Hi Chris,
    I am a female, 22 years old, from Portugal.
    I was a bit overweight when I was a kid and diagnosed with hashimoto’s at the age of 14. My TSH was extremely high and I of course was a depressed kid.
    During my teenage years that follow I became anorexic. I didn’t stopped eating at all, actually I ate every 3h..but just granola bars and everything that was low-fat. I lost nearly 17kg.
    When I cured myself (did theraphy, gained weight, my period came back etc) and reintroduced carbs, I experienced reactive hypoglycemia. It’s like a plague. One hour after eating my blood sugar was 50. The doctors advice was to eat carbs every 2h … you can imagine what happend next.. I got stuck in a cycle where every 10 minutes to 1h my blood sugar was 35. Sometimes riight after eating. Being this young I had no idea why this was happening… I though I was going to die from this. I could never leave my house without something with sugar in my purse and I passed out in supermakerts, school, coffee, shopping center… My doctor prescribed me anti depressants and refused to understand that RH is real. Anyway, I did a 21 days sugar detox which seemed to be solving my reactive hypoglycemia, and started supplementing with Omega 3 and Chromium. (which I think was crucial). Of course now I am still afraid of this happening again,specially because I couldn’t and still can’t find a doctor in my country who can help me understand what was happening. Reading your posts and doing my own research is what is helping… Do you think I still need to do cortisol/adrenal tests? Perhaps I still have low DHEA? In Portugal is hard to find someone who can do them but I will do whatever I need to do to guarentee I will no longer be through such pain again.
    sorry for my english! and for being scared and confused…..I’m afraid it can all come back…… I almost died. And I’m going to go to college again and wanna make sure I can have a life again. Please give me some advice or at least suggest all tests I shoud do…

    Thank you so much and sorry for the long text and taking your time!

    • Lynn says

      Me either! It was bad news for my mental and physical health, and in fact *worsened* my IR. The mian thing I changed when I went back to eating good carbs was that I massively decreased my PUFA intake. I don’t eat pork and avoid vegetable oil and poultry skin like the plague…

  75. Margaret says

    “One caveat here is that very low-carb diets will produce elevated fasting blood glucose levels. Why? Because low-carb diets induce insulin resistance.”

    This seems to militate AGAINST a low carb diet, as insulin resistance is BAD, correct?

    I was on VLC (30 g or less a day with a weekly refeed) for about 5 months. During that time, my fasting glucose was around 96. Prior to this, low 80s had always the norm for me. Since going off the diet 3 months ago, my levels are still elevated. I think by going low carb I’ve destroyed my body’s ability to process carbs.

  76. richard lewis says

    I am new to this so exuse me if I have missed something but wouldn’t intermitent fasting produce the same effects on your insulin resistents as a no carb diet?

  77. Jinal says

    Hi. I am Registered Dietitian. One of my friend developed gestational diabetes even though there is no family history of diabetes or GD. She controlled her sugars by diet and exercise during pregnancy. Now she is pre diabetic where only her OGTT is 154. Her fasting and HbA1c are normal. Y is tat so ? How can she control her sugars and post pone diabetes.

  78. Anna says

    hi, I would like to know if insomia and anxiety can cause high BS. I have to take sleeping pills to sleep, but only get 4 hours a night. I take anxiety meds, but still have anxiety. Have racing heart rate. My FBS is 95-100 and after a small snack of one bite bagle and 2 sips tea it was 137. in evening it went to 156. Help…..

    • Glen says

      Aany type of stress on the body can raise BG numbers. IT just vareid as to what extent. I know when I have a cold they shoot up quite a bit higher than ususal.

  79. Melissa says

    Hi. Just ran across your article. I’ve had some confusing numbers pop up in regards to my blood sugar. Last fall I had some lab work done at the doctors. Fasting sugar was one of the things tested. And it came out at 79. A pretty healthy number. Just recently, I bought a home glucose meter out of my own curiosity and because I’ve been having some symptoms that could possibly point in that direction such as peeing more often some days (although that could just be from anxiety and green tea) and feeling tired (although I don’t sleep very well). I tested my own fasting glucose. One morning it was 99, 107 the next, and 104 the third day. I only tested post high carb meal one day where I ate a bagel. One hour after it was 125 and 111 at two hours, 110 at three hours. So those numbers were pretty well within normal range, but my FBG seem to be high. I called my doctor to tell her about it, but she doesn’t seem to be concerned about it as long as it’s not over 110. But I am concerned. I don’t exactly fit the bill for pre diabetes. I’m not over weight (118 lbs). My blood pressure is always fine. Last fall my cholesterol was healthy (170). I exercise three times a week. And my diet isn’t horrible. I don’t eat enough vegetables, but I reserve soda and dessert only for special occasions. I did go from an active factory job to a sedentary desk job last summer (couple months before the FBS of 79), but like I said, I try to get to the gym three times a week. I’m only 27. My grandparents on my mothers side had diabetes, one from poor lifestyle choices and obesity, the other didn’t get it till in his 70’s. But neither of my parents or any of my siblings have it. So what do you make of this? Should I be worried? Could anxiety or insomnia be causing my FBS to be too high? Or perhaps my home meter isn’t very accurate?

  80. John says

    Now, i’m worried. I had a prediabetes test done several months ago and my FBG was 91 mg/dL and my A1c was 5.6. I’ve been testing my blood sugar levels with a True2Go meter and my FBG is below 90 and, in some cases, is as low as 70. My post-meal blood glucose is usually below 130 45 minutes to an hour later. But, a breakfast of two reggs on a white roll, accompanied by some white potato and bell peppers, brought my blood glucaose level to 149 after 45 minutes. I immediately did another test with the same blood drop and got 142. But, 15 minutes after that test, my blood glucose was 123 and, an hour after that, it was 108. Should I worry? Am I headed towards diabetes in ten years?

    • Sharon says

      John, when my doc diagnosed me with prediabetes, my FBG was 78, but the A1C was more revealing. It was 5.9. It took me about 2 years to get it down to 5.5, but I’m still not satisified as that is an average BG of 112. My goal is to get the A1C below 5. My AM fasting is always quite low. My post prandials are pretty good because I follow a low carb diet. You may do well by reading The Diabetes Solution by Dr. Richard Bernstein…very informative.

      Your post meal readings are just too dangerous, in my opinion. I would ditch white breads and potatoes and perhaps follow a more low carb diet, as Dr. Bernstein advocates.

      Keep in mind that the test strips that are available today are just flat out not accurate.
      It really sucks, but until the multitudes complain, nothing may be done about it.

      May I also suggest checking out http://www.bloodsugar101.com
      You will learn alot. Good luck!

      • Craig says

        Sharon,

        If the test strips aren’t accurate then what is? I’m so lost with all this information. When I was diagnosed 3 months ago the test strips were showing 280 but now since I have cut out bread, sugar and pasta my levels are consistently 88-110 so what do you suggest to test your levels?

        Thanks

        • Sharon says

          Craig, I know it’s all very frustrating. The last I heard from Dr. Bernstein’s podcast is that the Aviva strips, the old version, are the best ones and can be purchased from Canadian pharmacies and they are pricey. You can write to him and see if they came up with any solutions yet.
          You can write to them publisher@diabetesincontrol.com

          I got so disgusted with testing, I just eat right and don’t test often.The accuracy is really for people who are dependent on insulin and it’s imperative that they get the most accurate reading.

          I just get strips from my father (who is diabetic and Medicare sends him strips) and I use those.

          Take a listen to Bernstein’s podcast the last Wednesday of every month. I believe there is one coming up tomorrow. Read his book, it’s well worth it. The Diabetes Solution.

      • John says

        Thanks, Sharon. It’s a great webpage. There’s so much contradictory stuff on the web that I don’t know what to believe. But, Blood Sugar 101 looks pretty good.

  81. Carrie says

    Over the last few months I have developed some alarming symptoms. My toes are numb and my entire hands go numb off and on. I have intense leg and foot pain that burns so bad, I cannot sleep at night. Most recently, I have had intense thirst and non-stop urination throughout the night and day. In general, I feel horrible with fatigue, back pain, headaches and an unexplained ravenous appetite. I am about 40 lbs overweight and most of it is in my belly. I have extremely high cholestorol along with a hypothyroid issue. I’m beginning to feel like a hypochondriac. The kicker is…. my bloodwork is all normal and my doctor is not concerned. She prescribed Lyrica for the pain, but I cannot dismiss these symptoms. What could possibly be causing this? Does anyone else have this problem?

    • Dan m says

      Carrie, what do you mean your bloodworm is all normal? What tests did you get and do you have copies of the results? What tests did you do for thyroid function? What do you do for your hypothyroidism? It sounds to me like you need a new doctor who understands the intricacies of thyroid related issues, and who will be able to assess whether you are taking the right medication, particularly if what you take now is thyroxine.What does your diet consist of generally?

  82. PBoss says

    Hi Chris: thank for your article, it is very informative.
    I am 54 male, now 83 kg ( and guess about 8 kg over normal weight for my height; have lost 2 Kg in last 2 months). For last few years I have had all kinds of tests done, including blood work, MRI etc for feeling light headed, headaches, disoriented giddy feeling, ringing in ears, seeing spots etc etc. Litany of issues. Have had cardiac workup done as well

    Everybody looked at my blood work, Pre-fasting around 100, post around 140 and said I was in range, need to lose weight, get fit. And everybody says Sugars are not the problem.

    This did not compute.

    Finally got to India last month and had insulin levels and sugar checked every half hour, and low and behold, PP jumped from 100 to 160 in half hour, 190 in 1 hour, and then settled to around 140 in 2 hours.

    The spikes are killing me. Very unsettling. Sometimes cannot even walk, and feel very unsteady. I can feel my right eye veins start to hurt and throb. Other times are better

    I am on half tablet of Metformin (500Mg) twice daily ( was on 500MG twice daily, doctor said cut the dose over last 2 days; seems to improved tolerance for spikes). Also take Blood pressure medicine for 30 years; and multivits, cinnamon, omega 3.

    I have started watching diet, and working out. Will improve.

    Anymore need to be own Advocate and find out what is wrong and how to solve it

    1) are there any other tests I need to do to pinpoint issues or find out about beta cells etc, get to bottom of issues
    2) anything else I can do to reduce to fasting sugars to below 100???

    Best Regards,

  83. Craig Cameron says

    Hi,

    I was losing weight, thirsty and peeing a lot so I went to the doc and she had me take a blood test. The test came back that my FBG was 330 and my A1C was 12.6. The doc immediately said I had diabetes and told me to eat no salt, sugar or pasta. I did that and within 2 weeks I brought my FBG down to 98 – 118 range and continue for over a month to be around 83 to 110.

    I have been trying different foods to see what spikes my levels and so far nothing spikes my levels. Is it possible that I’m pre-diabetic and not full blown diabetic?

    Thanks for the very informative information.

    Craig

  84. laura tyrrell says

    Is it normal for blood glucose to go to 59 one hour post a meal of pasta? 90 minutes at 96.

    I am highly active and not overweight. However, over the last 8 months I have put on 10lbs without reason. If anything, I have cut my carbs to low and increased my activity. 90 minutes cardio some days. 3-4 days per week of boot camp on top of the cardio.

    I am now on 1000mg of metformin.

    Super confused

  85. Amanda says

    Hi Chris

    Would a pregnant women who eats a low carb diet with 1 hour post meals blood sugar range from 94-110, but a fasting blood sugar at 94 be considered to have gestational diabetes?
    Thanks.

  86. Danna says

    Chris, do you have a link that connects all parts of this article together?? I am having a hard time finding the other parts!

  87. Stephen says

    Hi Chris, Thanks for the informative article. I did what you recommended and got a monitor to see what was happening to my blood sugar levels. Here are a few of my results

    (eating a footlong sandwhich)
    Fasting: 87
    pre-meal: 82
    1 hr: 149
    2 hr: 124
    3 hr: 101

    (eating chipotle chicken and rice bowl)
    1 HR: 143
    2 HR: 104
    3hr: 93

    I was wondering what your thoughts are on this. It seems that your article and the research it cites tend to say that small spikes up to 140 can be normal, but even at the 2 hr mark it is till hovering around 120. However the other meal I had, theres the spike of 140 at 1 hr, but at 2 hr it is way below 120. So I’m a little perplexed at what this numbers might mean, but I guess it really depends on how much carbs you are eating at that particular meal. Any thoughts would be greatly appreciated

    • Stephen says

      I forgot to mention that I do have several risk factors. I am 25 yo, my BMI is 29, my a1c was 5.6%, and both my grandmothers have diabetes. Does the results above suggest that I might be pre-diabetic?

  88. Jinal says

    Hello Chris,
    I liked your article. I am 7 weeks postpartum. I was diagnosed GDM at 28th week of pregnancy. My fasting was always normal. I was only on diet and exercise control and managed my blood sugars v well. At 6 week post partum my fasting is normal but 2 hr OGTT is 154 mg/dl and hbA1c is 5.9. I do not have family history of Diabetes. What could have made me pre-diabetic ? I am again on diet and exercise control.

  89. Melissa says

    I am confused a little and maybe you could help me. I took the OGTT and my results were FBG 73, one hr 47, 2 hr 57. This test was murder and my body has not been right since. However, I do understand now that I have experienced these low levels before. I have since bought a meter and if I eat a high carb meal I will see my #’s at 196 one hour after then 112 @ 2nd hr. I have also seen 162 2 hrs after eating. I have low numbers in my diary as well 54, 47.. I am not overweight nor have I ever been obese. I was an athletic kid but the strange thing is I remember throughout my 37 yrs of life frequent urination, inability to drink alcohol, sensitivities to medicine, food additives, restless leg syndrome and extreme fatigue ( sleeping entire days as a kid and have recently started to do the same). My Mother and Brother have hypothyroidism and similar urination trouble. My Brother was going to get checked for hypoglycemia but his endocrinologist said she doesn’t believe in it. I will admit after checking with my meter, it’s more accurate to check that way. My hypoglycemia symptoms will come as my bg is declining. I have an appointment with endocrinology and of course my TSH is normal. We all know how accurate that test is. Anyway, your thoughts or suggestions would be appreciated. Also, the high numbers I quoted were found when I wanted to test myself with carbs to see why if I eat potatoes I get pain in my back by my kidneys. I hate that pain so the numbers are lower since I eat low carb. Makes me wonder what they were when I was eating the way I was before with more carbs and chocolate with lots of tea. Oh my, I can’t even tollerate one cup of tea now.
    Sorry this was so long. I am frustrated and have had some horrible experiences with Dr’s in the last year. I am eager for someone who will examine, the big picture.Thanks.

  90. Derrick says

    I was at the hospital a couple weeks back and mentioned to a nurse that I think I might have pre-diabetes or even type 2 diabetes, as my one hour blood sugar level after thanksgiving dinner was 250 mg/dl. She laughed and said that hers ‘probably hit 300′ and said not to worry about it. It’s stuff like this that makes me not want to use doctors for anything. Many are clueless, granted this was just a nurse and I know the medical industry is very compartmentalized with lots of ‘specialists’ that are just good at one or two things.

    I control my blood sugar levels with salads and high omega 9 dressing to go with it which has replaced lo mean (chinese pasta) that I used to eat. I found out about this blood sugar spike myself, since my fasting sugar readings at the yearly health screenings were always in the 90’s which is ‘normal’

    Sad thing is, these post meal blood sugar spikes have likely been going on for years, without my realizing it, looking back at past fasting numbers. My a1c was at 5.6% when I tested it, so it’s not super advanced by any means. Usually my blood sugar does not rise above 110 now with my meals, and will be lowest in the evening, where I can find it down in the 80’s.

    First mistake of the medical industry.. using 100 as a good fasting number, it should be set under 90. Second mistake, not testing post meal levels or encouraging people to do so on their own. It’s actually very easy to self monitor for diabetes but I never see this brought up in the mainstream media, nor is the connection between high blood sugar and heart problems due to inflammation ever brought up.

    Seems to me reasonable to assume that undiagnosed type 2 diabetic conditions could be more at fault for heart attacks than saturated fat, since people who eat saturated fats usually eat a lot of things like potatoes and french fries, and have a high level of omega 6’s in their diet, which are arguably bad in excess.

    • Derrick says

      forgot to add, other than suffering from anxiety/stress issues I’m fairly healthy. I’m hoping reducing the anxiety/cortisol levels through lifestyle changes will reduce the insulin resistance.

      My cholesterol is tested at 130, triglicerides I forget the exact number, I’m pretty sure they were in the 60’s. My HDL higher than LDL. 6 foot, 170 lbs, don’t drink, do jog in 4-5 mile stretches. Blood pressure usually from 118/78 to 124/78. Don’t drink or smoke. No family history of anything medical issues on either side of the family, they all live to be very old, even when they are overweight they still hit 80 years old.

      My one failing are lifestyle habits that maintain my stressful personality type, which has gotten up to panic attack levels since November. Stress kills. The medical industry likes to blame it on a whole list of things but are reluctant to approach one’s mental state which can be hard to fix but can be done, with discipline.

  91. Cathy says

    I’m trying to put these all together:
    A1C: 6.1
    CRP: 3.4
    Fasting blood sugar: 6.5-6.9 (117-124)
    Following a low carb diet for 1.5 years (50-80gms carbs per day)
    Anemic (106 the last test)
    Low iron for 12 years (heavy menstrual)
    Post-meal blood sugar: 7.5 (135)
    Over weight. Mostly belly fat
    Female age 49

    Started metformin 2 weeks ago at my insistence. Went up from 250mg to 500 two days ago because I have seen no change.
    The doctors here have no clue. But I have no where to get help. I’m sure you don’t want to diagnose over the message board but could you point me in the right direction?

  92. Lana says

    I was diagnosed with Type 2 in January (2012) and this article has been incredibly valuable to me, in terms of setting personal goals, and aiming for truly good health, as opposed to just stalling serious illness. Aiming for the markers mentioned in this piece, as opposed to the benchmarks set by so many other diabetes forums and sites, I regularly have a BG level of 120 or so two hours after a meal, and have brought my A1C down from an 8.3 in January, to 5.7 just last week. The amazing thing is that it hasn’t actually been difficult – more a matter of paying attention to how my body reacts to both food and activity, and making informed choices. Thanks for this valuable resource.

  93. sarah singh says

    Hi Chris
    i recently test my fasting blood sugar and the result was 116. This morning i drink a milk shake and test it 11/2 hour ( One and half hour) later and the result is 119. can u please give me some advice, i am over weight also.

    thank you
    sarah

  94. faz says

    Dear chris many thanks for ur efforts towards diabetes .ur blogs reallys helps those who have many concerns abt diabetes .i am on of them ,,,i am 35 years old male
    i was diagnoses only once with FBS 122 and total cholestrol 215.however my HDl ,LDL and trig was fine ,,after a week my FBS was 99 and my 2hours after posmmeal sugar never corss 125 its always stays between 110 and 125 ,,and now my total cholestrol is under 200 … i m using two machines at home one is bayer contour wich always showing my fbs below 100 and accu check above 100 to 105 ,, my AC1result is 5.1 my Dr said its ok nothing to worry about , i m very concerned and afraid if sometime diabetes gonna catch me , my question is am i at risk of having diabetes ? what does one time spike ? i have no family history of diabetes , i m not over wieght and doing regular excericse .i m not friend of sodas and fast foods .please reply .

  95. shashi Desi says

    Hi Chris,

    My husband had recent health chech up. Here are the nos
    FBG:117 mg/dl
    post pradial (2hrs): 81mg/dl

    He is identified with slightly enlarged liver and has high tryglycerides (335mg/dl). Does this indicate anything alarming? He has high BP and takes medication for that.
    Please advice me. me

  96. Sarah says

    My fasting blood sugar is 72. Should I be concerned about it being too low? Is this an indicator of a sort of pre-hypoglycemia? Or am I completely ok?

  97. Jill says

    Hi Chris,

    I was wondering if you could help me understand the connection between the adrenals and blood glucose in my situation.

    I never used to monitor blood glucose until going on Hydrocortisone due to depleted adrenals that would not respond to any other supplements. My main symptom before going off of it was continued night wakings, up for hours at a time, usually presenting with hunger or adrenaline. I just weaned off of the Hydrocortisone after being on it for approximately 10 months. I gained quite a bit of weight on it, and had other symptoms, like increased systemic candida, that prompted me to go off.

    Since being off – I am now waking in the middle of the night with that same gnawing pain in my stomach (despite a high protein, high fat snack before bed), and often eating some Goraw sunflower seeds throughout the night, as I wake frequently. My blood glucose is usually around 100, slightly under or over. I also have had higher fasting readings since weaning.

    This is extremely puzzling to me – and I know there is a connection with cortisol. Do you think this points to high cortisol or low? I eat paleo/GAPS, and it almost seems as though I started having issues when I went grain free.

    Thanks so much for any advice!
    Jill

  98. Holly says

    Endocrinologists say her numbers do not make sense and are at a loss at this point. Would love an opinion on where to go from here.

    11y/o female with unexplained weight gain for past 6 years.

    Fasting OGTT with 75 gram glucose drink: ( This was done twice due to high insulin levels, with similar results )

    Glucose:
    Fasting specimen 66
    1 hour specimen 102
    2 hour specimen 107

    Insulin Response to Glucose:
    Fasting Specimen 23
    1 hour specimen 215
    2 hour specimen >300

    Leptin 42.5 (high)

    C-Peptide 3.09 (normal)

    Glycosylated Hemoglobin A1C 5.4 (normal)

    Lots of bloodwork, everything else basically normal. Strange that C-peptide is normal, but insulin is outrageous. She is on NO medications and no exogenous insulin.

    Also had negative MRI of pancreas.

    Thanks for looking and for your thoughts.

    • Magnus says

      I’ve been in a similar situation since age 16 (23 now). I’ve seen two endocrinologists so far, on top of five different general practitioners and none of them could give me answers beyond “its diabetes but not diabetes”, which explains and means absolutely nothing. It is extremely frustrating.

      My fasting insulin is/was (?) an average of 24 mU/L (optimal is 6 mU/L).

      My fasting glucose is anywhere from 87 to 104 (average 89) mg/dL

      Insulin C-Peptide 2.5 ng/mL (normal)

      A1C always normal (never over 5.5%, currently around 4%)

      oGGT 220 mg/dL at 2 hours
      bona fide diabetic range, but I’m not actually diabetic. I continued the test myself until 5 hours where I then experienced a sudden drop to 77 and then 72. I did experience hypoglycemia at those levels.

      24 hour Cortisol 117 mgc/24hr (over 50-70 mcg is officially hypercortisolism by most reference ranges; Kaiser’s cut-off is far too generous at 125 which is why it was not explored further).

      None of these results make sense together. They are not supposed to be possible. Especially not the C-Peptide and Insulin level discrepancy because Proinsulin is supposed to split into a perfect 1:1 ratio into actual Insulin and C-Peptide (C-Peptide is basically just a byproduct or waste in the Insulin manufacturing process). I’ve not been able to find anything anywhere about what could or does cause this to be imbalanced… I’ve been searching for six years. As far as the internet is concerned, there is no explanation (though its probably in some obscure textbook somewhere that costs too much money for the lay-person to reference…). One possible theory out there is that this COULD be the result of ‘impotent insulin’, but I have my personal reservations about that. It wouldn’t be interesting enough to get a diagnoses even if it was (extremely expensive too I bet, “experimental” something not covered by insurance and all that).

      Point is, I also cannot get a definitive diagnoses and they’re not interested in helping me either (they’re not even looking/testing anymore). My pediatrician actually told me I was perfectly fine even despite his running the same metabolic panel that the first endocrinologist did. She pegged it as ‘syndrome x’ but it actually is not (it is but it is NOT the primary cause of everything else, it is a secondary condition). However, at least it was a start… even if it is now a dead-end.

      Very strangely, after I’d followed the advice of Mayo Clinic with the MED or Mediterranean ‘diet’ (the alleged “cure” for this) in just two months of that, I encountered my first and severe hypoglycemic episode (before that I’d only ever had very slight hypoglycemia). The significant change I made for that? Replacing my carbohydrates from white flour to wheat and whole grain. It was severe enough that I lost sensation over my entire body (it started in my liver area and then rapidly spread everywhere else – it had to have been an extreme amount of insulin flooding out of my pancreas) and then I also had an absentee seizure. A movie was on one minute and it was infomercials the next. I slept for over 24 hours after this attack and I felt absolutely fried, like every nerve in my body was shot (I felt toxic actually; like I was intoxicated but I really wasn’t. I don’t even like aspirin). I know my insulin was sky-high because I could smell it and taste it, not just feel it.

      I know I’ve had whatever this thing is since I was at least 12 years old (that is when the rapid weight gain began as well as some of the lesser symptoms) and I still don’t have an answer. I wish I could help you but I just wanted you to know there is an explanation for this. Keep pushing it and advocating for your daughter. I wish my mom would have done that for me… maybe I’d have the answer if she would have. Too late now. I’m not a cute kid anymore… they don’t care about adults.

      Diet and exercise failed. This is NOT ‘lifestyle’ related. It is something else.

      You know what… even having high Cortisol AND Insulin is not supposed to be possible, let alone mismatching levels of Insulin and C-Peptide. Cortisol is the anti-Insulin and Insulin is the anti-Cortisol. It is always supposed to be one over the other, never both like this.

      However, it seems entirely possible that this is a liver-related problem in the first place. Look into the new information about that. Something to do with the FOX06 gene. There is also now strong indication that ‘hepatokines’ (liver hormones) are involved in causing insulin resistance (and therefore the myriad of other later progressions, e.g. actual type 2 diabetes). So its not the pancreas, but the liver that is the problem… no wonder they’re not making progress with diabetes and other diabetes-like disease processes. The nimrods are looking at the wrong and non-causative organ! How embarrassing.

      I hope you and your daughter get the right diagnosis soon. Sorry I can’t help more.

  99. Jack says

    Oh, one more question. If you’re on a VLC diet, are your PP target values the same as everybody else’s? My PP readings are rarely over 120 (unless I eat too much fruit or dessert during my night meal). (Incidentally, I’ve also noticed that if I eat too many carbs, my readings are usually lower after a long meal than a short one.) For my first meal of the day (during which I have very few carbs), my PP readings are almost always below 110 and quite often below 100 as well. OTOH, my PP readings rarely in the 80s–should they be? If so, why?

    • Chris Kresser says

      The PP targets are the same; it’s the VLC diet that is probably keeping you from exceeding them (that’s the point of VLC in people with insulin resistance). As long as you’re under the targets, statistically speaking you are not at greater risk for future blood sugar complications.

  100. Jack says

    This is a fascinating article. I had never heard of the “dawn effect” before, but it describes some of what I’ve observed with my own readings.

    Concerning “2 hour” post-prandial readings, I’ve read that if your meal lasts less than 30 min., you should start timing “2 hours” from when you begin your meal. However, if your meal lasts longer than 30 min., you should take your blood-sugar reading 1 1/2 hours after the end of your meal. I’ve also read that the target for your reading should really be < 110.

    I have a question. Does anybody know if it's common for one's body chemistry to change as you reach middle age? When I was younger, I ate a high-carb diet with relative impunity and had normal weight. When I was 30, for instance, I had a FBG of 84. However, once I reached my mid-30s, my weight just started creeping up and up. Until then, I usually weighed in the low 140s. But then my weight started to get as high as 153. Unfortunately, I don't know what my blood-sugar readings were then. About a year later, I completely changed my diet and switched to the "Weston A. Price" diet. It wasn't a low-carb diet per se, but rather a healthy moderate-carb diet with more protein and fat, and no processed foods. On that diet, I ended up losing nearly 20 pounds. However, even though my weight was in the 130s, when I had my FBG taken a couple years later, it was 105! I don't remember what my HA1c was, but I believe it was pretty high as well. Anyway, I changed to a strict low-carb diet after that, and my readings got better, and my fasting insulin was even less than 2.0! Currently, I usually don't consume more than about 30-40 grams of carbs a day.

    But what I'd really like to know is why my body seemed to lose the ability to tolerate a lot of carbs in my mid-30s. Has that happened to anybody else? Why would my FBG be 84 when I was 30 and on a high-carb diet (with lots of white sugar and sometimes fast food), and then 105 when I was 38 and on a healthy, moderate-carb diet (with no white flour or sugar or fast food), and weighed less 5-10 lb. less at 38 than I did at 30? I shudder to think what my FBG was when I was about 35 and weighed as much as 153.

  101. Baz says

    Hi Chris,

    I wonder if you can help/comment – I am T2 & was wondering if one should skip breakfast when experiencing high waking blood sugar readings? The reason I ask, is that I am worried by eating breakfast with high readings, this would only elevate the readings much higher? If one should skip breakfast, how long should one wait before eating anything?

    Another thing I would like to mention & am wondering if anyone else has experienced is that I can somewhat control eating during the day or eat very little but get very intense hunger prangs during the night – I have been eating my main meal later & later – now at any time between 23:30- 00:30 but a couple of hours later, I still get hunger pangs & cravings? I find myself getting top a few times during the night as I have a huge urge to snack? What is going on?

    Many Thanks!

  102. Roxanne says

    Dear Chris, my question is a bit different. I really want to know if “normal” can be different for different people. I’ll try keep my back story short; I was diagnosed as T2 in 2001. I first tried the doctor recommended route of metformin and regular testing with little to no diet modification. That unsurprisingly (I know now) didn’t work. I did my own research and eventually went on the induction phase of Atkin’s diet (never got off phase one because it was working so well for me, lol!) Got pregnant after years of trying, and then had to go high carb again due to money issues. After my first pregnancy, my blood sugars actually looked normal according to every test. I stayed relatively low carb, having gotten ALL sugar and most non veggie carbs out of my diet. Got pregnant again. My blood sugar numbers still looked good and my doctor asked me if I was SURE I was diabetic. (I don’t have daily numbers to reference, sorry.) While staying relatively low carb, I do not get the symptoms of high blood sugar – such as sleepiness after eating, nausea, and frequent headaches. Nor do I “crash.” Most importantly, my cycles stay normal!
    During my second pregnancy, I had my first case of gout – complete with high uric acid levels, but normal blood sugar levels. It resolved itself with no drugs in a very short period of time.
    Fast forward to this year. Over the last 1-2 years, I have slowly allowed more and more carbs into my diet. I feel it is important to mention that I am a food nazi. I insist on eating and feeding my children a nutrient dense, mostly organic, mostly low carb diet. All our fruits and veggies are organic. As for these carbs, even they wouldn’t be considered much to most people. A sandwich for lunch on authentic sourdough about half of the time, and a pasta dish using organic noodles about 2-3 days a week. (On foodstamps, I have to save money somewhere, and even organic pasta is so much cheaper than meat…) I make a LOT of homemade soup. I make it from scratch starting with the bone broth and then adding the rest as I go. It tends to have a lot of noodles as fillers too though. Otherwise, meat and veggies for dinner.
    Lastly, when scrutinizing my diet, I realized that about 6 months ago, I somehow got addicted to a homemade lemonade drink of organic lemon juice, water, and organic unrefined sugar.
    I still have no symptoms of high blood sugar, my cycles are still regular, and I even got pregnant again, which is something I generally cannot do unless VLC (almost no carb). Then I miscarried AND got my second episode of gout. So, I decided to have my blood checked for A1C and uric acid. (I would have been surprised by high uric acid since I tend to be moderate with my protein intake too.) My uric acid was normal, but my A1C was 7%!!!!
    I had long ago stopped testing my after meals blood sugar because for a long time, it was within “normal” levels, and I knew the warning signs for high levels. I got a new meter, and started testing a TON. I tested first thing in the morning and 1-2 hours after every meal. At first, my average was between 170 and 200 (this was on June 1st ’12. That prompted me to cut ALL carbs and sugar from my diet, and as the month has progressed, my average levels have slowly fallen – or perhaps quickly depending on perspective – to an average of 130 to 150 with odd days like today where it hovered around 170 for no real reason.
    I will give one day’s readings so that you can see that I am not spiking after meals and am having reduced numbers after meals.
    6-13-12 First reading after waking up – 138 at 10:35am. Ate cottage cheese with sunflower seeds and had cup of black tea with cream. (NO sugar, just cream.) Ran errands and couldn’t test until 3:05pm. 146. Ate hotdogs w/o bun but with dab organic ketchup and mustard. Drank another cup of tea with cream. Tested at 8:17pm 111. (I actually think this was probably a mis-reading.) Immediately had a snack of organic sugar free peanut butter on lettuce and tested at 9:41pm. 143. (I want to see how different foods make my blood sugar react.) This shows how my glucose levels actually stay within a few points of each reading throughout the day, except for the abnormally low (for me right now) reading when I had gone a little over 5 hours without food. (It seems to be easier for me to remember to test right before I eat than after, BUT I do test as often as possible to get a good range of numbers.)
    A different day, when the numbers were all higher. Woke up and tested at 9:39am, 152. Ate an utterly no carb breakfast of hotdogs. (We were at my MIL’s and that was pretty much all she had!) 178 at 1:07pm, No idea why!. Decided to have tea with cream. 133 at 2:44pm. Went home and deep fried a whole chicken in tallow (that I rendered myself). Ate around 4:30, tested at 5:39, 135. Around 9, decided to eat a basic salad (no croutons! A sprinkling of sunflower seeds instead) with homemade red wine vinegar and organic olive oil vinaigrette. (No sugar in it.) Tested at 10:16, 156. Had nothing, tested at 12:19, 130. Next morning, woke up at 150, shrugs.
    More importantly, I feel fine. My gout cleared up once my average fell below 170 (remember it was between 170 and 200 when my gout flared up), and I see it going down a point or two on average each day. My blood pressure is normal, and blood tests show no other abnormalities. I know I already am diabetic, but since you stress that it’s the post meal numbers that are the most important. For the past 19 days, my 1-2 hour post meal numbers have consistently been between 5-10 points higher, so no spiking. Wouldn’t – if high numbers really do so much damage – wouldn’t there be SOME indication of it? I’m not trying to get out of being low carb, I really like it, but if my numbers really are bad, then why don’t I feel bad? Why don’t I have some sort of symptoms?
    Curious,
    Roxanne
    http://www.5degreesofweirdness.blogspot.com

  103. Melanie says

    Hi,

    I recently had a fasting blood glucose of 111 at the docs. He stated that he is going to put me on insulin if it doesn’t lower. I am constantly on a low carb diet and my home glucose test always reads 98 or 99 . Please advise.

  104. Rachel says

    Is it possible to take certain nutritional supplements to control blood sugars in addition to exercise for life, instead of taking oral medication? My A1c is 6.3 and if I eat sweets it can spike as high as 230. I’m 42.

  105. melissa says

    Chris, I have been reading this whole post and find it quite interesting. however, I do seek yoir opinion. I kust had my yearly physical And my fasting blood sugar was 101. Now diabetes runs on both sides of my family, however, I am slightly over weight but I do exercise 250 minutes a week or more, so I am losing weight, an I cook all my meals, never .eat eat fast food so I am wondering what I am doing wrong. That is the highest it has been for a physical

  106. Graham says

    I believe i have coritsol issues. I am type 1.5 diabetic (with declining beta cell function) and have been doing paleo for appx 9 months – which has gotten me off of insulin completely. I workout in early mornings and have noticed my fasting blood sugars have crept up when i wake to the 140s and can even feel something happening a few hours before i wake. Eating a snack at bedtime seems to make my blood sugar numbers go higher at waking. What is the typical treatment to balance out cortisol?

  107. Patty J. says

    My fasting numbers were mostly in the 80’s and then started creeping up to 90’s and a few in low 100’s.
    I realized I had not been drinking much water so I made sure I was having at least 6-8 glasses a day. And the last few days I have had fasting numbers of 82, 83, 88 and 84. Do you think my drinking of water has anything to do with this as I have not made in other changes that I am aware of.

    Thanks.

  108. Kim says

    My son has a problem with very low blood sugar levels. Once he eats he has to eat every hour and a half. His glucose drops to 60’s and he becomes lightheaded, hands tremble, eyes bother him. Been to several doctors and they are not sure if it is reactive hypoglycemia

  109. Sharon says

    I have been hearing , from various sources, including a naturopathic cardiologist here in Phoenix, that Stevia is not a good idea. I’ve been using green powder and liquid Stevia for more than 10 years and I was wondering what the final verdict may be.
    Chris, would you kindly view this article and it’s comments and give me your opinion. Thanks!

    http://www.healthyalterego.com/index.php/ask-dr-huber/q-a/q-does-the-sweetener-stevia-cause-your-insulin-level-to-spike/

  110. Sharon says

    Chris, do you have any tips for driving down the A1C numbers?
    If anyone knows what would help, I’d appreciate the input.

  111. Tatjana says

    Hi Chris,

    As I was diagnosed with diabetes type 2 just few days ago, I was surfing the internet looking for some answers and came across this interesting blog. I now have much better understanding of why and how it happens that your blood sugar rises as well as what to do to prevent it.

    I did a thorough medical exam in Germany last week and while I’ve occasionally had high blood pressure and was eventually diagnosed by hypertension, my blood sugar tests were always good. I’m 39 and am not overweight (h: 1.70m, w: 64 kg) and I exercise 5 times a week. In Germany, I did gastroscopy, colonoscopy, CT of abdomen and ultrasound of heart and blood vessels. I also did full blood examination. The only problems are gastritis and slightly fatty liver. All the rest is perfect. On Saturday morning, before I left the hospital (I stayed there for three days) I had OGTT with following results: FBG – 60 mg, 1h – 280, 2h – 113. Based on this the doctor concluded I have diabetes type 2 (and maybe even type 1 so she order some more tests to be done). I was then released and sent home with a bag full of medication. I was also given a glucometer to measure my blood sugar every day one hour after meal for 10 days. And today is a second day that I measured it 1 hour after lunch and it was 91 mg – yesterday it was 89 mg. N.B. I still haven’t taken the medication and just continued eating what I normally eat as I wanted to see what my results would be.

    Chris, I would very much appreciate if you could tell me what you think about all this. Can diabetes be diagnosed after one such test?

    Thank you in advance and many regards from Holland.

    Tatjana

  112. Sharon says

    Thanks Lynn. I have read Stephan’s blog before and I have seen this article.
    You are right…worry is not good. I guess I would call it more concern and confusion..lol.
    I will test again in a few months and see what happens then. My biggest goal is to drive down that A1C.

  113. Lynn Dunning says

    I get what you are saying Sharon, I really do. However my reading tells me that optimal is less than 10 and perfect is less than 5. Dr. Mercola’s views on extremely low insulin levels are incorrect in my view.

    Also, bear in mind, that worrying about getting things perfect can be even more detrimental than insulin levels of 15. JMO.

    Check out this well balanced article:
    http://wholehealthsource.blogspot.com/2009/12/whats-ideal-fasting-insulin-level.html

  114. Lynn says

    Sharon – An insulin level of 5.3 IS good! Anything under 10 is considered to be optimal. Why are you worried?

    • Sharon says

      Lynn, my insulin, 3 yrs ago was <2. About a year later, it was 3.2.
      Now it jumps to 5.3??
      According to Dr. Mercola and other experts, a healthy fasting insulin should be between 2 and 4.

  115. Knowledge Sponge says

    Hi Chris,

    I’m hoping you can answer this question for me. I had an GTT done and the results baffled me. My 1 hour result (180’s) was actually lower than my 2 hour result (200’s). Is this a normal occurrence? I thought blood sugars drop over time not rise.

  116. Sharon says

    Just got my latest bloodwork and I must say, I’m baffled. First, I did test my fasting sugar at home before the AM test. It was 83 and the lab test read 83 which means I have a good meter.
    I was so proud that my A1C went down to 5.5. It was originally 5.9, the went to 5.8, then 5.7.
    I was also happy to see my Triglycerides on the regular lab test was 48, way down from 75 last September. With that all being said, I was kind of shocked to find my fasting insulin was 5.3! I know it has always been between 2 and 4 (optimal?).
    I should mention that I also took the NMR Lipscience profile and my Insulin Resistance score was 3, which is excellent. Their lab values were different as my Tris read 36 with them. They seem to have different overall cholesterol readings than LabCorp. They claim my HDL was 88 and LabCorp has me at 103. Either way, I’m thrilled.

    Chris, any reason why the fasting insulin would be so out of whack? I do follow a pretty low carb diet.

    • Sharon says

      I forgot to mention that my post prandials are always under 100 except if I do the occasional sweet potato. Then it can soar over 120.

      • deb b says

        Your numbers seem great Sharon (good job)! Will be interesting to see Chris’ reply on Insulin.
        Lab error? I’m sure you have heard Chris’ KResser and Masterjohn speak about how unreliable the lipoprotein tests are, maybe Insulin as well? Once I was firmly low carb/paleo, I found I could no longer tolerate occasional cottage cheese and/or greek yogurt (even tho no added sugars). They are insulinogenic, thus Im thinking that they increased my insulin, and since my BS was pretty low, caused too great a drop. I would pretty much pass out/fall asleep until my glucagon kicked in (10-15 minutes). I’ve only had Insulin tested once and it was below their detection marker (2 I think). Art DeVany says his is as well. Do you eat much dairy or more than 6-8 oz. protein per day?

        • Sharon says

          Thanks, Deb! Yes, the first thing I thought was lab error, but that is like thinking the dryer shrunk your jeans when you actually have gotten fat..lol.

          Yes, I have heard Chris’s info about the unreliability of the NMR test, but I thought I would go for it anyway just to see how I progressed from last time. I’m crossing my fingers that my insurance will pay for it. They did last time, but I’m just not sure about this time.

          I have been having some dairy all along and never saw my insulin this high. I do use mostly goat products (Kefir, yogurt and cheeses). Goat dairy does not have casein which from my research claims it is safe over cow’s dairy. I do take in quite a bit of protein. I also use Whey Concentrate Powder before and after workouts. According to my size, I need about 56 grams of protein per day. I do pump iron also and I’m trying to keep and gain muscle. The goat dairy and the protein never raise my post prandial sugars very high, so I am not sure that is the issue. I would think my BS would be raised upon eating them.

          Here is an interesting tidbit…Dr. Richard Bernstein (diabetes doctor) claims that people who eat nuts cannot lower their A1C. Hmm…I eat nuts (way too many) and I seemed to have lowered it.
          Berstein says NOT to eat nuts at all. He’s ok with dairy. Ugh..it can make you crazy with all the different input and opinions. Dr. Cass Ingram who wrote Natural Cures for Diabetes also is against nuts but says dairy is fine. I’m trying to cut back on nuts, even though it’s very Paleo. They are so expensive. Goat dairy is expensive too, but I am not sure I want to give that up yet. I wouldn’t mind giving up dairy and sticking with nuts, but I am not sure what is the healthiest thing to do. Nuts are pretty high carb, in case you don’t know. If I give up both, I think I will have to seek out other fats to keep me satiated. Drink gobs of coconut oil? LOL

  117. Dan M says

    Ps I think I understand your viewpoint as to why this particular reason for insulin resistance is the result of an efficiently working fuel system when eating a very low carb diet, however I’m just wondering whether being ‘healthy’ might make one more sensitive to the damage carbohydrates can potentially inflict, not simply from the perspective of blood test results. Does that make any sense?

    • Luke Timmons says

      Dan M, I see it’s been over a year now, but I’m hoping Chris can somehow chime in on your two comments here. I would love to know his thoughts.

      • Dan M says

        Go for it Luke. I have to say that I have long since moved past this way of eating and would no longer consider it to be healthy.

  118. Dan M says

    Thanks for the reply Chris. So can I ask, in your opinion, does that mean that one becomes more susceptible to the negative health effects of insulin resistance or excessive glucose in the blood if one was to intermittently eat carbohydrate rich meals, whilst eating a predominantly ketogenic diet for the majority of the time?

  119. Dan M says

    Dear Chris, thanks for the great blog and the wonderfully informative and entertaining podcast. I wanted to ask a question in relation to the caveat you mentioned regarding an elevated fasting glucose for low carb dieters. I was just wondering if the resultant decreased sensitivity that goes along with this process could mean that one might notice larger fluctuations in post meal blood glucose after a meal that includes a proportion of carbohydrates like potato or rice, if one does not include such ingredients regularly. I hope i’ve explained what I mean reasonably clearly and that it’s not a question that has already been answered.

    Thanks again, Dan.

    • deb b says

      Great question – looking forward to more info on this as well (I have read +10 higher on low carb post-prandials) but hope this Chris has time to address this).

    • Chris Kresser says

      Dan: yes, that can absolutely happen. Which is why I recommend that people eat 150g/d of carbs for at least 5-7 days before taking an OGTT if they have to do that for some reason. Otherwise, it will be artificially high.

  120. ebonydawn says

    This morning really scared me. My fasting blood sugar was 197. The highest it has been before today is 130 but usually around 110-115. I ate breakfast and 2 hours later it was 171. Two hours after lunch it was 156. I have been testring steadily everyday for the last month 1/2 and only twice has my reading been over 160 and those were 1 hour post meal readking. I am on 500mg of Metformin a day. Should it be increased? Can menstral cycles play a role in rising blood sugar. I am at a lose right now,

    • Chris Kresser says

      I am not a doctor and cannot advise on medication dosage. If you aren’t following a Paleo-type, low-carb diet right now, I would do that as soon as possible.

  121. Jo Whitford says

    Hey Deb,
    Tell me more about a high starch diet? I’m confused isn’t carb and starch the same?

    Smiling your way!

    Jo

    • deb b says

      Hi, Did you mean me (Deb B)? A great majority of people manage T2 (or pre-diabetes) with a low carb diet (generally 50ish grams per day range). If you are INSULIN RESISTANT – that is generally conceptualized that your body cannot tolerate carbs. However, there is also a certain % (Mary Vernon thinks its 10-15% of the population) that can do the high carb levels and still have wonderful A1c and Blood sugars (I think it tends to be the younger and more athletic types). Typically in “Paleo world” and Paul Jaminet Perfect Health Diet – “starches” are the pure chains of glucose (white rice, yams, potatoes – i.e. they are avoiding the fructose) vs. a carb would also included fruit (more of a blend of fructose and glucose) and I think grains are (Maltose)? a monosaccharide – but with the long gluten protein structure which causes issues for many. I should look it up for 100% certainly, but am experimenting with cold thermogenisis and rush to get into Lake Michigan for a few minutes!
      Your blood numbers all seem good, but seems something is off metabolically for you to feel that way. I think Chris asks people about thyroid numbers. Also, would you consider some raw animal products (like salmon roe)?

  122. Jo Whitford says

    Wow, very informative and enjoyable information.
    Had blood work done in January routine although it had been over ten years since I had this done. I’m a 52 year old extremely/athletic female, 5’3 114lbs. I had been feeling awful for quite some time, experiencing blurred vision, mood swings, and general fatigue ( hard for me to say, I push through fatigue quite well). I felt like I had a magnet attached to my body and the earth was metal. Chalked it up to menopause. Continued to work out but found myself on the couch way too often. I also had huge cravings for sugar, all forms and lot’s of it which was unusual. Still exhausted.1

    Blood work results were perfect, with the exception of (A1C 5.9). Huge history of diabetics in the family both type 1, and type 2 so I though I’d better get on it.
    Fasting running (ten day average of 74) 1 hour post meal mostly around (85) two hours well below 100.
    I’ve basically cut out all refined sugar with the exception of a drizzle of pure maple syrup in my morning tea. I am a strict lacto ovo vegetarian have been this way well over 25 years. I miss having a piece of cake once in a while.
    Will do another A1C test on mid April.
    The most prevalent thing I’ve noted is a bit lower than normal reading some fasting below 70, and post meal low 80’s.

    I have great insurance but was told I didn’t need to see a doctor because I am not diabetic, but pre diabetic. jeeze. how does one avoid becoming pill dependent?

    Thank you,
    Jo

  123. Lynn Dunning says

    Elizabeth – Bear in mind that A1C is not the most accurate test. Kris actually wrote an article about this. You are better off testing your fasting and 1 hour post meal blood sugar numbers, to see where you are really at.

    I don’t count anymore, but 250-300 carbs comes from a lot of 1% milk in my tea throughout the day, my GF bread or buckwheat cereal in the morning, pasta/potato/rice at lunch, and soup, GF bread/crackers at supper. I also sometimes have a piece of fruit in between meals, not that often though, maybe twice a week.

    Sharon – LC seems to work wonderfully for some people. However, if your glucose and insulin levels are rising on it and you feel like crap, it may be a sign that it is not for you. I ignored my body’s signals for years!! I’ll never be married to a theory again.

    I’d be very careful about the nuts though, they contain a lot of PUFAs.

    Also bear in mind that your initial blood sugar reaction to starches is likely to change over time. My BG numbers were way higher when I first reintroduced carbs.

    I think that your friend’s hubby should do what makes him feel best and what helps his numbers. We are all different, and what helps him may harm someone else.

  124. Sharon says

    Chris, my friend’s husband was just diagnosed with full blown diabetes. She told me his doctor told him he must go on a low carb diet but what is strange is that he said he can only eat non or low fat dairy, absolutely no coconut oil or fats. He said that diabetes is caused by sugar and fats and not what most people think.
    Is this guy for real? High(good) fat, moderate protein, low carb is what I thought was the diet to follow.
    Where would he get such misinformation?

  125. Lynn says

    Hi Deb b

    I don’t count anymore, but last time I checked I averaged 250-300 carbs a day.

    I get my carbs from potatoes, rice,rice pasta, gluten free bread, bananas and some other fruits. I strictly avoid gluten.

    • deb b says

      Thanks – interesting how people can be so biochemically different! Glad you kept investigating and found a way of eating that lowered your numbers.

  126. Lynn says

    Sharon – Dr. B is wrong and I am proof positive. We are ALL different, but I had a fasting insulin level of 33 (extremely insulin resistant) after four years of low carbing and after a switch to a high starch, low PUFA WOE my insulin fell to 4.7. Optimal is less than 10 and perfect is less than 5. My HOMA score was also <1.

    Finally, my fasting glucose now averages 75-84 and 2 hour PP also 75-84. It rarely ever goes above 100. Whereas on low carb, it was always late 90s fasting and 2 hours PP was 120.

    Elizabeth – Sounds like you have become insulin resistant and that your thyroid function has decreased on LC. The exact same thing happened to me. I was already hypo, but LC just made it worse. The body often increases RT3 in response to weight loss/low carb intake and some people become insulin resistant on LC.

    • Elizabeth says

      Lynn- I was already on a real foods diet when I went primarily Paleo/Primal, LC/VLC. I included raw milk/cheese/yogurt. I didn’t lose any weight ditching grains, potatoes or fruit. Low-thyroid symptoms increased.
      Since the A1c result the doc advised to eat meat and veggies only, I told him that was primarily what I ate and he said this is the only way to bring the A1c down, so keep doing it.
      Against his advice I have added carbs back in, I have no idea how much, but my temps are rising from 95.-96.4 to 97.- 98. I feel as if I have more energy. I’m still gluten free, but have added back rice, potatoes, carrots, dates, honey in my green tea, organic popcorn popped in coconut oil (a splurge). But in the back of my mind I’m wondering if I’m raising my A1c. My blood glucose level from the same doc visit was 113, but that was non-fasting.
      Also, while on Paleo/Primal I developed LPR, it may all be coincidental – I dont know.

      What does 250-300 grams of starch/carbs look like in proportions?
      thanks!

    • Sharon says

      Wow, Lynn, now I’m really confused!
      Should we low carb or not low carb?
      My fasting sugars are usually in the 70s, sometimes low 80s and my PP is usually under 100 .
      I stopped the starches and my only indulgence is too many nuts.
      May I ask what WOE and HOMA stands for?
      According to Dr. Joe Mercola, fasting insulin should be between 2 and 4.
      When I had it checked last year it was 3. I’m going for another full panel of tests next week and I’m anxious to see where I stand.

    • Maddieaddie says

      Lynn – I realize it has been a year since you wrote this, but I liked your response to Elizabeth. I believe I have increased rT3 in response to LC diet, and I believe I have become insulin resistant as well. I am self-testing currently for more info. I would like to ask, what did you do to resolve your issues? Did you go on thyroid medicine and/or metformin, or were you able to treat nutritionally?

      • Elizabeth says

        I have gone back on a good amount of carbs…clueless as to how much. I have gained at least 15lbs.
        I’m still on a real foods diet. I have added back spelt or einkorn grains with few splurges on organic spelt pretzels or sprouted corn chips.
        I’m tired of thinking about what is right or wrong in the diet world. I eat real food, but try not to over think it any longer. I feel much less stressed.
        My hair is growing back in. I do not have a lot of the thyroid symptoms anymore, I do get cold hands and feet from time to time.
        My rT3 I have not had checked lately.
        While on lc I was heavy on nuts, those I eat sparingly now.
        My blood sugar is still prediabetes level for the most part, so I’m taking cinnamon and chromium supplement. It seems to help a lot in keeping my fbg and pp under the target numbers.

        My huge success is no longer being a slave to my diet… and not over thinking it. This has been a blessing not only for me, but also my husband who doesn’t always have to hear, “I can’t eat that!!” I had to work on my mind when first eating the “evil” foods. To me, this is a much more healthy way of life.
        Freedom to eat and enjoy life without tons of guilt is a blessing, I’m glad I made the choice move away from lc.

      • Lynn says

        Hi Maddie

        I have been on Glucophage for 12 years: well before I developed an insulin level of 33, also during the time that my insulin levels became optimised. I am on Gluc because of my PCOS. I am also on T3 only because I have thyroid resistance caused by Hashimotos.

        My diet hasn’t affected my thyroid, but low carb or high sugar intake puts my glucose and/or insulin in the wrong direction. So I still eat gluten free. good carb and low sugar.

  127. Elizabeth says

    Late to the party – any idea what would cause a 5.9 a1c, elevated rt3, low thyroid symptoms while on a low carb diet for over a year? Makes no sense to me. Thanks!

  128. Sharon says

    I just listened to a podcast from Dr. Richard Bernstein (The Diabetes Solution).
    He’s far from natural, but pretty informative.
    Someone presented the question to him about “safe starches” and mentioned The Perfect Health Diet.
    He said there is no way that eating starches will improve insulin resistance. The only thing that will do it is losing belly fat, strenuous exercise, muscle building, taking Metformin.
    He said if it’s too good to be true..don’t believe it.
    Chris, once again, another opinion is out there.
    What are your thoughts on Dr. Bernstein’s methods and philosophies?

    • Chris Kresser says

      I agree with him on some things, but not on others. In any event, with questions about starch or carbohydrates the answer varies depending on who’s asking. A diabetic will have different needs than a non-diabetic.

      • Sharon says

        Well, all I know is that I did the “potato test” where I tested my fasting sugars (81) then ate one white potato. One hour later sugars tested at 142! Yikes! 2 hrs. later I tested at 88.

        I read that if you are a low carber, you can minus 10 from the post prandial number. Still, I must say that I freaked out a little but felt better to see the 2hr PP at 88.

        Any thoughts?

  129. Nelly says

    Hi Chris,
    I am just reading your article here since I am still trying to make sense of a 2 hours glucose tolerance test I had last Sept. My Dr just said, all your numbers are normal, no big deal, but refused to explain them to me. They were all the same number, which really threw me off since I thought blood sugars went up then down. I am trying to make sense of this, and I took my own fasting blood sugar this am and it was 95, so this is back on my mind.

    2 hour results as follows, all arm stick test, except at 95 minutes:
    fasting 89
    drank glucose
    After 1 hour 89
    After 95 mins (I had them test since I felt slightly dizzy–this was finger stick) 104
    After 2 hours 87

    I always thought it was odd the numbers are nearly the same except it went back up? after an hour?
    I have always thought I had blood sugar issues, but I was told I am normal.

    Brief history, I had gestational diabetes diagnosed with only one baby, before him, I had a 10 pounder (only 1 point over what was considered abnormal on my test with him, I believe it was 141), then an 11 pounder when I changed Drs who went totally with the test, and said I did not need to watch my diet. I had smaller babies 8 lbs 4 ozs when I was on a diabetic type diet, which I did on Drs orders since I had gestational diabetes before, he said “just do the diet, I’m not testing” I have had 9 babies, the last 2 we induced and even 10 days early my last one was 8 lbs 14 ozs.

    Also, both my grandmothers had type-2 diabetes and one of my uncles does. Neither parent does and no one else that I know of, but both of them are fairly healthy and not overweight.

    Soooo…..am I normal? or should I find a new Dr?
    Oh, and I am not terribly large, although my BMI is 31.6

  130. Carmen Ovici says

    Thank you so much for this article! It had the information I needed. I was extremely frustrated that my last two analyses showed increased BS levels of 110 and 112 after I went on a low carb diet! Never had high BS before that. I started a low carb diet about 5 months ago to help my daughter who has been diagnosed with polycistic ovarian disease, and both BS tests I’ve had since then have been higher than normal. The HGB a1C levels have been staedy at ~ 5.5 over the past three years. The same was true for my daughter, who also had a BS level of 100 at the last test. Needles to say both of us were concerned and upset by the results.
    My question is: is it OK to continue to low carb diet even with the higher BS, or should I increase the carb content of our diets?

  131. Matthew says

    Hey Chris,

    I started feeling rough a few months ago and have been struggling ever since. The first time I checked my BG was maybe a week into feeling bad and it was 60. It’s never been below 60 for me. It will always go back up and not get too low. Usually it seems like my BG drops into the 60s after 1 hour or 1 hour and a half. Sometimes I remember in the mornings it would drop into the 60s like 40 minutes after eating breakfast. I started eating 3 eggs with cheese on wheat bread for bfeast. So I thought this may be why I feel bad was because my BG was getting low. My fasting was always 71-73 basically maybe 74 or 70 but never in the 60s so I think that’s probably good even tho I seem to feel a little off in the mornings like dizzy or something so I always eat bfeast before anything else. I also went to a Endo. and he told me my blood sugar levels looked normal and that 60s is probably normal for me and didn’t care to much and said I would just get better. What happened was I was in China for 4 months and at that 4 month mark I started feeling crappy and didn’t know why. So I had to come back to America cause I couldn’t hardly walk when this all hit me. I’m not sure if I just have bad Anxiety or if it’s just hypo causing this. I’ve been on a good diet for about 3 months now. This all started in mid November of 2011.
    I did start feeling better tho about 2 months after this all started. I felt pretty normal for 2 weeks. I thought I was getting better. Now I’m started to kinda slip back into this again but not as bad as it was in China. I felt I would die in China. Now I just feel lightheaded and weak sometimes or something like that. I haven’t really gotten sweaty no blurred vision, no hunger pains or anything. Usually just dizzy, heart rate goes up a little, feels like I may faint. So Idk if it’s all anxiety or what. I do seem to feel a lot better when I can control my anxiety but 60s just seemed low to me but maybe it’s not. I’m 6’2 and way 177 now. I did get pretty skinny in China. I lost a lot of wait because I was always riding a bike and walking every where. Also they eat lots of rice and noodles. I probably didn’t eat well enough. I weiged 160 I think in China. And people said I looked pretty skinny and could see my bones in my face and things. My Endo. here in America said he thinks I just got malnurished and since I’ve gained my weight back I should just get better. He also said to try to just stop eating every 2 hours and try to get back to eating 3 meals a day maybe with a night snack. But I haven’t really been able to do that I feel too bad I guess to do that. I don’t want to take the chance yet. He also did some blood test on me. I think one was called a cortisyn stem test. They injected me with something that did something to my adrenalin and checked my cortisol levels. They injected me at 10am I think then checked my blood at 10:30am and my level was 25 something then and at 11:00am they checked again and it was 30 something my cortisol levels. I saw in my medical record the normal range is between 6-22 or something like that but my Endos. nurse called me back and said all my blood work looked perfectly normal and my BG levels were pretty much normal. So I hope this isn’t too long just worried why if seems hard to control when I’m eating right. Who knows maybe it is all just anxiety but that seems hard to believe when my BG drops into the 60s so fast and when I eat I feel better. I used to check my BG a lot but haven’t now for probably a month. Checking it just gave me anxiety and made my feelings worse. Thanks for the help!

    Matt

  132. Bobbie says

    I”m an overweight RN who eats a MOSTLY paleo/low carb diet. I have been feeling ‘strange’ lately, frequent urination, thirst, etc.

    Just got a glucometer, thought I’d do some testing on myself.

    My FASTING BS was 139 this morning – terrible. But my POST PRANDIAL blood sugars are running 100-130.

    What the hell do I take away from THAT?

  133. nana says

    i have a very big worry. my a1c level is 6.7 and my fbs levels are all with in normal range of 75 and 77 when i do check them. random checking through the day is about 80. my pharmacist told me that there was nothing to worry about. i am however of african decent and dont know if this influences my a1c in anyway. i would be grateful if u kindly get back to me

    • says

      Hi nana. I hope Chris will also jump in here, but when I saw your post, I just HAD to comment.

      The pharmacist who told you there was “nothing to worry about” is absolutely wrong, in my opinion, as well as the opinion of many other medical professionals and the American Diabetes Association (who isn’t even in the cutting-edge when it comes to diagnostic criteria…)

      For many people who become diabetic (studies are showing this is particularly true for middle-aged women) the fasting blood sugar level is the very LAST measurement to become abnormal.

      There’s an excellent write-up here: http://www.phlaunt.com/diabetes/14046621.php – read particularly the section just over half-way down the page with the heading “Why Fasting Blood Sugar Levels are Often the Last to Deteriorate” — it explains it quite well.

      A HbA1c of 6.7% is now ABOVE what the ADA’s latest recommendations are for diagnosing diabetes. As of the most recent standards, the ADA is stating >6.5% meets the definition of diabetes. (American Diabetes Association. Standards of Medical Care in Diabetes 2010.)

      What this means to you is according to current diagnostic criteria, you ARE diabetic. It’s quite likely you have very high post-prandial (after-meal) readings, but not high fasting levels yet. You can still reverse this in the early stages – but you likely need to address things ASAP.

    • Chris Kresser says

      Nana: it really depends. A1c is not a particularly reliable marker in individuals because it depends on the assumption that everyone’s red blood cells survive an average of 90 days, which we now know is not true. If your fasting glucose is in the mid-70s, and your post-meal (one-hour after and two-hour after meals) blood sugars are below 120, it’s possible your red blood cells live longer than the average, and you have a falsely high A1c reading. I’ve written about that here: http://chriskresser.com/why-hemoglobin-a1c-is-not-a-reliable-marker

      On the other hand, if you’re having dramatic blood sugar spikes throughout the day that are raising your average blood sugar, and that is showing up in elevated A1c, it’s definitely an issue.

  134. Knowledge Sponge says

    Hello Chris,

    Thank you for this website, you do an excellent job at educating diabetics and nondiabetics about diabetes. Why is there so little said about thin people who have been diagnosed with type 2 diabetes? I come from a family with a strong history of diabetes. Some of them were thin people.
    Thin diabetics are often recommended to begin low carb and low calorie diets when many of us are already at or below a reasonable weight. The result is we often end up looking and feeling deprived. How can we maintain a sensible weight and have good blood sugars?
    Also, I was testing my blood sugars 3 to 4 times daily (fasting and 3 post-prandial). This routine kept me (which can get expensive) very informed about how portion size, GI, and even the time of day I ate certain foods would affect my blood sugars. My doctor told me testing this often is not necessary and testing once daily would be sufficient. I was a little suprised to hear this news, I had always assumed testing frequently is one of the diabetic’s greatest weapons. It’s sort of like having the enemy’s strategy book. Could you please tell me your opinion on blood glucose testing?

  135. Mom2-5 says

    Hi Chris,

    I posted early about my daughter with no answer to it. I love the input you give and am at my wits end at this point. Please respond to this one and tell me what you think…

    My daughter had BG of 350 at age 2 ish. and once more at that time it was 200. After that she was fine. She is now 8 and has been having periodic high fasting sugars of anywhere from 90 – 140. Not always and i can’t really predict when she will have issue. But we can usually tell when she is having the issues because of her behavior and attitude. Then we will test her and watch. During the day its kind of high after meals during those times. Nothing scary. 120 – 140. This will go on for a few days to a week and then go kind of low normals. 80 after meals FBG of 60 – 70. Twice in a row she has had an A1C of 5.7% and after giving her a GTT her 1 hour was 200 and 2 hours was 108. The 2 hour was great.

    Yesterday we finally got in to see the Pediatric Endo. He said that none of this is indicative of anything and that having a bad emotional day can lead to sugars of 350 or whatever. He said that I am just being nervous and that she is 100% fine. An A1C is no signs of anything, and that fasting blood sugars less than 200 are just fine. So, now I am pretty confused. I kind of don’t trust him. Really?? FBG can be 140 and he doesn’t consider this a problem? Now, while I dont’ believe she has diabetes and I am not trying to borrow trouble I would like to know what is causing the off sugars. She is a small girl so none of this is weight related. He also said NOTHING except diabetes causes high blood sugars in a person. Is that true? There are no other conditions that would lead to high blood sugars? He wanted her to go get a blood draw for a FBG test this morning. I didn’t do it because I know right now it would be normal anyway. I don’t need him treating me like a nervous silly mother.

    Now, I am really not sure what to do. Second opinion with a different Endo.? Or visit a naturopath? Or just continue being strict with her diet and hope that this truly is her noraml.

    THANKS FOR SOME IN PUT!

    • Chris Kresser says

      It definitely sounds as if she has some insulin resistance and blood sugar issues. Unfortunately, it’s impossible for me to know more without a more thorough intake. I suspect autoimmune involvement, but that’s speculation at this point.

      • Mom2-5 says

        Thank you. If I was nearer to you I would be knocking at your office door first thing in the morning. LOL I live in Arizona, though. What would you do if you were me? Another Endo.? I really don’t want to ignor this and wait for it to be too late. I would rather deal with the hang nail and not wait for an infected finger if you know what I mean. Would you do intake over the phone or through email?

  136. ebonydawn says

    I was just diagnosed with pre-diabetes last week. The Dr put me on 500mg of Metformin for two weeks and then said to increase 2 twice a day if I can tolerate it. How loing does it take for the body to get settled with the medicine? Sometimes I feel worse than when I wasnt on the meds. My morning blood sugars have been
    118
    128
    111
    126
    108
    121
    92
    102
    My ave after meal have beeen 117. Is his incrediblly bad? I meet been really watching my carbs and meet with a nutritionist next week. I have overwight and have lost 6lbs since I found out so I am trying to get on the road on to a healther weight. Is it possible to control with diet and exercise alone or is the mecdicine going to be a part of my life foerever? Any comments or advice is appreciated.

    • Chris Kresser says

      If those are 1-hour post-meal numbers, they’re within the recommended targets. Statistically speaking, if you stay under 140 at 1-hour and 120 at 2-hours, you’re at no greater risk for blood sugar-related complications than a normoglycemic person.

      • ebonydawn says

        Thanks Chris–the first list of numbers are my morning #s prior to eating.
        My sugar count today:
        Prior to having any food :102
        1 hour after breakfast 101
        2 hours after breakfast 85
        1 hour after lunch 102

        I am new to this so since I am going to start working out what is recommended? I heard that this causes the sugar count to to decrease quickly.

        I really appreciate this forum. Its very helpful.

  137. Kit says

    Hi Becky…
    I didn’t have any luck finding any info other than the link that Lynn sent. I had been told to drastically reduce my breakfast carb intake to 15g. After reading this article, I increased my intake to 30g with no drastic consequence and felt much better! lol. However, my fasting numbers were still bordering in the high 80’s to low 90’s. I feel ridiculous even complaining of such numbers because I know people who have type 2 diabetes that would kill for these numbers. However, the medical establishment has become quite strict that fasting numbers during pregnancy remain under 90; the practice I go to is not exempt from this. What I found that worked well for me after much trial and error and keeping a food diary was that I needed to eat a relatively light dinner…salad, protein – lighter on the carbs for this particular meal. I don’t seem to have a great issue with carbs during the morning or afternoon. I try to not eat anything after 8:30pm. I also found that I didn’t necessarily need the snack they suggested before bed. If I am still hungry before bed I have a very light snack, for instance five wheat thins. And like clockwork I wake up at 3am every morning, so I drink about 4 oz. of milk… I don’t follow the eat every two hours philosophy that is also very prevalent – I eat when I feel hungry. Usually I eat every 4 hours. This has worked better for me in that I don’t feel like I am constantly keeping track of when I need to eat…I started to feel like this entire eating business and sugar control was taking over my life. lol. I still have occasional fastings numbers in the low 90’s, but I personally don’t find this all too concerning…my postprandrials are all in an acceptable range. I personally would not agree to insulin use during pregnancy unless my fasting numbers were over 100 on a regular basis and/or I seemed to be having problems after meals as well. Strangely enough…when I went back to eating similarly to how I ate before the diagnosis of gestational diabetes (which was relatively healthy, minus the refined sugar) I found that I felt better, was less stressed, and seemed to have better results. So there you go! :) It is my opinion that this entire diagnosis of gestational diabetes is made out to be more serious than it necessarily has to be. I recommend reading Ina May Gaskin’s view (Guide to Childbirth) on gestational diabetes as well as Henci Goer:

    http://www.ivillage.com/gestational-diabetes-common-sense-approach/6-a-129188

    http://www.gentlebirth.org/archives/gdhgoer.html

    I found both of these articles helpful in dealing with this diagnosis, as well as in making decisions regarding the recommended treatment.

    I also found this website useful:
    http://www.plus-size-pregnancy.org/gd/gd_index.html

    Best of luck to your daughter! I hope she can figure out something that works for her.

  138. Terry says

    Any thoughts on high morning fasting levels? The last six to nine months mine have gone from in the 110-130 to around 140. I’m usually 90-100 at bedtime. My last A1c was 5.9 three months ago. Been type II for 3 and half years now. First A1c was 7.9. Dr. didn’t seem concerned over the high morning levels.

    • Connie says

      Thanks Lynn, yes I believe so. Will see if some of Chris’ recommendations for adrenal insufficiency help with symptoms. I also have crushing insomnia.

  139. Connie says

    I’m a 45 year young female nurse. My FBS is 3.8 (68) and my 2 hour post BS if I have simple carbs (which I crave) is usually around 3.5 (63). My 1 hour post BS is never over 6 (108) no matter how much carbs I eat.

    I get symptomatic with tingling hands and feet, palpitations and a feeling of unreality. All of which go away with more carbs. I tried low carb paleo and my morning blood sugars were very low and symptomatic.

    Any dietary advice would be appreciated.

    • says

      Connie – fyi none of the readings you mentioned are truly hypoglycaemic.

      If your only symptoms are the ones you mention, I would get tested for reactive hypoglycaemia. It’s something commonly overlooked by medical professionals who are more concerned about testing for hyperglycaemia, in all honesty.

      That being said – there can be other reasons for the symptoms you mention – including anxiety. But I’d start with reactive hypoglycaemia due to it’s oft-overlooked status and the post-prandial readings you metnion.

      • Connie says

        Thank you Glen,

        I won’t give all details but I have an indepth knowledge of TCM & nutrition with a special focus on Paleo nutrition. I was looking for input from Chris whom I view to be more knowledgable than myself.

        I was thinking reactive hypoglycemia as well and was wondering about diet. Perhaps I need to give low carb a longer chance to adabt. These symptoms most often wake me up at 4 or 5am when I have to eat something to go back to bed and usually sleep soundly for another couple of hours. Perhaps given the timing there’s also an adrenal component die to timing?

        Connie

  140. Sharon says

    Chris, I have noticed that lately, my AM FBS is in the low 70s. I follow a LC diet. My post prandials are usually under 120 or even 100. If I eat or cheat with a starch or sugar, they will go higher.
    My concern is the FBS. Are numbers in the 70s cause for concern?

    • says

      I hope Chris doesn’t mind me jumping in on this one, Sharon. As both a diabetic (Type 2) and a medical professional, I’ve done a great deal of research on this myself. I’m hoping what I say is in line with Chris’ thinking – I’d be surprised if it wasn’t…

      Fasting readings in the low-70’s are nothing to be worried about in my opinion. There’s various ideas on why hypoglycaemia is, but technically, it’s simply “low blood sugar”.

      However, there’s a difference between being low, and being low that requires intervention.

      Most emergency rooms consider severe medical hypoglycemia to be a combination of three things:

      1) below 65mg/dl, and;
      2) showing physical symptoms relating to hypoglycaemia, and;
      2) continuing to quickly drop.

      If you’re low 70’s, even high 60’s, but not dropping, and you feel OK, and your breakfast meal brings you up to healthy post-prandial levels you’re technically not hypoglycaemic and you’re just fine.

      Here’s the thing about hypoglycaemia – it affects everyone according to what they’re USED to.

      When first diagnosed as a diabetic, my sugars were routinely so high that when I got down in the 120’s I started experiencing physiological symptoms of hypoglycaemia (shakiness, confusion, etc.) yet I was technically not so. But my body FELT hypoglycaemic because it wasn’t used to normal readings.

      Now that I’m in the normal range again, I only feel hypoglycaemic when I’m literally under 55mg/dl – which used to happen to me due to some medication I was on but no longer am taking. I felt fine in the 70’s as you likely do.

      Again, fasting readings in the low 70’s are nothing to be concerned about. I know some people regularly in the 60’s in the morning. It’s only a concern if you’re symptomatic and dropping fast.

      I hope that helps.

  141. Lisa says

    I’m 56 yo female with recent medical blood tests showing FBG of 89, and I am overweight with the most fat concentrated in my belly region which I already know is unhealthy. All my doctor says is “you’ve gained weight since the last time you were here, why?” I have 1 living brother who is morbidly obese and has HBP and Type 2 diabetes which he manages both only with medications. I would prefer to avoid that if possible. Having said that, I do have HBP and manage that with lisinopril-hctz, and I have started an exercise program and am working up to making it 5x per week. I also have COPD with multiple sinus/allergy problems and manage those with various nasal sprays, and a stabilizing inhaler rather than rescue inhaler daily. I have become acutely aware that I must eat more healthy and increase my fresh veg and fruit intake, but I want to make a lifestyle change where I can manage it for the rest of my life. I’ve been looking at various diets, and one of the most trendy tells me that by eating high protein and vegs that my blood sugar will drop but this sounds to me more like Atkins/HPLC diet. Is it really necessary for me to give up all white starches and all bread/pasta? If my FBGL is 89 why am I gaining weight all around my belly?

    Everything I have read here is very enlightening, but I wonder if I need to start to monitor my blood sugar post meal as indicated earlier, along with new eating and exercising patterns? And by the way, where is the future article you have mentioned about how to monitor it? I haven’t seen a link to it anywhere. Did I miss it?

    Thanks for everything you’ve written and shared on the web. I really appreciate it!! :)

    • Chris Kresser says

      A significant percentage of type 2 diabetics have normal or high normal FBG, so yes, I always recommend testing post-meal blood sugars for this reason if you suspect you have a problem. And yes, it is necessary to give up white starches and pasta if you’d like to optimize your health and your blood sugar regulation.

      • Lisa says

        Thank you so much for such a speedy response, and I will get to work on this absolutely! I’ve been told by a trainer at the gym that the only starches I should consume are sweet potatoes, brown rice and oatmeal. Do you agree with this? And I have recently become more aware of artificial sweeteners, even those touted as Stevia but are actually chemically produced. What is your opinion about artificial sweeteners? Do I need to lose them altogether too?

        Again, many thanks, I’m so grateful I came upon this website and your willingness to share your knowledge!! Be blessed!!

        Kind regards,
        Lisa

      • says

        I’m glad you mention this Chris – unfortunately for many Type II diabetics the FBG is the LAST thing that is compromised.

        As such, since medical doctors often rely on FBG to screen for diabetes, they often miss something that should have been diagnosed years earlier. That was my case.

        The OGGT (Oral Glucose Tolerance Test) is usually a much better indicator – but most doctors don’t send someone for this test unless they already suspect diabetes, which is somewhat backwards.

        http://www.youtube.com/watch?v=2cr9dDbVHuk is a great video with Dr. Tara Dall talking about how we currently diagnose diabetes… Worth a quick watch. Lots of research is showing advanced lipid testing can give an indication of onset of type II diabetes years before it is diagnosed with glucose…

        • Sharon says

          Thanks for the info on Dr. Tara Dall, Glen. I really enjoyed the information.
          I think that NMR Liposcience test is really important and many docs will just skip it or say it’s unnecessary. The last time I had one, my LDL-P number was 1741..too high. I’m hoping that a low carb and higher fat diet changes it.
          We are told that even if the LDL is high, as long as the size is big and fluffy, you are safe, but Dr. Dall says differently. She claims the LDL should never be over 1000.
          Of course, the battle of the experts opinions charges on, doesn’t it?

        • Sharon says

          Glen, I’m very anxious to see what Chris thinks of Dr. Tara Dall and her view on diabetes and lipids.
          When I took the NMR test (back in Sept. 2010), my insulin resistance score was 13 which is well below their suggestion of 45.
          I called LipoScience to explain how to read the results. It’s a bit confusing.

          My LDL size was 21.1
          HDL size 9.5
          LDL P 197
          HDL P 11.2
          My last mainstream Triglyc. test was 75 (Sept. 2011)
          My total C at the time was 254. My last test in Sept 2011 was 236.

          Then there was a reading which got flagged..
          LDL Part number 1741 (flagged as HIGH) mainstream LDL read as 173
          HDL Part number 29.6 (flagged as LOW) even though my mainstream HDL read as 67

          I wonder if there is any way to bring down the LDL because according to Dr Dall, I’m doomed!
          My primary doc, who is sort of natural, gave me plant sterols to lower cholesterol. I took them for awhile, but dumped the idea. I thought cholesterol was good for us.

          I eat low carb, been pumping iron and cardio for 28 yrs.

          Any thoughts? Thanks so much for your input. It’s much appreciated as is Chris’s wonderful mind.

          • says

            Hi Sharon – first, I cannot give ANY medical advice over the internet, and it wouldn’t be appropriate on Chris’ fine blog anyway – (unlike me he’s not paid by the government and needs to make an independent living.)

            BUT I will say this:

            The evidence is quite clear that for many people (many, but not all – biological individuality tells us we ARE all different, naturally) when you eliminate refined/processed carbs/sugars and increase your intake of healthy fats, including saturated fats (as natural as possible) your cholesterol ratio improves AND your triglycerides drop.

            I personally get all my carbohydrate sources from non-starchy vegetables and a little bit of lower-GI fruit. (Of course, as a Type II diabetic I must eat lower-GI fruit than healthier people simply to control my sugars – your mileage may vary.) I will sometimes (very rarely, maybe two times a week) have one slice of organic sprouted-grain bread – but only when the family is having sandwiches for supper… Even then it’s only 13g of carbohydrate.

            Some people say you shouldn’t cut out fruit entirely – but you can if you wish. There is no nutrient found in fruit that you cannot get from vegetables – and with vegetables you get those nutrients with much fewer calories and much less sugar. Myself, I eat berries or cherries every day (they are my ‘go-to’ fruits, high-fiber and low-GI) and sometimes 1/2 a granny smith apple at a time. That’s all I can tolerate. Others that can enjoy more fruit are lucky, I suppose. =)

            I don’t know how long you’ve been eating low-carb, or how low-carb you are. For me I *always* have LESS than 10% of my calories from carbohydrate. But I am severely diabetic, not everybody needs to eat that low. Most paleo people, for example, eat more than that – especially the ones that also engage in crossfit.

            If you can afford it, it would be worth engaging Chris to look at your labs, your diet, and assist you in that regard – I’ve read enough of his work to believe in him, and have no problem recommending him as a medical professional. If you can’t afford it, I would recommend you read, research and learn as much as you can to help yourself – there’s a wealth of information out there for free if you take the time to look and find it.

            I hope that helps, and good luck!

            • Sharon says

              Hey Glen..I totally understand and with much due respect to you as well as Chris.

              I appreciate any input, so thanks for taking time to respond.

              I agree with you about being able to live quite nicely without fruit. I can go for days or weeks without and if I treat myself, it’s just like you..berries, a bit of apple, etc. Sometimes (very rarely) I’ll cheat with 1/3 banana in a smoothie..I’m such a wild, naughty girl..LOL!
              I will continue to stay low carb and hope for the best. I can’t wait to see my next blood test results.

              Again..thanks so much for being available and generous with your opinions.

              • says

                When I do long cycling rides in the warmer months I enjoy little bits of banana in my smoothies too – but what I do is buy GREEN bananas, and then peel (which is pretty-darned difficult if they’re green enough) and freeze them. I break them into 3 chunks per banana and will add them to a smoothie if I really feel like a little extra carbohydrate…

                Honestly, I also like the texture the small bit of frozen green banana provides – it makes it slightly thicker and more “milkshake-like” if that makes sense…

  142. Jason B says

    I am a 31 year ld male. I am overweight. I started getting more serious about my health the last couple of months. I figured i would screen for diabetes by getting a blood glucose meter from CVS. This morning was the first time I used it. I tested myself in the morning after not eating for 8 hours- it was 104. About 10 mins after testing I had a Fiber One oatmeal and chocolate Fiber bar for breakfast…. I tested exactly 2 hours after that, and it read 86. 2 hours after I tested 86 for breakfast, I ate lunch. I then tested myself 1 hour after lunch, and it was at 84??? I am very concerned as the internet when researching these results give me too many answers that dont seem to match up…. I have started running, and watching my calorie intake and switching to a better diet… but are these reading cause for me to now go and see a doctor???
    You reply is GREATLY appreciate Chris!! amazing writing!

  143. Tracey says

    My son is a 5yr old boy who was delivered as a premature 33wks due to renal failure due to bilateral hydronephrosis and hydroureters which was corrected by numerous surgeries. He now has developed glucose intolerance since march 2011 treated with diet control but now his spikes are above 10mmol an he is irratable agressive an un able to sit still an has trouble concentrating. I am worried about his eye sight an he doesn’t heal well when he gets wounds. What are my options regarding treatment because he can’t go on like this he is also so thirsty he can drink easily up to 2l of water at his age in a day he will finish a glass an immediately ask for another one. He also passes large amounts of urine. Please help me I live in south africa. Thanks for your time

  144. Patty J. says

    Everyone I know if being diagnosed with diabetes so I went to my doc for testing along with cholesterol testing. My A1c was 6.0 and FBG was 105. My cholesterol levels were all fine. I about freaked out but my doctor said everything was fine. I am confused about this. How could I be fine when everything I have read says I am prediabetic? I need to lose about 10 pounds so I have started on that, I already exercise a lot so am keeping that up, and am going on a low carb diet as I am a carbaholic! I plan on going back to have the A1C and FBG tests done in about 6 months and see where I stand. Is there anything else I should be doing? Thank you. P.S. – I am a 59 year old female with no diabetes in my family.

    • Chris Kresser says

      An A1c of 6.0 and FBG of 105 is not “fine”, unless your doctor considers pre-diabetic blood sugar to be not worth taking action on. Sadly, this is the state of our medical system, where common is confused with normal. You should be testing your post-meal blood sugars with a glucometer as described in a future article in this series.

      • Patty J. says

        Thanks for your comments. I did go to Walmart and bought the glucometer. My FBG so far has been in the 80’s and low 90’s. That is better than the 105 at the docs office but I need to work on getting it lower. I did test one night after eating pizza and my numbers were 135 after two hours so I have to work on that also. The beauty of the glucometer is you find out real fast what your numbers are and you can work on them immediately. My total cholesterol was 189, Triglycerides 86, HDL 52 and LDL 93. Do I need to work on them or are these numbers ok? I want to be aggressive with this.

        Chris – you do a wonderful job with this site. Thank you so much.

  145. Sharon says

    For the past few weeks, I have noticed my FBS has been low 70s and today it was 67.
    I do a LC diet and have been doing intermittent fasting. I didn’t do IF yesterday and woke up to this low number , 67, this morning.
    I don’t have hypoglyemic symptoms during the day and my post prandials are usually under 120, but sometimes during the night, I’ll wake up , or sweat or wake up with some anxiety middle of night.
    I’m wondering if cortisol is at play here. If it turns out that I am hypo, how do I test for that? How do I fix it and does it lead to diabetes?
    Would it be a good idea to test fasting insulin? Does it mean that my insulin is running to high during the night?

  146. says

    My FBS readings are between 110 and 123 and PPBS after two hours shows between 86 and 95.
    To make sure the readings are correct, i did my testings in different self testing machines and in lab.
    As per my machine value above 110 is diabetic.

    In my case, FBS is higher than PPBS. Why could be the reason ???

    • says

      FYI, 2 hours after a meal you SHOULD be back to normal blood sugars. To properly test post-prandial glucose, it’s important to realize that most people get their highest spike anywhere between 45 minutes and 1hr 15 minutes.

      To find out where my own highest spikes were, I tested multiple different meals post-prandial readings every 15 minutes. For me I typically spike between 45 minutes and one-hour.

      You should take a look at what your 1hr spike is, not just your 2hr.

      As for mornings being higher – it’s not uncommon in diabetics. Many of us have an issue often referred to as “Dawn Phenomenon” whereby the body determines it should likely dump some glucose into your system as you go through the process of waking. Various people have tried various methods to cure the issue – we’re all so different that there’s just no “cure-all” for everyone.

      For me what works best is not “sleeping in” – too much sleep keeps my liver dumping glucose and ensuring I eat a small snack just before bed. Again, we’re all different so what works for me may not work for you.

  147. Bob says

    Have you written the next article to this? I am very interested in this topic and would like to get my A1c down to what you suggest. My last A1c was 6 and the one before that was 5.7. I have not been lower than 5.6. I eat a low carb diet, I do eat fruit (apples, cherries, berries) but all before 3PM. I exercise on a regular basis and intense (I am a certified trainer). However, diabetes seems to run in my family. I see an Osteopath for my HRT program and this information mirrors much of his advice. However this blood sugar issue and my kidney function concern me. Any and all input would be greatly appreciated.

    Side note, I modified my diet myself because I realized that even moderate carb intake was causing me to experience low blood sugar within 20 minutes of eating. I also did so due to reflux issue and I read your articles there. Grain products and glueten were big culprits there. It’s a mine field out there!

  148. says

    Hi …
    My name si Utsav Pathak .I am 30years old , i am a Diabetic…..My Sugar fasting and post having some food ….both levels are comming 87 nad 83 …..i wanted to know that is it OK or not….

    Regards
    Utsav Pathak

  149. Lynn says

    Kit

    Low carb diets can indeed raise fasting glucose, and even insulin levels. I posted on this thread a year ago that I couldn’t lower my insulin levels. Well, I severely decreased my PUFA intake (eliminated nuts and seeds, pork and chicken skin, along with and all traces of vegetables oils) and increased my intake of gluten free starch. My insulin levels fell from 33 (extremely insulin resistant) to 4.7 (extremely healthy). My fasting blood sugars are now 75-85.

    Low carb is not the only way.

    My story is covered here: http://180degreehealth.com/2011/06/starch-lowers-insulin

  150. Kit says

    Hi Chris,
    How does this apply to a diagnosis of gestational diabetes? I just turned 33, was a few pounds overweight at the beginning of my pregnancy and have no family history of diabetes. I am approximately 31 weeks pregnant. I was diagnosed at 28 weeks with gestational diabetes and started treatment (measuring my sugar with a glucometer) shortly thereafter. I have excellent 2 hour numbers, almost always under 100 and usually falling in the high 80’s low 90’s…however, my fasting numbers have been higher recently. Before becoming stricter with my diet (carb intake), I was getting fasting readings between 75-85. Recently my highest to date has been 96. I am wondering if this could be due to the fact that I am on a low carb diet? Or could this be the insulin resistance that they speak of with gestational diabetes? I am trying to avoid insulin as well as other interventions during my pregnancy. I have been told that in order to do so, I need to keep my fasting numbers under 90. This diagnosis has created more anxiety and stress than is probably healthy! lol. But I have diligently modified my diet and activity levels nonetheless. I am at a loss as to how to keep my fasting numbers lower. It’s frustrating because I don’t have much time to figure all this stuff out before insulin will be proposed as a means to adjust my sugar levels. Any thoughts would be immensely appreciated. Thanks!

    • Becky Harding says

      Kit,
      I have been searching for an answer to this, as well – my daughter has gestational diabetes and all she is getting is “conventional wisdom” which now includes drugs. :(

      I could not find where Chris answered this, did you? Or did you find any other resources to help you? I am following the link provided by Lynn in response to your question, to see what that says.

      There must be non-traditional, non-pharmaceutical ways to fix this problem!

  151. Terry Osborne says

    I’m type II and my issue is primarily high morning FBG. Ususually 120 to 150. I can go to be bed with 90 to 110, but it’s always up in the morning. No matter what I do, snack, no snack. cinnamon, apple cider vinegar, fenugreek. I’ve experimented a lot. I’ve been trying 5,000 iu of D3 for the past month and that has had no effect either. My A1C was 5.9% two weeks ago. It was 7.9% when I was diagnosed three years ago. In addition I’ve notice that my after breakfast levels have risen considerably over the past six months. Used to drop down to the mid 80s but no longer. It really concerns me and my doctor just didn’t seem concerned. Really irritation not to get anywhere with a MD until it becomes a real problem. Any ideas?

  152. Mom2-5 says

    My daughter had a period when she was very young of high blood sugar (350) and it quickly normalized. We spent the weekend in the hospital and it never got high again, except once it was 200. That was when she was a toddler. She is now 8 and has been having some unusual sugars again. This started a few months ago when I noticed her being more dramatic than usual. This usually prompts me to check her. Her FBG was 126. So they gave her the A1c test. It came back in the range of “pre-diabetic.” It was 5.7 I think? After this the doctor was going to “get back with me” on how to procede or what to do or not do. On the home front I cut her fruit intake in half. That was the only change we made. She was eating quite a bit of peaches. She is a small girl with no wieght issues. She does urinate a lot, especially at night requiring pull-ups that are usually soaked through in the AM. But she does NOT drink an alarming amount. I am pretty strict with her diet, but she is ALWAYS hungry and craves fruits. (I don’t allow sweets other than natual raw fruit.) The DR never got back with me and I just let it go, because her blood seems to have normalized. But this past week she let me know that she has been waking up feeling dizzy and sick like she may throw up. So we checked her morning FBG and it was 110, one day and 90 the next. Seems kind of high to me. What are your thoughts on the whole mess??

    • Mom2-5 says

      I still would love some in put on this. We still are getting some periodic high Fasting BG. We’ll be seeing a pediatric endro. Tuesday. But I would sure love the in put of a more natural friendly person. Chris??? Any opinions????

  153. DD says

    I’m wondering if this is normal. Sometimes my hands gets cold and I feel really faint when my glucose reads 92. Tonight it was strange, I ate something to hold me off til I could fix something which was peanut butter on whole wheat toast 1 slice and milk and then a few pieces of dark chocolate and then a serving of yogurt….and 15 mins after eating or so ot was just 95 or then ate salad about a 1/3 of it chicken sald….something like that then 30-45 mins bout 112 then drank OJ to see what would happen 15 mins back to 104 I feel hands cold and shaky weak, I do have anxiety but it all feels the same to me I can’t tell the difference if I’m actuallly hungry or not as I don’t really get hungry, my fasting glucose is 101-108 for the past 5-6 years. A1C is 5.1. Should I be worried my sugar isn’t increasing?

  154. abhi says

    But is it very high?I’m very worried for him. His fasting blood sugar was 5.3 one day and 6.1 the other. Is his organs already being affected by this?Please advice me.

  155. John says

    Chris, just wanted to get your thoughts…
    I’m 28years old, 6’1″, about 240 pounds (overweight, I know), over the last 2 months I’ve had a few bloods tests and a physical, here are my results.
    HBA1C 5.7
    Fasting Glucose (12 hour fast, I did exercise that morning but only consumed water), 99
    Fasting Glucose Test (12 hours), I checked 2 days later in the morning as I woke up, no breakfast, etc 104
    Non fasting glucose after breakfast, about 2 hours, 97
    6 hour non fasting (Only had water between lunch and dinner) before dinner, 96
    2 Hours after dinner, which included a glass of soda, 103

    I’m not overly concered because I know I need to change my eating habbits, I like sweets to include chocolate (maybe have a couple of hershey kisses throughout the day) and probably eat a bowl of ice cream before bed 3-4 days a week. That has stopped.

    My blood test indicated that my tric were eleveated, HDL a little low but the Chol was in the normal range..

    Long story short, everything as a whole did worry me, I’ve significanty changed my eating habits and did start working out 4-5 times a week about 2 months ago.

    Would any of the numbers above concern you. What I thought most interesting was my Glucose levels, fasting and non fasting, even after a meal, were all ~ 100, which I thought was acceptable? It always quickly came back down to 100.

    My Dr. said that a 5.7 is within the normal range and I had no reason to be concerned with a FGT of 99 and the HBA1c of 5.7 but a few minutes online left me concered.

    Thanks in advance for the reply!

    • Chris Kresser says

      High fasting glucose along with high A1c is not a good trend. Probably a good idea to address it now and clean up your diet before it progresses.

      • John says

        I assume that eating too many sweats regularily over a long period of time would increase the A1c level? Are you at all surprised that with an elevated fasting glucose that it comes back to ~ 100 so quickly after eating? All the indicators I’ve read for “pre-diabetic” indicate that <140 after eating is normal and I'm no where near that.

        • John says

          Chris, I guess to be more clear on what I was saying, I see that “pre-diabetic” is the HBA1C, FGT and Random Glucose tests can point to a problem depending on the results. I’m aware that my FT and A1c are high, and I contribute that to my lack of exercise and poor eating habits, but i’m surprised that my Random Glucose tests all came back at 100.

  156. Rick says

    Hi and thank you for this site.been a very good read. I have been getting diabetes symptoms after meals. Been checing bs. Fbs is 95,120. Post meal goes up to 230+ after an an hour of eating. But will drop to 150 and so on after a couple more hours. I think it may be type 1.5. Im 32 slim and very active. Walk about three milrs a day for work. I know somthing isnt right. I have checked bs levels a couple years ago, and y readings never went over 90.
    thank you and let me know your thoughts on this.

  157. Radhika says

    I have been regularly testing my blood sugar (both fasting and post prandial) and my HBA1C. While the sugar levels seems normal (90 and 130), my HBA1C seems higher at 6.5%. My HBA1C has gone as high as 6.8% while my sugar levels remained the same. I am very confused about the readings as they do not seem to add up. Can you please advise.

  158. taylor says

    My fasting BG was 101. Normally, it is 99, or under 100. I do not eat a lot of bread, or rice. All I did that morning was gargle with mouthwash, and prior blood test before this one. Have not been exercising lately. Do I have a mild case of insulin resistance?

  159. kapil says

    hi chris
    i am 35 yrs old male from india with normal BP,
    & both my parents are diabitic

    my bg reading before medication were-
    fbs- 136
    pp-202
    random-218
    & a1c – 8%
    doc just recently i diagnsd me with type 2 diabetise & priscribed me glusofin xl 500mg once daily after dinner…

    my bs readings after medication are as under-
    on 3rd day- fbs -119
    on 4th day fbs-122
    my queries are-

    1) Am i severly diabitic? or in my case can i ever get back to normal range without medications?
    2) what calorie diet should i get into?
    3) I have stopped having rice & sugar stuffs completely, will this help?
    4) wht should be my approach towards this condition considering my age?
    5) i am really worried…do i really need to right now?

    would be highly obliged for your early reply

    thanks a ton

    kaps

  160. Baz says

    Hello Chris,

    I am a male aged 50 & have ben low carbing for the last 2 months whilst also reducing considerably both quantity & calorie intake & I have lost 20 pounds in the process from 216 to 196 resulting in a BMI of 27.3. I have been very disciplined & well controlled with regard to diet & carb intake.

    My Bayer Contour meter readings show an overall Average Reading of 5.3 with a break down of:

    Before Breakfast:
    Maximum =6.1 Minimum = 4.1 Deviation = 0.5 Average = 5.0

    After Breakfast:
    Maximum = 6.2 Minimum = 3.5 Deviation = 1.0 Average = 5.2

    Before Lunch:
    Maximum = 6.1 Minimum = 3.7 Deviation = 0.7 Average = 5.2

    After Lunch:
    Maximum = 7.3 Minimum = 4.5 Deviation = 1.0 Average = 5.6

    Before Dinner:
    Maximum = 7.1 Minimum = 3.8 Deviation = 1.1 Average = 5.1

    After Dinner:
    Maximum = 8.3 Minimum = 3.9 Deviation = 1.0 Average = 5.7

    Night:
    Maximum = 7.4 Minimum = 4.3 Deviation = 1.0 Average = 5.9

    From using a number of online calculators I was expecting an HBA1C figure of 4.9% but I was very concerned to find that the actual HBA1C result was 6.0% & cannot understand why. I have been restricting calories, fat & carbohydrates as well as losing 20 pounds in the process & this has me very dismayed as achieving a low HBA1C was my prime motivator & it now seems all my hard work & efforts are have been in vain.

    It may further interest you to know that my previous HBA1C conducted earlier in the year was also 6.0% & I had very little if any control over any aspects of my diet. How can it be that if I pigged out & ate terribly with high carbs, processed & junk foods in large quantities heavier results in exactly the same HB1AC 6% score as when I was most well controlled low carb, low calorie, low fat diet & resulting weight loss & that my average numbers do not match that of the calculators?

    Many Thanks

  161. 4hand says

    Hi Chris

    Love the podcast and blog (BTW, congrats on the new addition!). You’ve been very kind answering all these questions. Quick one. I’ve been Paleo for nearly a year but am very low carb (consistently under 100g per day). My recent blood tests have me a bit worried. They are:

    FBG: 95
    HA1c: 5.6
    C-Peptide: 1.5

    So, I bought a glucose meter and found my results over about a week to be as follows:

    Wake: 90-105
    Before Meal: 78-101
    1 Hr After meal: 85-122
    2 Hr After meal: 78-100
    Before Bed: 89-101

    So, anything I need to investigate here? Are the ranges normal? Why does my glucose level seem to rise late a night? A little worried about the lower C-Peptide score along with the 95 glucose. Thank you for all your help.

    • Chris Kresser says

      Pretty normal to have high FBG on a VLC diet. You’re well under the 1-hr and 2-hr targets. Can’t see much to worry about.

      • 4hand says

        Thanks a bunch Chris. Any worries about the low-normal C-peptide in conjunction with the FBG of 95? Some have hinted at LADA possibility. Take care and thanks for all your work. Can’t express how valuable it is.

  162. Yami says

    Dear Chris,

    Thank you for the the rich article. I did the Glucose Tolerance Test (75 grams) yesterday and my results where as follows:

    H A1c: 5.3
    Fasting Blood Glucose : 88
    After 1 hour: 152
    After 2 hours: 93

    I’m 31 year old male & I’m really worried of my numbers after I read the article; so would you please tell me if I’m pre-diabetic or not because my doctor told me that I’m fine and there is nothing to worry about.

    Thank you very much

    • Yami says

      sorry I forgot to mention that I’m around 150 lbs and about 6 ft tall, also recently donated blood and my Iron level was 15.5, blood pressure 106/72, and cholesterol 145 mg/dl. Just mentioned these in case they might help asses my situation.

      Thanks again
      Yami

  163. Steven says

    Awesome articles Chris. While trying to attack a cholesterol issue, I thought it would be a good idea to buy a glucose meter. My first fasting test was a level of 97! I freaked out a bit. But after reading, I found the fact I’ve been low carb (under 100g/day) for 10 months may have something to do with my fasting levels. So, my results were as follows:

    Before meal: 95
    1 hr: 98
    2 hr: 83

    Anything out of the ordinary here I need to investigate?

    Thanks for the help

    Steven

    • Chris Kresser says

      Not at all. It’s normal to have high FBG on a VLC diet. As long as it goes down into the 80s after eating, not a problem.

      • Steven says

        Thanks Chris. Had an A1c test with the result of 5.6…. yikes, a little too high. Still after testing my meal values I consistently get:

        FBG: 90-98
        1 hr: 90-105
        2 hr: 78-88

        Wonder what’s going on here. VLC diet… and lately been too low on the calories so need to improve that. Any suggestions or advice?

        • Steven says

          Forgot to add… maybe these will help. Thyroid numbers are:

          TSH: 2.8
          T3, Free: 3.2
          T4, Free: 1.5
          T4: 8.8
          T3 Uptake: 36%
          Free T4 Index: 3.2

          Couple were on the upper end of the reference. Anything you can glean from these and if they could be affecting my blood glucose readings? Wonder if calorie reduction with some days of 12-16 hours fasting would affect these numbers? Thanks so much for your help!

  164. Kristin says

    Hi Chris. I am a relatively healthy female age 41. I’m petite and thin – 5’1″, 97 lbs. However, I just recently found out that my last two fasting blood sugar counts (one last year and one just a couple of weeks ago) were 97 and 96 respectively. I haven’t been able to talk with my doctor yet as I just received the results of the second test, and he is currently out of town. From what I’ve been reading here and in some other online articles is this could be a predictor of future diabetes. However, I have none of the other indicators associated with metabolic syndrome. My waist is small, my blood pressure is consistently low, my HDL is high and my tricglycerides are normal. Still, should I be concerned? I have had several bouts of reactive hypolglycemia over the past few years. I’m thinking it must be related.

    • deb b says

      Kristin – Could I suggest (based on my experience):
      Define “fasting blood sugar” Often they tell you 8 hours and coffee, tea is ok. Should be water only (the caffeine will raise your blood sugar) and my understanding is a true fast is 12 hours. Also, Per Jenny Ruhl, your 1 hour post prandials (checked with a meter) is FAR more predictive of blood sugar dysregulation – you should test yourself for awhile on the post prandials. Check out Jenny Ruhl (Blood Sugar 101) website. Im pretty sure Chris refers to her in his writings as well.

      • Kristin says

        Thank you Deb. I’m sorry. I should have specified. I did a water-only 12-hour fast before having my blood drawn. The result was a FBG of 96. I will see if I still have a blood glucose monitor. I used to have one but haven’t seen it in awhile. I’ll then test my blood sugar after a meal. I’ll also check out Jenny Ruhl’s website. Thank you

  165. Talayna Testa says

    Hi Chris. I just read the blood sugar part 2 article you emailed me and now I am being referred to the next article which discusses,” How to measure your blood sugar at home.” Can I please have that link. Thanks again, Talayna Testa

  166. says

    I follw strict regiment diet wise , no sugar etc. All of a sudden my blood Sugar Spiked to 484, I’m nt a drinkr, I took double hot Of Crown Royal whisky an hour later it was 117! This is never happenedb-4 machine is calibrated rt. I checked it 2 hours aftr 3 OZ. Of Chicken, 491-like I said it has been happening for a month My PHYSICIAN tld me not to worry about it-AND I thinkhe is wrong

  167. bob says

    Thanks for the 2 articles but it did not answer the question: Why your “normal” blood sugar isn’t normal (Part 2)

    bob

  168. Andy says

    Chris,

    Thanks for writing this article. I just got back my annual blood test results and the numbers were surprising. My FBG is 90, while my hba1c is 6.7%. My HDL/LDL/Triglycerides are excellent, and nothing else in my results clearly points to a cause for the elevated hba1c. I am and have always been slightly anemic, although I don’t yet know the root of the anemia (B12, iron, etc.). Last year at this time, my hba1c was 5.9, and nothing significant has changed in my diet or exercise. I am 40 years old, 5’9, 148lbs. I exercise 5 times a week, alternating between high intensity strength training and cardio. I eat a moderate carb diet, although I’ve never felt the need before to measure my macronutrients, so I don’t know exactly where I fall in that spectrum. I haven’t measured my post-prandial glucose, but I suspect that is the next step. This is all very confusing, but I’m trying to keep a cool head until my PCP comes back from vacation so we can talk about it.

    • deb b says

      I have the normal FBS with high A1c issue. HAve done much searching, and am convinced it is due to longer-lived red blood cells. Google “physiological” insuliln resistance (vs. pathological). Also, listen to the recent JEnny Ruhl podcast with Jimmy Moore, she talks about why A1c isn’t a great INDIVIDUAL (vs. population-wide) marker, and the author of another best-selling diabetes books use of continuous blood glucose monitoring. Her BS never went over 90, but she had the high A1cs. OF course, you should still monitor post meal blood sugar to make sure there are no bad surprises there.
      It’s interesting to me that I have the anemia issue, also. Its normal now, but ferratin seems to take forever to replete.

  169. Eddie says

    I’m eating Paleo / low carb and have just started tracking my blood glucose. A typical day sees me at a average of 5.5mmo/L of 99mg/dl, no matter if it’s FBG or post prandial. Also, my 2hr post prandial is the highest. Can you touch on delayed insulin response on a future podcast? Should I be aiming to get BG any lower? A1c results are due in the next week, so that’ll reveal more.

    Date Time mmol/L Notes
    09-Mar 06:13 5.1 FBG
    09-Mar 08:05 5.2 Post workout, fasted, 10g BCAA
    09-Mar 08:50 5.5 Post workout, 10g BCAA
    09-Mar 12:21 5.4 Pre-lunch
    09-Mar 13:31 5.4 1hr post prandial
    09-Mar 14:31 5.7 2hr post prandial
    09-Mar 15:28 5.5 3hr post prandial

  170. Chris Kresser says

    Reem: seems your glucose tolerance is impaired for some reason. There’s no way of knowing why without investigating further. The typical culprits when blood sugar doesn’t improve with dietary changes are cortisol dysregulation or (less likely) late onset autoimmune diabetes (LADA, or Type 1.5). A1c isn’t particularly helpful in this situation – post-meal #s are much more accurate.

  171. reem says

    update:
    I#ve been continuing eating the same way for the past few months, but still no improvement. Occassionally my blood sugar readings are normal (especially if i eat alot of fat with carbs, or i eat them after a workout or with whey protein).
    However today i ate about 80g carbs (white rice) with about 2 tsp fat (first thing i’ve eaten today)

    12pm – ate half the rice
    12:30 – ate the rest of it
    1pm – 128 mg/dl
    1:30pm – 174.6
    2pm – 156
    2.30pm –

    Clearly i have problems..I called my doctor the other day requesting hbA1c, etc, but she refused because i am “20 years old and not a diabetic”

    I’m really not sure what to do now. I#m cutting out the white rice,and will see how other starches affect my blood sugar, but is there any way to reverse this? Any supplements/nutrients to take, lifestyle changes, etc? How can i find out what is going on with my body?
    Would appreciate any advice as i’m really at a loss here…

    • deb b says

      Could I suggest trying to immediately replicate? i.e. if you get one that high (174.6) immediately do another stick. This happened to me today. I have been testing a lot the last 24 hours and knew from the quantity of CHO I had eaten my BS could not have increased as high/fast as it did. I retested using “better technique” (I got a bigger initial drop of blood and it filled the strip more rapidly) and this time it was what I would have anticipated. I sometimes use two glucometers side by side (there is far more variability than it seems there should be). Also, next time you are having a lab fasting BS, take your glucometer and do finger stick just before the draw – then you will have an idea of the accuracy of your meter. Bayer Contour is working best right now – but I am using up my Accu-check strips, just as a relative indicator (i.e. does exercise make BS go up or down), as it routinely runs 10-20 higher than the Bayer.

      Question for Chris – from the “data” (google David Mendosa ‘Free Foods’ blog article where Dr. Bernstein weighs in) we would expect that 10 gm CHO will increase BS 50 in Type 1 and non-obese type 2. Do you have an “overlay” for low-carb/Paleo type eaters? I am wondering if this might also happen?

      Still trying to understand why intense exercise (kettlebell type work out for an hour) in a fasted state increases blood sugar, while 10-15 min easy cardio (treadmill walking after mea) decreases. Does this make physiological sense in terms of glycogen and glucagon kicking in:fasted state and muscle uptake of glucose: fed state?

      Other ideas: Listened to a lecture on continuous blood glucose monitoring results. It showed (in agreement with what Calorie Restriction society says) that your am (first) blood glucose response is the strongest (insulin production is shut down from the overnight fast, and needs to be gently teased awake – not shocked with a quick glucose spike). This is great reinforcement for NOT starting the day off with CHO (especially something as glycemic as white rice).

      • Sharon says

        @Deb B…I have a suspicion that the reason your glucose is high after your intense workouts is something I learned from Dr. Bernstein. It depends WHEN you workout. I tested this myself and it’s true. If you do an intense workout, like serious weights or HIIT cardio (which I tested mine on) within 3 hrs. after awakening, your bloos sugar shows a significant rise.

        I tried this as my routine was always doing intense exercise sometimes on an empty stomach within the 3 hr. awakening mark. Sure enough, I tested at 94. You can try this yourself and see if it helps to wait 3 hrs. and then get to your exercise. It has something to do with AM cortisol, according to Berstein.

        • deb b says

          Sharon, Thanks for your response. Yes, I tend to agree (I have the new ed. of Dr. Bernstein, have to read up on this part).
          Thanks for posting the Dr. Dall info as well (wonder if she collaborates with Dr.”Wheat Belly” Davis, Milwaukee, WI.

  172. deb b says

    My post exercise BG# is higher after weight work out (but is lowered with 10 min of “easy” cardio). Would this be “expected” (I’m paleo). Also, BS is often higher after overnight fasting. Does this indicate that glucagon or gluconeogenesis has kicked in as BS drops during the night?

    At some point, can you define “low carb” ….I get my carbs almost exclusively from low glycemic veg – but these can add up. When people are quoting under 50 grams of carbs per day, does this usually mean TOTAL carbs, or are then netting out fiber? I can easily eat 3 cups raw brussels sprouts (yields about 2 cups cooked) either way total carbs are about 24 grams. Same for cabbage, etc.

  173. says

    How would all this apply to children? would the numbers be the same as adults? If not, could you share what optimal levels would be for kids? I would love to show my kids what happens to them after they junk out on high sugar foods!

  174. David says

    Hi Chris,

    Just spent five days collecting BG levels. Found this article after as many days of searching–most searches return information for diabetic rather than non-diabetic scenarios so it took awhile.

    I’ve gone on a keto diet on-and-off over the last 10 years and always feel dramatically better on one, but eventually grow weary and give it up. Idea is that the glucometer will help motivate me to stay mostly low-glycemic even when keto grows old.

    As expected, my levels are below ADA pre-diabetic, but are not idea by the standards of the studies cited above. Will be interesting to see if I can knock the 10-20 mg/dl off the baseline over time.

    The thing I find interesting is that my BG level goes up quite a bit after each of my three weekly weight lifting sessions. I work out pretty hard and consistently, always going as close to maximum intensity as reasonably possible. Today, three days into keto, my BG was 95 before a lower-body session and a tad lower at 93 at the end of the session. Twenty minutes later it went to 120 mg/dl and gradually drifted back down to 105 over two hours. Haven’t eaten since hours before the session. Before switching to keto BG peaked at 130 after lifting. On cardio days (500 kcal in 35 minutes rowing) BG followed a similar pattern on high-carb and was close to flat on keto, rising 10 mg/dl at the end of the workout and staying there.

    I’ve read that an increase in BG post-workout is to be expected since the liver brings glucose out of storage for muscles to use, but can’t find much information on what levels would be reasonable to expect for an normal to mildly glucose intolerant person.

    Do you have any information regarding this? Any interesting studies?

    Thanks,

    David

  175. Chris Kresser says

    It’s actually not strange at all to see normal FBG and impaired post-meal blood sugars. There are studies showing that people with normal FBG and impaired OGTT are at higher risk for developing diabetes later on. I don’t say this to scare you, but to clarify why post-meal #s are a better indicator of glucose tolerance and insulin sensitivity than FBG.

    It may be that your numbers come down further after more time. However, it’s possible that you have LADA or some other process affecting insulin output or sensitivity. The low-tech response is to simply avoid whatever raises your blood sugar above 140 mg/dL if you continue to experience this.

  176. lynn says

    Reem

    How long have you been eating higher carb? Glucose tolerance TEMPORARILY decreases on LC and will be higher at first. I once got a BS of 170 when I first moved to a higher carb WOL. Now I get a MAX BS of 120 for the same amount of carbs.

    So, give it time. Also, be aware that protein increases BS. You might be very surprised to find that a potato with some butter will cause less of a spike than a steak with potato. Strange, but true.

  177. reem says

    Hey chris, me again ;)
    I followed your advice and continued to test. I’ve been eating 30-50g carbs for several weeks now (in the form of white rice or winter squash).
    Yesterday, i tested my FBG and it was 77
    Today I ate 40g carb in the form of white rice, and 1 hour later it was 171 mg/dl!!! i just tested it now (1.5 hrs later) and it is 158.
    I don’t understand, i wouldve thought my body would be used to the carbs by now?? However it may be worth mentioning, that the past few days i have been recovering from jetlag and my sleeping cycle has been really messed up (going to sleep really late, sleeping 12 hours or more..) so maybe this has disrupted by BS balance?
    It still doesn’t make sense though that my FBG is normal, yet my response to carbs is insanely abnormal.
    BTW, I’m 20 yrs old, and have never been overweight. I’ve been eating LC for a few years now (and before that a high carb moderate fat diet, and before that a junk food, high carb high sugar high gluten and everything bad diet)

    I appreciate your thoughts!!

  178. Bryan Opfer says

    I definitely have digestive issues (IBS-C) that I have been working on for a while. It was IBS-D before I eliminated gluten. Also had a positive ANA test, so possible autoimmune issues, although lupas was ruled out. My new years resolution might be to book an appointment with you.

  179. Chris Kresser says

    Oops. My response got submitted before I was finished.

    One potential question mark is that your 2-hour reading was higher than your 1-hour on two days. That can indicate a compromised or delayed insulin response, or in some cases, slow digestion. Still, the important thing is that you’re below 140 at one-hour and below 120 at two-hours which you are in all cases except the white rice day.

  180. Bryan Opfer says

    Hey Chris, I did my glucometer testing. Here are my results for premeal, 1,2 and 3 hours after:

    Day 1: 87, 96, 100, 87
    Day 2: 89, 101, 114, 94
    Day 3: 92, 151, 141, 80

    I had white rice on day 3, which apparently I should not eat. Anything else I should gather from this?

    • Luke Timmons says

      Bryan, have you found out any further information regarding your fructosamine levels? I’m essentially [well-sourced] Paleo + raw whole milk and my levels came in at 2.08 – higher than yours. My FBG was 60 and triglycerides were 25. My fasting window is essentially from 7pm – 11am every day… Thoughts?

  181. Chris Kresser says

    Fasting insulin is an inaccurate marker, especially in the mid-to-later stages of insulin resistance. I think post-meal blood sugars are more useful in measuring insulin sensitivity and glucose tolerance.

  182. simona says

    Hi Chris,
    is very low fasting insulin (below the range) something worth considering or it is just good?
    2.073 mcIU/ml (you mentioned <5 mcIU/ml) or 14.4 pmol/l less than 16.5 lower end of the lab range
    at the same time glucose was 5.2 mmol/l or 93.69 mg/dl a bit high
    I was eating low carb which could explain the higher glucose but previously in the last 2 years since I'm low carbing my FBG has been low 4.5, 3.9, 4.1. or under 81.
    Thanks.

  183. Chris Kresser says

    Assuming fructosamine was measured in umol/dL, 1.9 is excellent and suggests you don’t have elevated blood sugars. But the glucometer is most accurate, so still a good idea to do that.

  184. Bryan Opfer says

    Thanks, Chris. I am going to pick up a glucose monitor this week. BTW, fructosamine was 1.9 in that same blood work.

  185. Chris Kresser says

    Bryan: test your post-meal blood sugars. A1c isn’t particularly reliable in that it can be influenced by a number of different factors. If your post-meal #s are normal, I wouldn’t worry about the A1c – especially in light of your FBG. You could also run fructosamine, which is another measure of average blood sugar that isnt affected by hemoglobin variation.

  186. Bryan Opfer says

    Chris, I just got some blood results back:

    FBG: 78
    A1C: 5.4
    HDL 63
    Trig: 65

    The A1C # seems high. My diet has been Paleo+raw dairy since April 2010. However, I was borderline anemic on a few tests during late summer. Think there’s anything to worry about with that A1C number?

  187. Chris Kresser says

    Reem:

    When your body has become accustomed to burning fat for fuel, it becomes naturally insulin resistant. However, this usually reverses after 3-4 days of a higher carb diet. I would keep testing and see if it doesn’t resolve.

    It’s possible, however, that there are other mechanisms causing poor glucose tolerance that need to be explored. If your metabolism is damaged from previous poor eating habits or from autoimmune disease, your carbohydrate tolerance may remain low.

    Another possibility, if you’re not doing this already, is to add high-intensity strength training to your regiment. This is an excellent way to restore insulin sensitivity and improve glucose tolerance. I’ll be writing an article on this soon.

  188. reem says

    I eat very low carb, except once a day i eat about 30-40g carbs in the form of white rice or sweet potato (this is to spare protein – i don’t want to have to eat an extra 50g protein a day just for gluconeogenesis).
    My fasting BG is about 83 mg/dl , but i just checked my BG about an hour after I ate some white rice, and it was 147 mg/dl!!!
    I’m pretty concerned about this! I’ve been eating this way for about 3 weeks now.(before, i was practically zero carb)..Will i always have peripheral insulin resistance, or will my body get used to this amount of carbs i eat per day?

  189. says

    Yikes! Lila, I read your post and the first thing I thought was that you might be a KPD. I really try not to post too much on other’s blogs so I wanted to see what Chris had to say.

    First of all, you’re one of the few people who I’ve heard of that have been officially dubbed “KPD”, that is a miracle in itself.

    What made me think you were KPD? Your fast acting doesn’t work. Your body is producing counter regulatory hormones strong enough to counter a fast acting insulin. You go low hours after the fast acting is long gone, which means that your body is making insulin. You have a very strong response to carbs and that A1c is hanging near 6. Welcome to the “goofy” diabetes.

    This is where KPD differs from regular type 2. Everything is still there and it’s working, it’s just all miss timed. It’s as if some control element is broken so the pieces no longer work together. The continual spikes, however, are going to keep messing up the system though.

    I am willing to talk with you about this. You can find me on “Diabetes Forums” as Rekarb or on Tudiabetes with the same name.

  190. Lila says

    Organ damage etc caused by spikes by themselves (with HBA1C below 6), or prolonged high levels (HBA1cs of 6.5 and above)?

    I’m being told only the latter, but you seem to be saying *both*

    With my deranged metabolism (slightly more deranged than your ‘average’ diabetic!), the only way I can never got above 140 is to never eat more than 10g of carb in one sitting.

    • Brish says

      Dear Chris
      Thank you for the nice insight. I was told after a routine blood test in November, 2013 that I am a prediabetic (106mg/dl FBG). However, since last 2 years I have been running 5-6Km almost everyday @ 11-11.5Km/hr. I was told to follow up after a month; my mom is a diabetic. However, recently my my BG trends were found to be interesting without major change in diet. Average general trend: Fasting BG: 77-80mg/dl. PP 40 mins after meal: 134-155mg/dl. PP 1 hour after meal: 125-127mg/dl. PP 2 hours after meal: 87-89mg/dl. Is that test on November, 2013 can be disregarded now?

  191. Lila says

    Hi – despite living my life like a T1, I am officially a ‘ketosis prone type 2′. So I have the double joy of MDI/hypos _and_ the T2 baggage of ‘sloth and gluttony’ etc.

    So does your advice on never going above 140 also apply to shooters like me?

  192. Chris Kresser says

    Lila,

    All of the research I’ve read, and people whose opinions I respect (like Jenny Ruhl & Dr. Bernstein), suggests that keeping blood sugar below 140 mg/dL is the best way to prevent future diabetic complications. I don’t have much experience with T1, so you might want to contact Jenny and see what she thinks. She’s usually pretty responsive.

  193. Lila says

    Hi, I have read both cover to cover.

    I’m just worried about constantly going over 140. My diabetes team isn’t too concerned about this because my BG is back in range by the next meal, and they say my A1C is fine and control is excellent. But from what I read from Jenny Ruhl and also from yourself (as in this article), BG shouldn’t go over 140 *ever* and I just wonder how concerned I should be as mine often does.

  194. Lila says

    Recently diagnosed with insulin-dependent diabetes, and told to check BG only before meals and bedtime. These numbers were usually nothing to worry about.

    But then I started post-prandial testing and was horrified to find out how worrying those were. I am on insulin but the ‘quick’-acting does absolutely nothing for the first two hours, then starts working about three hours later and is done in five hours. (A pattern verified by two weeks of testing hourly while awake, from which my fingers are just recovering, ouch.)

    My FBG is normally in the 90s and each 10g of carb will raise by BG by about 50. Anything I eat will stick around until my insulin gets going 2-3 hours later, so it only takes a piddling 10g to put me in the >140 danger zone. If I do a 2-hour PP reading, it is *always* high but if at that point I add a small bolus, I’ll hypo about 3 hours later.

    I have tried injecting further and further in advance of meals (up to 2 hours before eating, despite being warned not to do so by my diabetes team) but this hasn’t always worked as it is really hard to estimate how much you’re going to eat 2 hours later. Plus some days, the insulin does do what it says on the tin and leads to dangerous hypos (in the 20s).

    Most days when the bolus is matched to my food, I’m back in normal range 5 hours later. Evidently I would prefer never to go above 140 but since it only takes 10g of carb to do that, that is easier said than done even on a low-carb diet. How much do I need to worry about those hours when my BG is above 140, as it almost always comes back down later?

    My A1C is 5.9 which is a bit higher than what I would like; however my diabetes team doesn’t think it should go any lower.

    • Chris Kresser says

      Lila: Have you read Dr. Bernstein’s “Diabetes Solution”? He’s T1 himself and it’s by far the best book I know of for T1s because he goes into great deal on how to use insulin properly with an LC diet. You might also want to check out bloodsugar101.com.

  195. says

    Chris

    One thing I just thought about in relation to Khalid. Most of the world uses mmol/l for A1c. A 6.5 would translate into about a 5.5 mg/dl A1c which would be about the right number given his daily readings. He might just need to check the units.

  196. Chris Kresser says

    Khalid:

    What are your highest readings at 1-hour after meals? With an A1c of 6.5, and FBG of 110, it would appear you must be having some spikes somewhere throughout the day.

    OTOH, A1c isn’t always accurate for a variety of reasons. You could try getting fructosamine tested to see how it compares.

    Blood sugar regulation is complex, and individual. It’s hard for me to say more without doing a more extensive intake.

  197. Prof. Khalid says

    Dear Chris it is a great article. Two issues here (49y old)
    1. My blood sugar after 2 hrs from normal meal is 100-120
    However fasting is 110. I have low bg variance around 110 all the day.
    2. My a1c is 6.5 and does not match with my average of 110
    thanks

  198. Chris Kresser says

    Hi Emily,

    With reactive hypoglycemia (RH), it’s typical to see a big spike in blood sugar after meals, followed by a hypo. In your case, I’m not seeing any spikes at all so I’d be more likely to call what you’re dealing with plain old hypoglycemia.

    If you’ve been able to manage it with diet, that’s fantastic. Be aware that hypoglycemia is often associated with low cortisol levels or cortisol dysregulation, so that may be something you want to investigate.

  199. Emily says

    Hi Chris, thank you so much for your informative articles. I would be very interested to hear more of your thoughts on reactive hypoglycemia. I’ve had symptoms for as long as I can remember – eating moderate carb or low carb paleo helps a great deal. Not once in my life have I had a (fasting or otherwise) blood glucose reading over 100, though I haven’t done a careful two and three hour post-prandial test all together. Fasting is typically in the 70s, 1 hr after 50 g dextrose is low 80s, and other than that a few 90s over the years when not fasting. My symptoms of shakiness, sweating, and weakness occur approximately 2&1/2 hour after a high sugar meal (sugary cereal and skim milk, for example, back in the day, or a coke, which I haven’t had in 20 years due to this issue) and resolve with juice consumption or eating a piece of fruit. Once my blood glucose was checked then and it was high 60s, another time low 70s. (A aspartame diet drink while fasting, especially “cherry-flavored” will cause the same symptoms after 2 hours, though I haven’t checked the blood glucose then).

    Anyway, your more detailed thoughts on the whole topic of reactive hypoglycemia would be most welcome. I seem to have found my curative diet in any event.

  200. Chris Kresser says

    It would be the inflammation, more than the pain, that could contribute to cortisol dysregulation and blood sugar imbalance. But yes, the end result is the same.

  201. Susan says

    Chris,

    Thank you so much for your response. Could a chronic aggravating pain, such as in a heel spur, possibly be responsible for the inbalance of cortisol and/or glucagon that causes the rise in blood sugar?

    Once again, thank you.

  202. Jo says

    Lynn, I have Hashi’s, IBS, diagnosed with fibro, not yet convinced as I have chronically high inflammatory markers and signs of lupus without the ANA, kidneys at stage 2, elevated liver enzymes etc. I’ve just changed doctors and he is redoing all tests, so I haven’t modified my diet yet as I wanted to have these results without changing anything (to help eliminate factors that may be causing symptoms), then going to reexamine diet.

  203. lynn says

    Hi Simona

    Do you live in Ireland? Snap…..

    It is ILLEGAL for her to withhold your test results. You need to speak to her secretary and demand them. If that fails, send a written letter to the records department, citing the Data Protection Act 1989. If nothing within a month, threaten them with legal action. Worked for me, because they knew that what they were doing was illegal.

    T3 is available in Ireland yep. It’s not illegal.

  204. simona says

    Oh, my basal temperature was ok when I had a look at it in the morning but I’m freezing all the time especially at night when I go to bed late, however, very often it’s around 14 C in the house. I checked that website too.

  205. simona says

    Thanks Chris,

    Lynn,

    I saw a private endocrinologist in August and I think she asked for these tests, I had them done, but unfortunately I haven’t seen the results although I asked for them. She hasn’t said anything besides the fact that my LDL cholesterol is high. You would think she knows how to interpret them properly. She didn’t ask for a salivary cortisol test, so I’m just guessing there, from my experience. She doesn’t want to prescribe T3 as allegedly it is not licensed in Ireland.

  206. lynn says

    Hi Simona

    Peat is more gung ho anti PUFA’S than Stone is. A max of two eggs a day, olive oil only as a condiment and PUFA free meat such as beef and lamb.

    When one increases carbs, it can expose hidden issues. Have you had a cortisol saliva test, a full thyroid panel (TSH, Free T4, and Free T3, anti-TPO, anti-TgAb and Reverse T3) and sex hormone panel done?

    What are you basal temps? Temps during the day? Have you been to Stop The Thyroid Madness?

  207. Chris Kresser says

    Simona,

    High cortisol can cause insulin resistance, and vice versa. Low cortisol can cause hypos during the night. Insulin upregulates 17-20 lyase in women, which converts estrogen to testosterone and causes androgen dominance.

    Unfortunately this stuff is very complex and it’s impossible for me to say more without knowing the particulars of your case. There’s no one-size fits all approach. Over-feeding may work in some people whose metabolic function is still relatively intact (though under-functioning), but I don’t believe it’s a good strategy across the board.

  208. simona says

    Thanks Lynn,
    I have his free ebook. I have been low carb (50 g veg carbs) low Pufa (o6 only from meat, olive oil and eggs, o3 about 2 grams for a while, stopped it) and low sugar, low fruit, no wheat, no pulses for more than two years (aug 2008). Minimal supps. I was only increasing potatoes and sweet potatoes (see also Paul Jaminet’s blog) for the last month. I should be doing better, but still struggling with gum disease/infections, even worse than a year ago, acne, hairloss, weight loss stall. Wide ranging hormonal issues, I think, cortisol affecting inflammation, underlying androgen (5 alpha reductase) problems due to possibly inherited insulin signalling problems. Just guessing here, trying to make sense of it. Couldn’t get a clear PCOS diagnosis in the last 10 years I’m suffering of these symptoms. More recently low T3 shows the metabolism slowed down, the cause of which is not clear.

    • says

      my sugar was up last nite when i got off wotk to 177,, then todat it was 120 fasting,then after supper it was 199, then a hr later it wen to 106 it seemsthe more i move it goes down and when im stressed i havto take anxiety pills .every nite to sleep ,,plus i got a heraniated disc my bs has bee good till i hurt my back ,,,any ideas

  209. lynn says

    Simona

    If you want to try Matt Stone’s protocol, I would suggest you pick up his free RRARF eBook. His program is not just about increasing carbs; it is also very low fructose and very low in PUFA’s. There are other parts of it too.

    Also, feel free to email him. He is very responsive to emails.

    I have tried everything to get my insulin down and eight years of low carbing has done nada. So, I am trying the Ray Peat program. It is high carb too; but is extremely stringent re: PUFA, meat etc. The only thing Stone and Peat have in common with the SAD is that they both include carbs. However, thereoin they are world’s apart. Just raising carbs ala SAD won’t help at all. The biggest misconception re: Stone is that he advocates junk food and junk carbs. He does not. :)

  210. Jo says

    Thanks Lynn, these conditions have killed my brain! Am looking forward to the next article, I’ll be picking up a monitor shortly.

  211. simona says

    Hi Chris,
    I have two questions. You have been very kind and answered many already. I hope it’s not too much to ask.
    Regarding that effect of raised post prandial glucose after reintroducing carbs, I remember there was a day when I had two very small boiled potatoes in a salad with protein and fat for lunch and I felt very sleepy after a while. The idea was to help revv up my metabolism (a la Matt Stone) I got a bit scared but now (after reading Stephan and you) I understand that it takes time for the body to adapt. However, my body shows signs of previous hyperinsulinemia, like skin tags, small acanthosis nigricans, I was wondering how can I know if it’s still a problem after two years of low-carbing and losing weight. Is insulin resistance not the cause? Would high-cortisol (chronic stress) cause high insulin too and then high androgens (which is also a problem)?
    My mother has diabetes type 2 for the last 25 years or so. She has had severe hypos and some of them happen at night. What could be the reason for a hypo at 2-3 am when there isn’t much basal insulin left (taken at 8 a) Is the glucagon/epinephrine release necessary to get glycogen out of liver not working?
    Four questions, not two.

    Thank you.

  212. lynn says

    Hi Jo

    To convert US units to mmol/L, simply divide by 18. So, a US unit of 90 divided by 18 = 5.0 in the UK, Ireland and Australia units. To convert an Aussie unit of 5.0; multiply by 18 = 90.

    My blood glucose monitor is in the MMMOL/L units, but since all literature I read is in US units, I convert instantly and focus on the US number.

  213. Jo says

    Hi Chris, firstly thanks for your posts, I’ve read them all and it is helping me in my plans to manage some diagnosed and undiagnosed problems. I want to monitor my blood glucose levels as they have been creeping up in FB tests. I had an OGTT, came in under range, but not a lot. I live in Australia, is there any chance you can convert the lab values you recommend into the common ranges we have here? Our fasting levels (IMVS labs) are “normal” at 4 to 6 mmol/L, and two hours post OGTT <7.8 mmol/L

    Thanks
    Jo

  214. Chris Kresser says

    I’ve seen patterns like that in my practice and it’s pretty typical of cortisol dysregulation. That may be why your fasting blood sugar is elevated as well. The normal pattern would be a blood sugar peak 45 minutes after eating, returning to baseline by 2 hours. Something is raising your blood sugar in a fasted state, and cortisol (and/or glucagon) are the likely culprits.

  215. Susan says

    Hi Chris,

    What a timely post. I have been low carbing at about 50 carbs average per day for the past 21 months. I don’t normally check my BS but, was curious when I did do a FBS to find my morning level at 115. Then, I read about the phenomenon of LCers having high morning levels and felt a little more reassured. I have been checking my post-meal levels for the past few days and I am pretty confused. One hour after eating my level will be around 101 and two hours later it will be at 113. Even after three hours it is still going up, say to 119. I will have had nothing to eat or drink during this time. Is, perhaps, my meter not working correctly? Shouldn’t my levels be decreasing after that first hour postprandial?

  216. Chris Kresser says

    Angela,

    I think high intensity strength training is the best type of exercise for restoring and maintaining insulin sensitivity and glucose utilization. I’ll write an article about this soon.

    • Meltin says

      Hey Chris I have a very important question it’s regarding my 2 year old daughter. Ive noticed she acts weird sometimes she would ask me for water constantly or ice and would sweat uncontrollably or would just lay down for long periods. My mom, brother and maternal grandmother all have diabetes. One day I decided to check her blood sugar and it was 135 after that I kept doing it regularly and one day I noticed it went to 187 and her fasting reading would be 95 105 or 114 and so on but it would never be under 90. Is this something I should be really concerned about? I contacted her doctor and they will run tests on her but they don’t seem like its a huge concern. What would be your advice?

    • pam says

      chris – please do! i’m excited to hear about techniques we can use to keep our blood sugar in the healthy range.

  217. Angela says

    Hi Chris
    Thank you for your blog. It comes at just the right time. For the second time this year, my A1c was 6.0, so my doctor now wants me to do a 3 hour glucose test but I’ve been very weary of doing this (especially since my fasting glucose is 78). Your post-meal monitoring makes more sense to me. I know that I should be concerned that I might be pre-diabetic (even though I’m skinny). I’m looking forward to learning how to do this. Also, what kind of exercise do you feel is best to keep blood sugar levels down?

  218. Chris Kresser says

    Usually it can be addressed. It depends on what’s causing the problem in the first place. For example, if it’s “lifestyle”-related (i.e. diet, stress, sleep, etc.) and it’s early enough in the process it should be possible to completely restore healthy metabolic function. If it’s autoimmune, or has progressed long enough to where beta cells have been destroyed, then insulin signaling may be permanently damaged. In that case it would be a case of improving insulin sensitivity and glucose utilization to the fullest possible extent, and making dietary and lifestyle changes to prevent further damage. Feel free to check out my professional site and book a free 15-minute consultation if you’re interested in pursuing this further.

    • Jean says

      Chris, how can you tell if your beta cells are being destroyed? I usually follow a strict diet but at times I “just have to have something, (i.e. cookies, bread, muffin, etc.) and then my BG shoots way up, sometimes almost 300. Is it really bad to have these spikes?

      • says

        Hi Jean – hopefully Chris has the time to jump in here too – but I’ll add my 2c worth as well:

        Beta Cell function can be measured somewhat using the C-Peptide and insulin-level tests. If you have decreased levels of c-peptide (a protein) it’s indicative of beta-cell damage.

        If you have decreased c-peptide but hyperinsulinemia (high-insulin levels) – that’s usually an indicator of insulin-resistance, and it may be possible to still maintain your pancreatic function without insulin, if you reduce your carbohydrate levels enough to compensate. If you have low-insulin levels as well as decreased beta-cell function, then it’s very possible your beta-cells are damaged to the point you may need additional insulin to manage your condition, or go VERY-low-carbohydrate in order to manage your glucose.

        My own experience – I managed to damage my beta-cell function without realizing it. Now I MUST eat very-low-carbohydrate to manage by glucose levels what little insulin production I have left. I don’t need basal or bolus insulin at this point in my life, but I *DO* keep my carbohydrate intake UNDER 20g maximum per meal. 15g maximum for any snack. Depending on my activity levels for the day I may have as little as 30g of carbohydrate, or as much as 90g. Typically it’s 45-60g in a day. That’s as a 220lb man eating 3,000 calories a day, BTW. That’s how low I need to go to keep my glucose “in-check”.

        As for BG shooting up to nearly 300… YES, that’s really bad. It is physically damaging you – no if’s, and’s or but’s about it. Anything above 140mg/dl is causing damage – period. This is agreed upon by all experts in the field (with the exception of the ADA who seems to want you to be on medication and damaging yourself…) and is in position statements from both the IDF (International Diabetes Federation) and the AACE (American Association of Clinical Endocrinologists).

        Unfortunately many of us MD’s as well as nutritionists, dieticians, diabetic-educators and others go by the recommendations of the American Diabetes Association (or in my case the Canadian Diabetes Association) simply because that’s the information we’re presented. Much of our continuing education is sponsored by the pharmaceutical industry – so it’s really no surprise that misinformation is rampant in those occupations.

        Chris’ blog post here shows exactly why blood-sugar levels are important, and gives it straight, and all research I’ve ever seen shows it to be “spot-on” for targets.

        Please, for your health’s sake, keep those spikes under 140mg/dl.

        • Jean says

          Thank you Glen for that info. I’m curious – do you have to use medication/insulin? Do you eat a lot of protein? My goodness, 15 g. carbs per meal is hardly anything. I don’t know if I could keep it that low. I eat a lot of veggies plus I probably eat 3-4 fruits a day. Thanks again.

          • says

            Hi Jean – at diagnosis I was a very unhealthy 320lbs, with a fasting level of 267mg/dl and HbA1c of 12.1% … Not good.

            Initially my own doctor prescribed insulin, metformin and sulfonylureas … but after research I decided to ONLY go on the metformin and see about controlling everything else through a very-low-carb/ketogenic diet.

            As of now I have an HbA1c of 5.6% and virtually-all of my post-prandials are under 130mg/dl, unless I’m sick or very stressed. I’ve dropped 100lbs in the past year getting this under control.

            Yes, I eat considerable amounts of protein, usually a minimum of 35% of my calories – but I’m also exceptionally active. I work out a minimum of 5 days a week, (weight-training, HIIT, and cycling in the summer) usually for a minimum of 75 – 90 minutes. In the summer I’ll do 5 to 6 hour bike rides on days-off or weekends. With that level of activity I find I need the protein in order to maintain my lean-mass.

            I eat TONS of veggies – between 6 and 8 cups a day most days. I eat very little fruit. I’ll have at most two very small servings (like 1/2 of an apple or 1/4cup of berries) in a day. All the nutrients available in fruit you can get in vegetables with fewer calories and way less sugar. =)

            • Jean says

              Glen, first of all, congratulations!!! for what you’ve done for yourself! Hope I will be able to take this seriously and get my diabetes under “real control”. I must admit I find it hard to give up my fruit! I usually have a banana every morning (but at least I am trying to buy smaller ones these days). I know bananas are one of the worst for diabetes. One hour after my breakfast this morning (3 oz. turkey burger, banana and 1/3 c. whole milk, 1/3 c. 1% milk with my coffee) my reading was 167. Guess that’s not good huh? Again, thanks for your feedback.

              • says

                I used to love bananas too – and I still eat them – sort of…

                I buy GREEN bananas (less ripe = less sugar) and peel them and freeze them … then use 1/3 to 1/2 a banana in a post-workout smoothie if I’ve done exercise enough to deplete glycogen pretty severely.

                Otherwise, I just don’t eat them.

                I think you’ll find if you cut out the banana, maybe substitute an egg (from free-range chickens, if possible) and cut the milk (especially the 1%) you’ll have much better post-breakfast glucose levels.

                My typical breakfast is 2-3 eggs, 2 strips of nitrate-free naturally-cured bacon (free-range pork), and I skip the coffee too. There are many diabetics that don’t respond well to caffeine – I’m one of them. This provides me between 400 and 500 very low-carb calories (depending on the number of eggs I eat). My post-prandials at breakfast are virtually identical to my fasting numbers, maybe 10 points higher at most.

                If I’m exercising in the morning I’ll also add 1/2 slice of organic, sprouted-grain bread (no flour!) with 1/2 tbsp organic/natural peanut-butter and 1 tsp no-sugar-added organic jam – usually raspberry. This adds another 100 calories – 12g of carbohydrate, 4g of protein and 4g of fat.

                • Ganesh says

                  Hi Glen,

                  Can you give me information about Nitrate free naturally cured Bacon? What kind and where you buy them. I dont find anything without Nitrates or Nitrites, forget about the free range pork

                  Thanks
                  Ganesh

      • Chris Kresser says

        I agree, once again, with Glenn. C-peptide is a cheap and readily available way to indirectly test beta-cell function. It is definitely bad to have spikes up to 300, and it’s indicative of deteriorating insulin sensitivity and glucose tolerance. Not a direction you want to be moving in. It’s possible that by addressing the underlying causes of your condition, you may be able to recover some carbohydrate tolerance. However, if there has been beta-cell destruction, it’s likely you’ll need to maintain a low-carb diet to prevent those spikes. Your cravings can be addressed through proper nutritional treatment (identifying and addressing nutrient deficiencies). Best to find a practitioner skilled in treating metabolic issues with a natural approach. Good luck.

        • Jean says

          thank you Chris …..you say readily available …. is this a test one can do themselves …. a “kit” you can get at the pharmacy? Or do you need to see a doctor? I’m sorry, but I’m new at all this stuff (was diagnosed with diabetes quite a few years ago, but just recently took it really seriously)…… really appreciate your site. Oh, another ? ….. what do you think about the “peak” training? 30 sec. high intensity and then 90 sec. rest, etc. ?

          • says

            C-Peptide is only available from a lab. It requires special equipment to analyze – so no home test is available.

            As for training – what you’re calling “peak” training is likely what is referred to as HIIT – “High-Intensity Interval Training” and it’s by far the best exercise you can do as a diabetic – it’s also great for almost anybody – but it’s shown in several studies now to burn more fat and decrease insulin-resistance compared to moderate cardio.

            Weight-training, sprints with rest in-between, jumping rope on/off, etc. are all good examples and very beneficial.

            http://chriskresser.com/9-steps-to-perfect-health-7-move-like-your-ancestors

            also, don’t over-train: http://chriskresser.com/why-you-may-need-to-exercise-less

          • Chris Kresser says

            You’d need to see a doctor to get cystatin-C. What I meant by readily available is that it’s not an exotic test your doctor hasn’t heard of. Any Labcorp or Quest lab can do it.

    • LEVI PAGUNSAN says

      what do you mean by low carb? can this be followed just by anyone? is carbohydrates the culprit of causing diabetes? would you pls tell me the cause of diabetes? because if the real cause is identified i think the problem of what kind of food to eat will be settled.

  219. Mark T says

    Chris, thanks again for your advice. So do you think I should eat a low-carb diet, monitor BG to keep it under some level (140?), occasionally check HbA1c, and continue to exercise regularly? Should this prevent further trouble? Can the metabolic problem be improved, or just worked around carefully?

  220. Chris Kresser says

    Mark: if you’ve always had that response, and if you feel sleepy after carby meals, I wouldn’t recommend the carb re-feeding. That’s indicative of a metabolic issue, and it’s probably not wise to potentially push your blood sugars above 200 in light of this.

  221. Mark T says

    Thanks for your thoughts, Chris. I may give your carb-up test a try. I think I may have always had this response to carbs, at least the reactive hypoglycemia part. I get a little sleepy after an unusually large meal, which in the past has always meant a meal with plenty of carbs. I used to think everyone reacted that way. Maybe my mom’s side of the family (where the CVD is occurring) all have this too, staying mild enough to not trigger investigation for diabetes, but causing damage. My wife (a doctor) and a friend (a nurse) both are very skeptical I could be T2 diabetic, perhaps because I am not overweight and seem healthy. But BG of 237 is not healthy! Do you think I should get a HbA1c test to assess the current damage level?

  222. Chris Kresser says

    Mark: that kind of pattern is consistent with reactive hypoglycemia, which is often the earliest stage of the progression towards diabetes. I’m glad to hear you’re now eating low-carb, as BG of 237 after a potato is definitely cause for concern.

    If you’ve been LC for some time, it’s possible your body has adapted to burning fat and that’s why your glucose tolerance is impaired. The only way to find out would be to eat a higher amount of carbs over a 3-day period. If your blood sugars start to come down, it suggests you are adapted to fat burning but don’t have metabolic damage. If your BG stays high, it suggests you’ve got some metabolic damage that needs to be addressed.

  223. Mark T says

    Chris,
    This is very interesting. I recently started eating fairly low carb, trying to follow the guidelines of the Perfect Health Diet (thanks for reviewing that, great book!) Then I got a FBG among other screening tests, because suddenly three elderly members of my family have been stricken by cardiovascular disease. The FBG was 110 mg/dL, causing me to investigate and freak out. Using a cheap glucometer I found evidence of the “dawn phenomenon” (83 mg/dL fasting usually, but 95-100 in the morning, have not repeated the 110 lab value). More shocking, I ate 8 oz of potato and it spiked my BG up to 237, down to 169 at 2 hrs, then mildly hyperglycemic (70 mg/dL) for a couple of hours. Response to a normal low-carb dinner was pretty benign. I did not mention the potato test to my doctor, who is unconcerned. I don’t know what to think. Looking forward to your next post!

  224. Chris Kresser says

    Not necessarily. It’s common for LC folks to have FBG in that range. Presuming your A1c and post-meal numbers are good (which it sounds like they are), I probably wouldn’t worry about it. As your body becomes accustomed to burning fat for fuel, insulin sensitivity decreases. This can cause a “dawn effect” where FBG is higher than you’d expect it to be.

    Some people find that adding a moderate amount of carbs in the form of safe starch, for example, helps normalize their blood sugar.

    • Melissa says

      I am a 51-year-old female, I weigh 108 lbs, and on most days I eat between 70-80 grams of carbs per day, most of which come from white rice. Before finally landing upon this eating routine, I would feel light-headed and disoriented within a couple hours of eating a meal (of meat, whole grains, beans, veggies, fruits, dairy). With my current eating routine of mostly meat and fish and white rice my blood sugar problem (if that’s what it was) seems to be under control. As added benefits, I am able to maintain my weight quite easily and my digestive problems have resolved.

  225. Jay says

    Another great article, Chris. I’m puzzled by my FBS being around 95-99 but frequently my 2 hr post prandial will be below 90. Shouldn’t the FBS come in lower? Is this a morning cortisol stress response?

  226. says

    Chris

    Just read your replies on Whole Health. Here’s something to test on people you know who spike easily. Give them a NSAID for two or three days. If their blood sugars cease to spike then it might be a glucose desensitization issue. The has to do with inhibiting COX-2 and PGE 2. I’m reporting on this on my blog.

  227. says

    Chris

    Thank you for doing this topic. I write a diabetes blog and I try not to club the ADA all the time but those guidelines always seem to pop up. They are a major problem because they give people a since of security that they shouldn’t have.

    I was actually thinking about this just before I read your blog. I’m a type 2 ketosis prone diabetic with a family history of diabetes and because of this I view the ADA guidelines as nearly tragic for people like me. I’ve come to a decision that I’m going to tell people in my family what are the real guidelines for diabetes. Basically, I’m taking the FBS ADA guidelines and using them for everything. Less than 100 is normal. 100 to 120 is the prediabetic range and above 120 is diabetic. I know that sounds pretty drastic for postprandials and the like but I would rather my children and grandchildren have a chance for a healthy future.

    I wrote a long blog on hemoglobin and A1c and put up charts of the people who are most likely to have these sorts of problem, whether they are diabetic or not. Interestingly enough, this seems to match up with peoples that live where Malaria or Malaria like diseases occur.
    http://ketosisprone.blogspot.com/2010/10/a1c-glycation-problems-and-dka.html

  228. Chris Kresser says

    Julie: also note that some people actually experience better blood sugar control on a moderate carb. diet than a low-carb diet. I suspect this is related to the phenomenon I described above, where introducing some carbohydrate gets the body accustomed to burning it again, and probably prevents cortisol and/or epinephrine from getting involved.

  229. Chris Kresser says

    Julie:

    I didn’t mean to imply that it is never a concern; just that it may not be a concern. It depends a lot on what your post-meal and A1c levels are. For example, if you wake up at 105 mg/dL but drop down in the 80s soon after, and stay between 80-120 for the rest of the day, I may not be concerned (I’d also have to consider your symptoms, micronutrient status and other clinical variables).

    However, if you wake up at 105, never drop below that level, and experience post-meal BS of above 140, then I’d be concerned. Those are two totally different patterns.

    The studies that were done showing FBG >95 causing harm were likely done in people eating the Standard American Diet (for the most part). I suspect had the researchers tested their post-meal blood sugars, they would have been high. So I’m not sure we can extrapolate those results to someone eating a low-carb diet. I believe there are some studies showing that higher FBG with normal post-meal BG doesn’t predict future diabetes, but the opposite is not true, i.e. studies show that you can have a normal FBG, but if you have elevated post-meal BG you’re still at risk.

    This is a complicated topic and several variables are involved. Check out an interesting article and discussion in progress at Stephan Guyenet’s blog. Make sure to read the comments.

    • Juliann says

      I stumbled on this thread quite by accident, but this could be a total paradigm shift for me. My blood sugars have been out of whack for years – usually low. But stayed having high FIG readings so I went low carb. But the numbers get worse. I’m going to scour and devour this site. First thing – your 3 day increased carb challenge. Question: menopause seems to have really mad things word. Advice?

  230. Julie says

    Chris: if, as you state, “low-carb diets induce insulin resistance,” why isnt it a cause for concern? I went low carb some time ago, no processed foods or bad oils, lost 20 lbs, do regular strength and resistance training, A1c 5.3, post-prandials <120, usually <100, very low BMI and BFP.

    But now my FBG levels are as high as 125! (Used to be 87) I guess I don't get the logic behind the assurances that a low-carb diet "may not be a cause for concern" when in the same article you quote studies showing diabetes risk in people with FBG levels above 95. Type II diabetes runs in my family, including those who are not overweight. Does someone like me need to be concerned? What are the botanicals and nutrients you refer to that can improve insulin sensitivity?

  231. Chris Kresser says

    Could also try high intensity strength training, to make sure you’re really depleting muscle and liver glycogen occasionally. Something like Body By Science.

  232. Chris Kresser says

    There are a number of botanicals and nutrients that can help improve insulin sensitivity. You could also try intermittent fasting, provided your cortisol levels are not out of whack.

    • Sharon says

      In February 2011, my cortisol level was 17.3. My naturopath at the time told me it was too high.
      My insulin tested at 3.0 and my A1c was 5.8.
      Is there any suggestion on how to lower AM cortisol? He never really gave me any help on that and he is no longer in my employ for a myriad of reasons.

      My new practitioner is a typical MD and he told me I didn’t need a fasting insulin test, a CRP or homocysteine test. He gave me some lame explanation about my other numbers indicating the information. Finding a good doctor is almost impossible these days. Even the naturopaths really don’t know what they are doing.

      My last total cholesterol (Sept. 2011) was 236. HDL 68, LDL 153, Tris 75.

      I do have stubborn belly fat that I have had most of my adult life but I’m losing some of it as I work on my diet.

  233. Lynn says

    Any other thoughts on correcting IR? I read all your posts and I watch my carbs, eat a strict gluten free diet, limit vegtable oils (I have recently gone further and embraced an extremly low PUFA diet, so no more bacon etc. for me) and get good sleep. I also take metformin and natural thyroid.

    Despite all of this, my insulin is never below the magic 10. Any ideas on what I can do?

  234. Chris Kresser says

    Lynn: I think there’s wiggle room here, and it depends somewhat on the metabolic function of the individual. But I don’t consider 150g to be low-carb. I’d say that’s more in the realm of “moderate”. I’m thinking more like 100g and below.

  235. Lynn says

    Great article. You mention that FBG can be elevated on a low carb diet. What do you consider a low carb diet to be in terms of grams? Anything under 150g a day or do you mean a keto diet?

  236. Chris Kresser says

    Thanks, Lacie. As for your BF, it could be a reactive hypoglycemia pattern, where the insulin surge after meals is too high, and he goes into a hypoglycemic state (which produces the extreme hunger). Cortisol dysregulation is often involved in this situation.

    • PK says

      I think I might have this issue also, extreme hunger shortly after meals(carb cravings) and also lately extreme fatigue 1 1/2 – 2 hours after some meals. If it is reactive hypoglycemia, what does one do to fix it?

      • HungryBetty says

        I was diagnosed with reactive hypoglycemia when stroke like symptoms presented themselves after eating quinoa for breakfast. (I had been eating more whole grains than I usually did that week.) The only thing that helped me was to cut out all sugars completely, (fructose, lactose, natural, artificial – if it was sweet, I didn’t eat it or drink it) and not eat any carbs EXCEPT if they were from certain types of vegetables like broccoli (no potatoes, or other overly starchy veggies). And, when I ate a veggie, I had to pair it with a protein. No nuts, except for a banana with peanut butter prior to a 4 mile run since then my body would use the sugars from both over time and I wouldn’t pass out. :0)

        Basically, all I ate was meat and dairy for three months straight (beans act like carbs, so they are also a no-go).

        My body reacted very well to this modified Atkins diet, but I could see someone having a heart attack if they stay on it too long. My sugars have been better for over 9 months since being that super strict for 3 months.

    • Beth says

      Hey Chris I have type 2 and have been on metformin but here lately I have had issues where my blood sugars drop after I eat they latey has not went over 110 and an hour later they are down to 83 I’m not on low carb but I don’t eat a ton of carbs I follow the servng guidelines I have been scared to take my metformin due the low numbers any idea strberigrl@gmail.com

  237. says

    Chris, this is some of your best work. My BF and I are two months into a low carb diet and my blood sugar has stabilized, but he still has extreme hunger between meals and has to eat 4x a day. Can’t wait for your third installment where you show how to check blood sugar between meals–I suspect he has some insulin issues that I don’t have.

  238. Chris Kresser says

    Did you read the article? The whole point is that the mainstream targets you learned in your CEU class are not supported by the scientific literature. An A1c of 7% maps to an average blood sugar of 172 mg/dL. Studies clearly show blood sugar that high dramatically increases the risk of cardiovascular disease and diabetic complications. The same is true for a fasting blood sugar above 95 mg/dL and 2-hour post-meal / OGTT readings above 140 mg/dL.

      • says

        Actually Laurie, it depends on which formula you use.

        Chris’ measurement was from the DCCT formula. There are SEVERAL formulas for determing eAG (Estimated Average Glucose) from A1c, including the ADAG formula you mentioned.

        Unfortunately, none are perfect or correct in every instance. I’d rather estimate high than low, personally.

  239. Bridwell CPhT says

    K… Don’t know where or how old this info is. I’m work in pharmacy and just took a CEU on Diabetes that the info is good on for the next two yrs. Normal is 70-130 and a1c of 7%. So… wondering what source is being used for these statistics. You can view mine at wwww.powerpak.com look for the CEU on Diabetes.

    • Glen Anderson says

      The AACE (American Association of Clinical Endocrinologists) and the IDF (International Diabetes Federation) are BOTH recommending Lower targets than the ADA (American Diabetes Association) which is where you get your numbers from, Bridwell.

      The IDF mentions the following targets:

      HbA1c 6.5%
      BP 130/80 mmHg
      Total cholesterol 4.5 mmol/L (174 mg/dl)
      LDL-cholesterol 2.5 mmol/L (97 mg/dl)
      HDL-cholesterol 1.0 mmol/L (39 mg/dl)
      Triglycerides 1.5 mmol/L (133 mg/dl)
      Urinary albumin:creatinine 2.5 mg/mmol (22 mg/g) – men
      3.5 mg/mmol (31 mg/g) – women
      Exercise 150 min/week

      Both the IDF and the AACE also recognize the importance of reducing refined carbohydrates and starches to achieve these goals. They don’t come outright and recommend Paleo or LCHF diets, but they do recognize better glucose control in those that adopt those diets than in those that maintain a typical (western) diet.

      BTW, the primary source of funding for the American Diabetes Association is Pharmaceutical and Processed food companies. I don’t have stats for every year, but in 2005 alone Big Pharma and Big Agro/Food companies gave them 23 MILLION DOLLARS. It’s only been increasing since then.

      Regarding post-meal glucose, in the IDF “Guideline for the management of post-meal glucose” (the most-recent version) they clearly state: “The new IDF guideline recommends that people with diabetes try to keep post-meal blood glucose below 7.8 mmol/l (140 mg/dl) during the 2 hours following a meal.” Not just AFTER two hours following, but DURING. In other words, no spikes at 45 minutes, one hour or two hours…

      The ADA still states 10.0 mmol/l (180 mg/dl) is a safe spike, which is ludicrous since every study done shows damage starts at 7.8 mmol/l (140 mg/dl)

      Interestingly, the ADA tries to look good by being a member of the IDF … but they’ve yet to adopt their protocols, as doing so would mean they could no longer accept money from companies that make money of cheap cereals that spike sugar. I mean, Honey-Nut Cheerios – one of the highest glycemic cereals around – covered in high-fructose corn syrup and other sugars had the ADA seal on it…

      • Lance says

        The ADA is sponsored by drug and food companies, they want you to keep using their products so of course they are going to say higher limits are “ok”, take anything the ADA says with a grain of salt, remember its your health, not theirs!

      • Chris says

        This is an interesting post, Glen. Thank you for your diligent research. Can you post the source for the numbers you post? I am above each of those numbers but below the US guidelines in all cases. Would like to better understand the difference. Thanks,

      • Salman says

        I’m not 100% sure about this, but even if over 140 causes nerve damage… The rationale for ADA I think is that at that rate nerve damage will take 100 years to translate into an actual problem for you. Vast majority of people are not going to be in this world 100 years from now, so whats the point of limiting yourself for no reason.

        180 is likely the number they came up with beyond which you are likely to see complications in THIS life.

    • Linda says

      My Doctor says I am Diabetic. My A1C was 5.1 and my average fasting is 105-109
      2 hrs after a meal is 95-112 (lowest to highest)

      I am confused with these numbers and would like to know why she is considering me diabetic.

      • Andrew says

        Linda there is no way these numbers are diagnostic for diabetes. The fasting readings imply impaired fasting glycemia, a possible pre-diabetic condition but not necessarily if you control risk factors. The A1C & post meal figures look completely normal.

    • Mike says

      Remember that the drug and insurance companies benefit by classifying as many people as diabetic as possible, particularly people who are, in fact, not diabetic. This will aid in (a) selling drugs and meters/supplies, etc., and (b) increase the amount of premiums coming in.

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