How to Prevent Diabetes and Heart Disease for $16 | Chris Kresser

How to Prevent Diabetes and Heart Disease for $16

by Chris Kresser

Last updated on

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

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

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

I love this technique because it’s:

  • Cheap. You can buy the equipment you need for $16 online.
  • Convenient. You can perform the tests in the comfort of your home, in your car, or wherever else you might be.
  • Personalized. Instead of following some formula for how much carbohydrate you can safely eat, this method will tell you exactly what your carbohydrate tolerance is, and which carbs are “safe” and “unsafe” for you.
  • Safe. Unlike the oral glucose tolerance test (OGTT), which can produce dangerous and horribly uncomfortable spikes in blood sugar, this strategy simply involves testing your blood sugar after your normal meals.
The strategy I’m referring to is using a glucometer to test your post-meal blood sugars. It’s simple, accessible and completely bypasses the medical establishment and pharmaceutical companies by putting the power of knowledge in your hands.

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

Step One: Buy a Glucometer and Test Strips

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

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

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

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

Step Two: Test Your Blood Sugar

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

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

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

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

Step Three: Interpret Your Results

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

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


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

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

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

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

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

If you’ve been eating low-carb for at least a couple of months before doing the carbohydrate challenge on day three of the test, you can subtract 10 mg/dL from your 1- and 2-hour readings. This will give you a rough estimate of what your results would be like had you eaten more carbohydrates in the days and weeks leading up to the test.

It’s not precise, but it is probably accurate enough for this kind of testing.

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

Step Four: Take Action (If Necessary)

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

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

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

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


Join the conversation

  1. What type of diet is recommended for reversing diabetes type 2? Should I eat to the glucometer? I’m having a hard time finding a medicine that I can tolerate. I could stand to lose a lot of weight. I’ve lost 45 lbs. Thanks

  2. I tried to read through all the comments but I didn’t see the answer. On the 3rd day, it says eat 60-70 grams CHO, and no fat, but can I include chicken or vegetables?

    • Not sure what Chris’ answer would be, but I would guess you should just have the starch. He did say “instead of eating your typical lunch.” Protein and veggies can definitely slow down the absorption of glucose into your bloodstream, so I would personally just do the carb.

    • no. the point is you eat only the carbohydrates specified, and nothing else that would impact how your body processes carbs into glucose. additional protein (chicken) would slow that down. addition carbs and fiber (veg) would impact it as well.

  3. The one thing i haven’t seen mentioned here is if you have issues at the 3 hour mark. I had a fasting 3 hour glucose test done at the clinic back in 2014. I’ve been told i have pcos which can affect blood sugar. My results were as followed after drinking the sugar drink…
    1 hour: 152
    2 hour: 108
    3 hour: 35

    Why would it drop SO low? I felt fine- just hungry. They unfortunately forgot to do insulin during the test- that was just glucose. My a1c came back at 5.7 about a week ago. Ice also had 2 unexplained really early miscarriages. Amy input would be greatly appreciated.

    • Some people have more of a tendency to get hypoglycemia than others. Sugary stuff is more likely to cause it since the quick highs it causes are more likely to lead to lows. The bodies of people with hypoglycemia tend to overreact by producing too much insulin. Even if you didn’t feel really sick, it sounds like you need to be particularly careful to avoid sugar. The solution is frequent, small meals that help to keep your blood sugar from going too high or too low.

      (Please ignore the part about low fat. It is unfortunately still conventional dogma.)

    • what’s probably happening here is that your pancreas produces insulin to clearing the glucose from your blood, but it’s not enough because you’re insulin-resistant – so your BG goes up. but then in response, your pancreas ends up flooding your system with insulin, which eventually clears out the high levels of glucose and then some — and voila, you have low blood sugar. this is a common pattern among diabetics / prediabetics.

      btw, the other solution, other than frequent small meals, is to eat a diet very low in carbs and high in fat, ie. ketogenic. this way your blood glucose never goes high OR low, and you don’t have to constantly be eating throughout the day.

  4. I have 2 questions:
    1. My baseline after many days of testing at different times seems to be 85mg/dl. Does this mean that the spike in blood sugar I am looking for should be adjusted since I seem to be on the low end?

    2. Does your blood sugar levels rising after a workout sound normal, and if so should you wait for it to go down before eating? Most often it will be higher (say 120) and then I eat my breakfast immediately after and an hour later (maybe 2) it is back down to 85.

    • Because the difference between 85 and 86 is like splitting hairs, you may be missing the point. As written in the post, “the goal is to make sure your blood sugar doesn’t consistently rise higher than 140 mg/dL an hour after a meal, but does consistently drop below 120 mg/dL two hours after a meal, and returns to baseline (i.e. what it was before you ate) by three hours after a meal.” In other words your BG shouldn’t regularly go real high, and it should return to “normal” after a few hours every time you eat something. If you’ve been exercising and it’s elevated some when you eat doesn’t matter; after a few hours it should return to “normal.” So what if it doesn’t? Then you may be insulin resistant, prediabetic or worse, and you need to be looking at making life changes to prevent diabetes.

  5. I seem to have the opposite issue- low blood sugar after eating. My fast BSG is usually in the low 80’s. A typical breakfast, 2 eggs, a little meat, and maybe have a sweet potato. 1 hour later I feel terrible and my BSG is 65-68. 2 hours after breakfast my BSG is 75-80 but I still feel crummy. If I have 50 grams of carbs, swet potato or white potato, for breakfast, my BSG at 1 hour is low 100s, and mid 80s at 2 hours, and I feel fine. From what I’m reading these low blood sugar may be from a overly large insulin release and might indicate that I’m insulin resistant. But if the cure to insulin resistance is to lower my carb intake, how so I so that without feeling like crap? Any thoughts are greatly appreciated.

    • Protein helps to stabilize blood sugar. Maybe an increase in protein would do you good. Also make sure to eat enough healthy fat. Lean protein and carbs together without fat would cause me major reactive hypoglycemia.

      • Airia, read his question again –
        the meal higher in protein caused him more problems with hypoglycemia. ‘Eat more protein for breakfast’ is not the answer for everyone.

  6. Here is question for you folks, that know more about this blood sugar thing then me……..when I wake up in the morning after a 12 hour fast….my sugar is in the 107-108 range…..testing during the day between meals it drops to the 90’s….even high 80’s…a safe range……..why after sleeping all night is it over 100….doesn’t make sense…….

    • Are you eating a low carb diet? Physiological insulin resistance is a common occurrence among low carbers—Google it for info . I had this issue and when I increased my carbs, the problem was resolved.

      • Hi there.
        I have the same issue.
        I am not sure how insulin resistance is the problem as someone else mentioned because your issue is earlier on in the morning.
        My educated guess for myself is cortisol. Cortisol is high in the morning and causes the release of sugar into the bloodstream.. My blood sugar is correlated to my cortisol level aka stress level/feeling. Always lower in the evening.

    • Just as exercise can cause your body to use insulin more effectively (the reason why exercise is included in life-style modifications for diabetics), rest can cause you to use it less effectively. This is part of what is known as Dawn Phenomenon.

      • what can we do about this?……I’m trying the bitter melon tea method before sleeping and when waking up in the middle of night….but I haven’t seen any change yet

        • well, an update…been on a low carb/no sugar diet for over 3 months and all my numbers are now good!….lost weight…( I didn’t really think I needed that)…but it did the trick……it is the sugar….I m convinced……even the dawn effect has dropped into below pre-diabetic range,

          • Hi Brian, I’m having the same issue as you described. How long were you low carb/no sugar until you noticed the morning BSL come down? And did you cheat at all in those 3 months?

      • thanks for the info Charotte……..the low carb diet seems to be correcting this issue……will have to wait and see……

  7. I am a T2 diabetic and for the last few years have had pretty good glucose and A1C levels with the help of Metformin 2x/500 and Tanzeum (6.1). My doctor took me off of Tanzeum after my total hysterectomy since my levels were good. After the surgery I began menopause, and now my levels are unbelievable high-fasting average 160, two hours after meals (around 200) and A1C (7.3). I exercise every day, eat a low carb diet, and drink coffee in the morning and water the rest of the day. I am so upset that I cannot lower my numbers, any suggestions? My doctor is threatening to put me back on Tanzeum and I really don’t want that.

    • I had 6.0 a1c, and 125 FBG while 220 lbs and on a std US type diet but without the junkfood. Meat at least daily, usually 2 or 3 times. I went whole plant food diet for other reason: coronary calcium score of 579 *very serious problem*. In a year I lost 40 lbs and a1c went to 5.5, fbg went to 97. But…this was using 2 x 750 metformin at same time, so… Anyway, interestingly my protein level went from lower-normal to mid-normal range on the plant diet with no meat or dairy. Before the metformin, but while on the plant diet, my urine test strips stopped turning colors, too, meaning postprandial glucose did not trigger the test anymore, even without metformin. I’ve heard that the whole plant food carbs are less trouble and raise insulin sensitivity, too. I have not added much exercise, this was by diet. The theory is the fat inside the cells goes away so insulin works better on this diet. Good luck with your efforts. Bob

  8. My father is a heart and diabetic patient from last 6-7 years. He takes a proper diet as well as he walks about 45 minutes daily in the morning but his blood sugar level is not decreasing. What should I supposed to do now?

    • This is a complicated, controversial issue with no quick, easy answers. You didn’t mention what he is eating or what pills he is/isn’t taking. Food is probably the most important issue. Some people swear by various supplements.

      IMHO, I would start by cutting out juice/soda if he is still drinking that, and cutting down on fruit and starch, if he is willing. If you want to help him, you and he will have to do your homework. I would start with Robert Lustig, MD’s books and youtube videos and Gary Taube’s latest book: The Case Against Sugar.

    • What is a “proper diet.” Most of the public dont have a proper idea of what a proper diet is. I would not be eating any carbs, and no sugar alcohols or fruit. Eat meat and leafy greens and fats like butter, olive oil, avocado.

      • I am currently enrolled in a FREE course given by Medicare. It is all over the nation, my Endocrinologist has a poster & referred me. Medicare wants to lower the cost of taking care of diabetes by educating the public. (Their words). Proper eating habits are a big part of it. The book they use (verbatim) is “Living a Healthy Life with Chronic Conditions”, the information comes from Stanford University School of Medicine. I feel the info is quite informative & of course as the title implies is for many conditions. The chapters for diabetes (if this eases the reading) in the order of the course are 1,2.11,18,5,6,12,8,9. They mention page #s too, which may not be in those chapters. Good Luck!

    • There was a Newcastle University study where an 8-week 800 calorie diet (600 calories on meal replacement sachets + 200 calories of non-starchy vegetables) reversed type 2 diabetes on some patients.

  9. I dispute the assertion that a low-carb diet makes you less tolerant of dietary sugar. I’m Type 2 and have been eating low-carb (lower and lower with time, until now I eat fewer than 30 grams of carbs per day) for over a year. As my A1c has lowered (from 10.2 to 5.0), I have become much MORE tolerant of sugar. I can now eat a “protein” bar that has 5 grams of sugar (8 total grams of carbs) without my BG going over 110 in the following hours. A year ago, when my dietary carb intake was much higher, such a bar would spike me above 150. Through this low-carb diet, I have pretty much normalized my BG without any drugs or insulin.

    • that’s what I want to hear….I was just told I’m prediabetic, never had this before, I work out, I’m slim…good diet…well, that’s about all I can do is cut some carbs and hope it works!

      • That’s sort of a strange argument that person is making. If you’re eating practically no sugar, your ability to tolerate it really is much less of an issue.

  10. My question is about hypoglycemia. I find a lot more written about diabetes and high blood sugar, than I do about low blood sugar. I eat a whole foods, varied diet. My carbs come from veggies and fruit, not simple carbs. I did the 3-day glucose test and after eating the rice my blood sugar spiked to 162 one hour after eating. My other numbers are in the mid to high 70’s and low 80’s. but in the low 70’s I get shaky, lightheaded, hungry. Do I just need to make sure I eat every 2 hours? I’m assuming those in between snacks should be fat/protein snacks.

    Thanks for posting this! It is so useful to see what my numbers really are.

    • Hi,

      I’m not sure what Chris Kresser has on hypoglycemia. It was a big thing in the ’70s, but it’s mostly forgotten now. I don’t have it, but my Mother did.

      I think the main thing is to keep your blood sugar stable. Major highs lead to sudden lows. So, yes you need to eat frequent, small meals that include protein & fat to lower the glycemic index. It’s particularly important not to eat too much sugar at one time, because the blood sugar high it causes will lead to a crash.

      This especially applies to juice, particularly orange juice. In the ’70s a doctor told my Mother to drink orange juice when her blood sugar felt low & that led to more crashes. Now it’s milk, if you can tolerate that.

      I remember reading a theory somewhere that hypoglycemia is a symptom of too much copper/copper poisoning. It’s not surprising that in those days, copper pipes were common. It’s worth checking to see if you have them where you live.

      Interestingly, High fructose corn syrup is supposed to interfere with copper absorption. There’s also much more fructose in the diet, so now we have an epidemic of diabetes.

      Hope this was helpful.

    • You are dependant on carbs. You should try a low carb diet, where you body no longer needs carbs every few hours for immediate fule. you wont be hungry or have highs or lows. You will feel better, you will be in the best shape of your life. Try it. Just need to get through the first week of getting used to burning fat as fuel.. You will feel “funny” for a few days.

      • I also have hypo glycemia issues starting about six months ago. I eat a low carb diet. Below 82 I begin to feel strange, below 75 I begin to sweat and shake.

  11. Hi there – I am a type 2, officially in 2011, on Metformin 2-500 ER. My last A1c was 5.7 which my doctor was really happy about. I eat about 75-100g carbs, 30 minutes of cardio every morning, lift weights, and weigh 105# at 5’3″ (I’ve been the same size forever except when pregnant). My morning numbers range from 95-115 mg/dL. I exercise when I get up and my number varies about 5 mg/dL up or down about 10 minutes after exercise. I rarely test below 90 even after not eating for hours – usually 100-120.

    dinner at 6:30 – 60ish carbs: split pea soup, grilled cheese, mandarin orange slice. 92 mg/dL
    30 minutes later
    1 hour 165
    1.5 hours 159
    2 hours 141
    2.5 hours 110
    4 hours (bedtime) 104

    dinner 102 mg/dL, had turkey pot pie around 40 carbs.
    hungry 3 hours later so tested – 150! no clue what happened during the 3 hours.

    108 upon rising, work out 30 minutes, eat breakfast of 2 eggs and toast (22 carbs). 40 minutes after eating 161.

    I feel like I take forever to not only spike but to also come back down. Am I right? Should I be worried? Does the body get used to high glucose numbers and think those numbers are normal? Suggestions?
    Thank you

    • What are your fasting blood sugars? The standards for prostprandial (2 hours after eating) and fasting blood sugars are different.

      Fasting: over 100 is considered pre-diabetic/insulin resistant & over 129? is diabetic (used to be 140)

      Postprandial over 130 is pre-diabetic/insulin resistant
      200+ is diabetic

      Also blood sugar meters are only accurate +/- 15% so if your real blood sugar is 100, the meter could register from 85-115.

      Nevertheless, because you have Type II, I would try to gradually lower my carbs permanently as far as I could tolerate.

      It’s especially important to avoid anything with lots of fructose like juices, sweet fruits like bananas & dates, and of course soda & candy. Read labels–it’s amazing what manufacturers will put sugar in & call other names like high fructose corn syrup, raisin syrup, coconut sugar, agave, corn syrup, fructose, sucrose, etc. Don’t overdo fruit in general–eating lots of fruit to compensate for no more candy was my Father’s mistake. Fructose increases your insulin resistance.

      IMHO many physicians still recommend diets that feed their patients way too much sugar. It’s better safe than sorry. Diabetes has some extremely nasty complications. You don’t want to start losing your toes or end up on dialysis.

      Your sugars aren’t all that bad, yet. Just watch it. Remember that no one’s perfect & you will have good days & bad days. Hope this is helpful. Good luck.

          • I second that. Take the word “fruit” out of the phrase “healthy fruits and vegetables”.. fruits are overall not healthy for you. Veggies have much more nutrients and fruit, especially fructose goes straight to fattening up your liver and increasing insulin resistance. Still see people getting Fruit smoothie and thinking they are being healthy. *shakes head*

    • Forgot to mention. Many people’s blood glucose levels can actually go up if they don’t eat for more than three hours because their liver dumps sugar. (It’s a natural process gone wrong originally meant to keep you from dying from low blood sugar.) It especially happens at night & is called Dawn Phenomenon. Your fasting blood sugar can actually be higher than your postprandials if your liver dumps more sugar than you eat.

  12. This article explains in full details how I can measure my blood sugar level and know if I’m pre-diabetic or diabetic or normal. But, it doesn’t say anything about preventing it! How can blood sugar measuring by itself could prevent diabetes?! The article doesn’t say much about what to do If the readings are not “normal”. Keep measuring?!

    • The reason for measuring your blood sugar on a regular basis is to see which foods raise your sugar more than others. This can actually be different, depending on the individual. Obviously, then you avoid the foods, or amounts of foods, that raise your blood sugar more.

      Be careful. Home glucose meters are not that accurate. They are only required to be within +/- 15%. So, your actual blood sugar could be 100, but you could get a number anywhere between 85 and 115. The numbers you get do provide a general guideline.

  13. I’m quite confused – on day 1 of testing sugar. My fasting blood sugar was 99, before lunch was 88. One hour post lunch was 110, two hours was 111, three hours was 92. Does the fact it was still rising between 1-2 hours mean there’s an issue with insulin resistance, despite the fact the values are in line with the table (aside from fasting which I know is a bit high).

    • Your numbers are well within the +/- 15% variability of home meters. For example, if your actual blood sugar was 100, the meter could read anything between 85-115, as permitted by government regulations. They’re really meant to help really sick diabetics regulate their insulin dosages, and they often get readings as high as 200-300, unfortunately, so anything close to 100 is considered OK.

      Professional tests are much more accurate and extremely more expensive.

      You’re fine. Don’t worry. Just don’t eat sugar & don’t overdo carbs.

      • Thanks for the reply Robyn, that’s a relief! I’ve done the other few days worth of checking and the fasting is a bit all over the place but still within range if you factor the 15% margin of error. Interestingly my post-meal sugar after the potato challenge was only ever so slightly higher than the lunch I had the first day which was considerably lower carb. I do really need to lose some stubborn weight that won’t budge so I think ditching the sugar and reducing the carbs is a good idea anyway. Thanks again for the reassurance 🙂

        • It’s good for both thin and fat people to avoid sugar.
          (You can be thin & still get sick. For example, thin people can still get Type II diabetes. The majority of fat people DON’T have it.)

          Don’t get discouraged or stop if you don’t lose weight. Most diets are ultimately unsuccessful –for weight loss– despite what you hear in ads & media. Just keep going.

          All of my elderly relatives were fat until a few years before they died–when they suddenly LOST weight–and they all made it to 80+. In fact, my Great Aunt made it to 97. (Her Doctor was still trying to get her to lose weight into her 80s.) Of course, she didn’t like sweet desserts. I guess they didn’t eat that stuff where she grew up in the old country.

          You’re doing the right things. Don’t worry so much. Stress is bad, too. Glad I could be of help.

  14. I’m glad I ran across this site. I had my first abnormal A1C results. It came in at 5.9%. My fasting blood glucose was 85. For the past 12 years, my FBG range is between 75 and 85 w/ no specific trends. I immediately kicked into high gear on my diet. I cut all sweetened drinks and moved to water only. After seeing this site, I moved to a low carb diet. I took it a bit further and I cut my calories to less than 1,000 per day. Veggies, proteins, and low carb.

    I purchased a glucose monitor and I started taking my post meal readings over a 14-day period. The first 5 days, the meter said my FBG was between 80 and 90. On day 6 it gapped down to 70 to 75 for the next week. Does this sound right?

    My meter now says my average glucose is 94.

    During those 14 days I tried a few experiments.

    Test 1. IHOP. 1200 calories for breakfast. Approx. 107g carbs total.
    At 1 hour. 141. I freaked. 2 more tests (different fingers = 127). Do I average those?
    At 2 hours. 127 (again)
    At 3 hours. 120
    At 4 hours. 85
    Question. Are these results ok given the fact that I ate 60% more carbs that what Chris called for in this article?

    Test 2. Single nutrigrain bar. Refined sugars (of course) 24G carbs.
    Hour 1. 115 glucose
    Hour 2. 115 glucose
    Hour 3. 80

    Test 3. Big corndog. Pot stickers. Vegetables. Tomatoes.
    Hour 1. 92
    Hour 2. 97
    Hour 3. 94
    Hour 4. 100.

    Test 4. BIG dinner. 2 beers. 2 red wines. Halibut w/ Pasta. Sourdough bread. Salad. Cheesecake.
    Hour 1. 83 glucose
    Hour 2. 89 glucose
    Hour 3. 100 glucose.
    Hour 4. Fell asleep. Didn’t get the reading. But I woke up the next morning with an 83.

    Test. 5. Typical smaller meal (w/ healthy choices). Quinoa w/ vegetables and a hot dog (not a healthy choice).
    Hour 1. 100
    Hour 2. 98
    Hour 3. 82

    I have many meals (average size) where the results show something like this:
    Hour 1. 85
    Hour 2. 100
    Hour 3. 85

    I am very active; but that activity level always allowed me to each as much as I wanted over the years. With this A1C of 5.9 I’m dedicated to dropping 15 pounds to see what happens. My BMI is 27.


    1. Do I digest slowly? With a normal healthy meal, I may not see the glucose rise until Hour 2 and then taper off.
    2. For test 4. What about that cheesecake? I thought I was going to spike to 120 to 140 like I did in Test 1. But that wasn’t the case.
    3. After 5 days of a very restrictive diet. Is it normal to see a gap down in fasting blood sugar?
    4. There was another interesting meal that I had. I had a philly cheesesteak sandwich, then 2 hours later I had another chicken dinner. Ranges were below 140, 120, and baseline, but my fasting glucose went back up by 10 points.

    Thank you for your input.

    • IMHO your A1C result is probably wrong. There are a number of factors that can make an A1C test come out wrong. For example, you could have red blood cells that live longer than average, or you could have hypothyroidism. (The A1C measures average blood sugar indirectly by testing the glycation, or sugar damage to red blood cells.)

      Relax. The A1C number you do have, even if correct, does not indicate that your blood sugar is high enough to cause much damage. Be careful and eat a good diet, anyway.

      Is your Doctor actually concerned? Even many Doctors don’t know this about A1C tests and assume the patient cheated on the fasting test. If he/she is concerned, bring your kit, show them your numbers & ask them to do a test using their equipment or yours while you are actually at the office. That should do it.

  15. I have been eating low carb for over a year. Until recently, my resting blood glucose was in the 80’s and 90’s, lately, though, I cannot get my reading below 106, and it is usually in the high teens and low 20’s. I do still drink wine, could this be my problem?

  16. In STEP 2, the article says that on day 3 one should eat a cup of rice or a boiled potato and then follow steps 4 through 6. Where is step 6? Is this just a typo and the 6 should really be a 5, or is there a step left out of the article? If I am going to do this I’d like to be confident I am doing it correctly.

  17. I went on a low-carb diet after my blood glucose levels tested at 210 mg/dL an hour after eating a cup of white rice! Since then, my levels are totally stable between 95 and 120. I was glad to hear that low carb diets raise fasting blood sugar, because that is definitely what has happened over the last month.

    My question now is … after lunch today (a handful of grape tomatoes, celery with cream cheese, and a no-carb meat ball) my blood sugar actually went DOWN to 98 only to come back UP after two hours to 105.

    Seems like that’s the opposite of what should happen? Shouldn’t it go up after a meal, then back down eventually?

    FYI my A1c two weeks ago came up as 4.9%

    Great article!

  18. Questions:
    Why does the fasting have to be at least 12 hours? Is this just for the initial readings to get a baseline and then I can back it down to 8 hours for testing on a regular basis?

    • The labs seems to like a 12 hour clearance. It may have something to do with insulin resistance. The latest article from Chris offers the best way to monitor what your body is doing with food. I use to check my BG 3-4 times a day to see what was happening. Now I just check it in the a.m. and occasionally in the p.m., if I eat the “wrong” way.

  19. The A1C test I had a few months back showed me at 5.5.
    The A1C I just did had me at 5.8 but my fasting glucose was 77!

    I’m gunshy about pricking my finger, I am such a wuss.

    My doctor says he’s not too worried about my latest results…

    I’m not sure what my question is, Im just frustrated. I am eating pretty darn healthy..I can’t believe it jumped from 5.5 to 5.8 but I am encouraged by the fasting glucose number!

    • Try using the lancer on your forearm! It might take a couple of tries to get enough blood, but it beats not knowing what’s going on because you have sensitive fingers.

    • Relax. With a fasting blood sugar of 77, you really have absolutely nothing to worry about. A1C tests are not always as accurate as is believed. Factors other than your actual blood sugar can affect the results.

      Also, small variations–which is what this is–from test to test are mostly within the margin of error of any blood test and probably don’t reflect much of any change in you.

      For more information:
      (more technical)

      The best way to keep your blood sugar down is just don’t eat sugar. No soda. No fruit juice. Etc. Also watch out for hidden sugar in foods like tomato sauce. If it tastes sweet, it has sugar.

      If your fingers hurt, just stop testing for a while & give them a chance to heal. In your case, your doctor will probably say you don’t need to do all that testing. Testing your arm, like someone kindly suggested, can certainly be done, but don’t be surprised if the results are a little different. Testing your arm is not as accurate.

      Other than that, stress is actually bad for your blood sugar, so stop worrying so much. You’re fine.

  20. Would it be any good for a T1D to do this test with their regular carb ratio for the meals to see if his carb ratios are appropriate, or does a T1D’s system respond differently as far as the timing for getting back to the baseline and all?

  21. What if the postprandial values are still within the healthy range but worse than previous years? (I test for a few days once per year).

    Is that a cause for concern?

    My readings are accurate, I take multiple readings using both OneTouchUltra and Accu-chek and average them.

    Thanks for this helpful post by the way!

    • Store-bought testing machines are not extremely accurate. The acceptable range is +/- 20%, so if your actual blood sugar is 100, the machine could register anything from 80-120. Different machines will also give different numbers for the same blood sample.

      I am not a physician, but according to my understanding, whether you should be concerned would depend on several factors:
      1. How much of a difference is there? (Are you using the same machine? How old are the strips? Could it be a bad batch of strips?)
      2. How consistently are you getting these higher results? How often have you tested?
      3. What did you eat before you tested? Did it have a lot of carbs/sugar? Was it a very big meal?

      Do you have a family history of diabetes? Is that why you are worried about your blood sugar?
      When was the last time you got your fasting blood sugar tested through a laboratory? What was it then? Maybe it is time to get another official test?
      How much sugar do you eat? Maybe you should cut down? Maybe you are eating something that has sugar without realizing it?

      Again, I am not a Doctor. Maybe you should go to one if you are worried, but if your sugars are still in normal range after a fasting done in a lab test, he/she will probably not be concerned.

      • Thanks for your reply, Robin.
        You’re right, most doctors probably would not be concerned, but that’s what worries me! I’m not sure my GP would be impressed by this blog post and the ranges given here, either.

        The only cure for diabetes is prevention, right? So if there is even a small sign of worsening numbers, it should be addressed immediately. But in a way that is appropriate for my level of risk. I already eat a pretty bland, healthy diet most of the time.

        In addition to multiple readings, I keep food logs and try to replicate the test conditions from previous years, to reduce the type of variables you mentioned. Because of this, the increase I spoke of last comment, although small, was troubling.

        Having said that, since writing my past comment, all my values have shot up, including fasting values in the early 90s. And they’ve been slower to come down. I used to be consistently close to 86 after 2 hrs, lately I’ve been at around 94 after 3 hrs. I’m hoping it’s due to health anxiety, will continue to gather more data next week (ran out of strips).

        • Honestly, if your fasting blood sugars are in the low 90s, I don’t really understand why you are so worried. Stress is bad for you, too.

          The only reason to be so concerned is if you have a family history of diabetes. Even if you do, the only thing you can do about it is avoid sugar & cut carbohydrates as much as reasonably possible.

          Relax. Life is too short & we are all going to die of something. Appreciate the gift of life while you have it.

          • My fasting glucose went up 15 points in 2 years. From 75 to 90. Last one I had was 99. I agree that I want to figure this out now and not wait until it goes up more each year. I certainly have more anxiety just worrying and not taking action. Monitoring my blood sugar keeps me feeling better. Especially since I have PCOS (linked to insulin resistance) and after heavy meals I feel foggy headed and my vision blurs a bit. I started keeping my carbs to 30 grams per meal or under and I feel like I have my life back. I made the mistake of eating white rice every day and it got to the point where I had difficulty breathing. Nothing wrong with staying on top of things.

    • It depends upon what is a “healthy range.” You are getting older, and things may be changing. What matters is whether your pancreas is making enough insulin to handle the sugar load. Make sure you document what you are eating prior to checking. Check one hour after eating, and again at two hours. Compare the reads for at least one week. Don’t forget to check your fasting BG also. It’s not which meter is better than others, but the relative readings. If you’re using the same meter(s), then that’s the constant, and the variable is what you eat.

  22. I can’t tell from your instructions if I am supposed to eat breakfast after taking my morning fasting glucose test, or if I should continue fasting until lunch and then proceeds with step 2…

  23. My A1C is a normal 5.5; My fasting glucose is 130- 145. Post meal glucose 150-160. My GP sent me to a endocrinologist who inserted a internal glucose monitor that I wore for 1 week while I took 4x/day my external readings. They were the same as the monitor! Diagnosis? “not Diabetic!” I get many foot cuts, etc that take mos. to heal A cracked foot bone never healed. some neuropathy. I’m age79 and 55 yr. aerobic exerciser & dietary “nut” Both Quad tendons permanently rupture-no trauma. HOW MUCH Met4man should I take?

    • A 5.5 AIC actually correlates to an average blood sugar of 111. At 137, you’d be at 6.4 A1C. Are you at all anemic? That might explain the 5.5 A1C, which sometimes leads to a better reading, when it isn’t. Waking up with a fasting sugar of 135-140 is not very bad, but it’s not that great, either. Your doctor may believe that at age 79, you’re still okay. I like the method of checking one’s sugar one hour after eating, then two hours after. 140 or under, after one hour is okay. After two hours, though, nothing one eats should make the blood sugar go over 120. Watch what you eat, especially wheat products that typically have a high glycemic value, stick to gluten-free foods whenever possible, and watch how your body handles it. You’ll be amazed how your sugar will drop then, and without meds! The nutraceuticals, ALA (600 mg.), 2x/day, along with GTF (500 mg.), 2x/day, has helped keep my sugar down. I wait at least 20 hours between my last meal and my next; it has helped me for more than 40 years, and I’m age 68 now. My sugar upon awakening runs between 80-95, depending upon whether I ate something the previous day that caused insulin resistance. Keep reading up on this, as I have, and try different things before you jump to Met. Met has its own problems. Wishing you the best.

      • It’s not very well known, but A1C’s aren’t always accurate. They were originally invented to study large groups.

        Different health conditions can make them come out higher or lower than your actual average blood sugar. For example, if your red blood cells live longer than average, it will show more glycation & a higher average & probably the reverse, too. Hypothyroidism also can make it higher than the actual numbers. I don’t remember all the reasons, but you can research it.

        Doctors like A1C because it’s an average for months. They also seem to have this idea that if your fasting number is lower than your A1C is showing that you’re somehow cheating the day before.

        I might also mention that home blood sugar test kits are not known for their accuracy, either, unfortunately.

        • Doctors tend to gallop together, and this controversial subject of AIC is no different. I prefer to view all tests as a relative measurement against a baseline or norm. In that manner, one can compare each test to a subsequent one and notice any differences, provided the conditions, lab, and procedures remain the same. I also believe in measuring blood glucose at one hour and two hour intervals after eating, for at least the first few days, to see how the body is handling it. For me, I am sensitive to anything with wheat in it, and refraining from those products works wonders for my body.

        • Hi Robin
          I didn’t understand exactly which a1c is better the 5.5 or 6.4.
          My fasting blood sugar was 79 today. I’ve been dealing with after meal spikes for nine years now. But my A1c as I mentioned above were from 5.2 to 5.7.
          But doctors don’t take it siriously even endocornologyst dismissed to listen to my concerns.
          I am not anemic and I don’t have any tyiroied problem.
          I just don’t know how long it will take for full blow diabeties to acure. Or is it possible or normal normal fasting and normal A1c but some after meal spikes.
          It’s confusing.

          • Lower is better but under 6.0 is considered OK. A fasting blood sugar of 79 is perfect. If it went much lower, you would have low blood sugar problems.

            If you’re really that worried, don’t eat sugar. Type II diabetes was pretty much unknown before the invention of table sugar, high fructose corn syrup, etc.

      • So do you only eat once a day? How is it that you wait 20 hrs betwern meals. There are only 20 hrs in a day. Also, if that’s so, how do you get enough calories hmmm.

        • I’m 6’0 and weigh 205. I never start the day with food, except for a cup of black coffee. My typical meal occurs around 2 p.m. every day. For example, if I dine out at 6 p.m. and finish by 7 p.m., my next meal at about 2 p.m. the following day will have occurred 19 hours later. I neither count calories, nor carbs, but I do avoid wheat (gluten), due to the high glycemic value. When I dine out, though, I throw out the” rule book.” I check my BG at 1PP, 2PP, and sometimes 3PP, if I eat something new or different, just to see how my body is handling it. I test out at 5.5-5.6 (A1C) every 3 months. I firmly believe that this type of modified fasting helps balance things out. I actually never feel hungry this way. I do supplement with niacin, GTF, ALA, acetyl l-carnitine and plenty of magnesium. The mag actually helps regulate the insulin response overnight.

          • Your A1C is perfectly normal. Test results are never completely accurate and tend to vary a bit. There seem to be a lot of members of the worried well posting here. All you can do is stop eating sugar & cut down on carbs. Unless you have a family history of diabetes or your sugars are really starting to rise, stop worrying.

    • Hi all
      I have a question
      My fastings are 78,80,89 and sometimes 96 or 99.
      1 hour After breakfast usually 130 or 110 and two hours is 103 or 90.
      But I have problem with my lunch numbers it confuses me. Sometimes if I eat pasta after an hour I’ll have 160 readings and after 2 hours 138 but another day if I eat the same food I’ll get normal readings.
      This happens with white rice too.
      The moment I think that I am healthy and I don’t have sugar problem I get high readings and when I think that I might have problem then I get normal readings.
      I’ve asked those with diabetes to see if they always get high numbers after eating any kinds of carbohydrates and they told me yes. So they avoid to eat most of the carbohydrates.
      I’ve also talked to my dr about my concerns but he dismissed them all. But I insist to be seen by endocrinologist as well. He was not worried too.
      My A1c for the past fiver years were 5.2, 5.3, 5,4, 5.5, 5.6 and I had few 5.7 as well. But both doctors were fine with the numbers.
      For example: today I just ate some pinto beans soup and I thought to check my blood sugar after an hour to see the effect my sugar was 146 I after 2 hours was 121.
      I also did OGTT just to see how my body handle the sugar the fasting was 86 and 1 hour was 146 and 2 hours was 120 and the 3 hours was 80.
      The doctors were again fine with the result.
      But I am the one who keep worrying and thinking about it.

      • Could there be some other factor like being under stress or having an infection at the time? Also, maybe you ate more sugar in previous meals? Why are you so worried? Do you have a family history of diabetes?

        In either case, it wouldn’t hurt to eliminate sugar as much as possible & not overdo starch. Sugar can cause other health conditions in addition to diabetes like high blood pressure, heart attacks & even possibly Alzheimer’s.

  24. Great article. That may explain why after eating eggs (yes, and both parts) with a starchy meal, my glucometer reads lower (fats?)

  25. Is this meter still the one you recommend? I hate getting poked and heard they have ones that are less painful or painless. But researching them is overwhelming.

  26. Today I did a test, eating the following for lunch:
    Chicken livers, coated in egg and coconut flour
    Cooked onions and non starchy veggies
    Black cumin seed oil (1 TBSP)
    Butternut squash (1 cup)
    For dessert I ate a ripe pear.
    My glucose levels were as follows:
    Pre meal: 83
    1 hr post: 114
    1.5 hr post: 106
    2 hr: 109
    2.5 hr: 103
    3 hr: 117, 109 (tested twice)
    3.5 hr: 99
    4 hr: 92

    So my levels never elevated to near 140, but they took quite a while to come back down. Any ideas what this means?

    • Hey Jon,
      I’m no expert, but your BS levels look quite normal to me. I bought the RelionPrime from Walmart, and it’s also available on Amazon for the same price. There is a small degree of inconsistency with it, but close enough to warrant the small price of the unit. Chris Kresser is so dang smart, so I highly value his opinion. Also, you might want to check out Steve Cooksey’s website or follow him on FB. He does a helpful comparison of different glucose meters; and although I think I read about those on his FB page, there is a ton of info (for free) on his website. He has a very interesting story and knowledgeable take on the whole Diabetes industry (yes, industry). Here is the link:

      • Thanks so much, Diana. I actually used to own a Walmart Relion product (can’t recall which) but I found the readings rather inconsistent. I was convinced by this article ( to try the Agamatrix Presto and it’s worked very well for me. Also customer service has been great. On one day I got some very inconsistent readings and they overnighted me a new one for free.

        As far as my personal situation goes, I’ve noticed I have much higher fasting readings (ie 105 or more) if I eat a decent amount of carbs within a couple hours of going to bed. In the event I do this, I’ve found doing a 15-min HIIT will ensure the fasting rate is lower – unless I really splurge. A couple weeks ago I ate the equivalent of around 2 sweet potatoes within a couple hours of bed. I did the HIIT, but it didn’t prevent a high fasting rate the next day. Continuing to experiment and test…

    • It may mean that, initially your pancreas secreted plenty of insulin (Phase 1), but insulin resistance kept the BG higher and longer than you’d like. You had also eaten a pear, which has a higher sugar content. Have you researched carb blockers?

      • I haven’t, but I will. Since posting my first comment I’ve noticed an odd trend:

        It’s not uncommon for me to consume a lot of carbs, then see when I measure 1-2 hrs later that my glucose appears to stay the same or even get several points lower. (Not into an unhealthy range)

        It’s a pretty odd phenomenon, but I’ve noticed it quite a lot lately. Any ideas?

        • Depends upon the carbs. Some have a lower glycemic value than others. Have you been keeping a record of every carb you eat, along with what was eaten with it? Whenever I eat anything with chocolate (Milky Way, dark chocolate, etc.), for example, my BG rises only ever so slightly and drops faster than with other carbs. It seems that consuming some fat with the carb seems to lower the absorption of BG in vitro.

          • Also, sugar is half fructose. Blood “sugar” tests only measure glucose.

            That’s why you hear all the comments about a slice of bread being higher on the glycemic scale than table sugar. The bread, being a complex carbohydrate, is made up of chains of glucose & no fructose unless added by the baker.

            Fructose is probably much worse for you than glucose. It can only be metabolized in the liver and might actually be the ultimate cause of insulin resistance, which was pretty much nonexistent before the sugar, i.e. fructose inundation of recent times. There are only a few people focusing on this. See: Robert Lustig, David Gallespie & Richard Johnson on youtube & Amazon books.

            • That’s because the liver does not stimulate insulin production from fructose. But that’s what ultimately leads to a high BG.

            • Huh, that’s an interesting notion. I’ve seen several personal accounts online which oppose that, though different strokes… It may be wise for me to cut down on fruit, unfortunately my diet is already so limited with sensitivities it’s getting a little tricky.

              • I take about 1 cup of strawberries before working out. It’s meant to increase energy naturally. My BG jumps to 122 after 2 hours, then gradually drops back into the 80s. But fructose does not stimulate the liver to produce insulin, so that’s part of the reason it peaks. Are you keeping tabs on what carbs you eat and what they do 1-2 hours later?

                • If you will excuse me, it is the pancreas that produces insulin and not the liver. The liver metabolizes fructose by turning it straight into fat. Insulin does not push fructose into other cells, because they can not metabolize it directly. Fructose in blood will NOT show up on blood sugar tests because the only sugar tested is glucose.

                  Just one cup of strawberries would not hurt anybody, especially before a workout, unless they had fructose malabsorption or severe diabetes. I wouldn’t worry if I were you.

              • You are right that you don’t want to limit your diet even more. It’s really all the added sugar that is not normally in food that is the problem.

                (Type II Diabetes was pretty much nonexistent before sugar cane. Fructose has a similar effect on the body to alcohol, except you don’t get drunk.)

                It also depends on how much fruit you eat & what type. A glass of juice has as much fructose as soda & no fiber.

                If you have blood sugar problems, avoid any really sweet fruits like dates & bananas.

                Whole fruits have fiber that slows down digestion. Berries, for example, have a lot of phytonutrients. However, I still wouldn’t eat several cups of berries or more than one apple at one sitting.

                • Actually, acute consumption of alcohol stimulates insulin secretion; conversely, fructose does not stimulate insulin.

                • True. Fructose makes you insulin resistant and causes non-alcoholic fatty liver disease. It doesn’t raise your blood glucose levels, because it is not glucose.

  27. Just an update to the obtainability of the glooku metersync cable….(apologies if this info already found furthur down in the comments). This product is no longer available. It seems Glooku has moved to a subscription model partnering with healthcare organizations/hospitals/docs. ($300?!/month) It does say you can get on a wait list for bluetooth cables that sync with smartphones…but that link is nonfunctional as of 1-9-16.

    If you have apple product and use iOS then you can purchase an ihealth align device that plugs directly into your phone/tablet (no affliation)

    If you have a android phone, (as i do) I could not find a product in the USA that synced. oh well. If anyone knows of one…please post there.

    Meanwhile this was the best comparison of glucometers on
    the market I found in my search.

  28. I bought a meter on the advice of a nurse teaching a Diabetes Prevention class. Interesting that she didn’t recommend this to the entire class, but when I came up to her after class and asked some follow up questions, she then suggested it. For me, it was life changing. I have always struggled with weight, had borderline blood sugar issues with both my pregnancies and in my late 40’s my A1C and fasting BG started creeping up. A year and a half later, after much research, experimentation and advice from an Endocrinologist as well as an Integrative Medicine Physician, I’m down 80 lbs and all my “numbers” are better.

    Getting a blood glucose meter allows me to take the reins on my own health.

  29. I’ve tried several of the best selling meters and I highly recommend the CVS Advanced Glucose Meter. It’s affordable and seems to be accurate. Results are repeatable (same value when I test again using a different finger) and map up with lab test values.

  30. The meter you recommended, added to a $40 cable, becomes expensive. The Bayer Countour Next USB is small, very accurate and can be had for $25 at Amazon. Strips are $11 for 50. Rechargeable, charge lasts for months.
    I normally take a morning reading, and one before and after meals.
    There is a home A1c test, called A1cNOW+, which can also be purchased at Amazon (2 or 10 tests/pack) and has shown to be very close to lab results.

  31. Hi Chris,

    I actually developed an online weekly log for my diabetes (prediabetes/type 2 primarily) clients to enter in their 4 to 5 blood sugar readings daily, all the food they eat and drinks, exercise and any stress management activities they undertake like yoga/meditation.
    I say the same thing; it is a great tool to educate them about what increases or decreases their blood sugar levels. It also makes it easier for me to detect patterns and make recommendations on what foods to eliminate from their diet.
    Seeing all this in writing on a weekly basis is very reinforcing!

  32. I just bought a glucometer and did my first test. I don’t knowingly have any diseases, but I’ve had unbelievably strong sugar cravings ever since I quit drinking alcohol (I am a recovering alcoholic, one year sober). I thought these cravings would subside, but after 12 months they still haven’t. I also feel really bad energy crashes most afternoons when eating my normal American diet.

    Before lunch (skipped breakfast): 81 mg/dL
    1 hr after lunch: 70 mg/dL
    2 hr after lunch: 85 mg/dL
    3 hr after lunch: 81 mg/dL

    For lunch I had a ham and cheese sandwich on whole wheat bread, and a big bowl of homemade apple sauce.

    I was surprised to see my levels didn’t spike up, and in fact went down in that first hour. This meal didn’t result in the after-meal crash I often feel, so I will compare this to other meals in the future. But what can I make of these results? Why would I not spike up, and why would I go down in that first hour?

    Thanks in advance for any help, and thanks so much for this article!

    • Hey TJ,
      Wow – congrats on those fantastic BG readings!!! The 70 reading 1 hour after meal could have been a fluke, but staying within the 80-range is something to feel thankful for. The ham (protein) and cheese (fat) no doubt helped to maintain an even BG level. I am not diabetic, and do not want to be.

      I love Chris Kresser’s wisdom and value his opinions. Please note, with this recommendation, I have no financial interest. A couple of years ago I stumbled onto Steve Cooksey’s website, I just want to connect you to a man with a great story, who turned around his life and blood glucose levels, through a low carb high fat diet. He also has quite a following on FB.

  33. I have tried this, but I didn’t find it very helpful. (Aside from the problem with the margin of error from glucose meters,)

    What I discovered is that my blood glucose either goes UP a little or stays the same when I DON’T EAT. (Eating before I go to bed does NOT stop the dawn syndrome.)

    My postprandials are pretty close to normal within the margin of error, unless I drink milk or happen to eat a lot of another high carbohydrate food.

    My fasting glucose is pretty much the same or a little higher than my postprandials every day unless I eat a very high amount of carbohydrate. So in the day, I’m normal, and in the night/early morning I’m borderline diabetic–because the goal posts change.

    Then, if I take my fasting glucose, eat a piece of cheese, and take my glucose level again in half an hour, it GOES DOWN.

    I can’t cut my carbs down to ketosis levels because I get low blood sugar symptoms, especially panic attacks. (Adrenal problems.) I can’t eat fruit because I have fructose malabsorption, and I also have probably a mild case of histamine intolerance–allergies, mild asthma & atopic dermatitis. So, combining all three leaves little food left. 🙂 I mostly try to concentrate on avoiding fructose, because the gas & diarrhea are the most distressing symptoms & the blood sugar issues.

    I don’t want to become paranoid about food, and I have to eat something besides maybe cucumbers, lettuce, and very fresh fish–oh wait, what about mercury?!. lol My blood sugar doesn’t follow the rules, so there really doesn’t seem to be much else I can do?

  34. Hi Chris, it’s taken me ages to find out what you have put together especially about post-prandial testing. I would love it if you had time to sift through the many valuable comments and give us a digest (there are just so many to read). Initially I did a whole series of readings and found I peaked on average around 75 mins at a significantly higher level than at 60mins. ( I am usually back at baseline in a little over two hours.) thanks Jem

  35. Thank you Chris.

    I love your proactive solution to preventing diabetes.

    Most doctors will tell you you don’t need a meter because you’re not diabetic.. You kind of have to be assertive and tell them you want a prescription for the meter, that’s if you don’t want to pay out of pocket for it.

    I cut out all sugar and carbs, exercise and test regularly. Now my prediabetic results are no more. Have to say the device is cheep but the strips are expensive and a wake up call if you test prediabetic.

    It does get expensive buying strips when testing every day not to mention the pain of the pricker.

    At the end of the day if you can turn your life and Heath around with a simple solution to prevent becoming a diabetic, it’s great.

    A few months of change can = a lifetime of positive results.

    Thanks Chris

  36. I am 59 years white women. My number for the past 6 months are going all over the place. Durning the day they are anywhere from 96 to 130 after eating. When I get up in the morning it is anywhere from 176-200, why? I tried lowering the carbs to see if this works. I am on Metformin 2500 mg a day. I walk over 5000 steps aday. Job not stressful. Any other help or to why the morning numbers are high?

  37. Hello,

    If the value of blood sugar is 156 mg/dL one hour after lunch, but after two hours is lowered to 100 mg/dL. What should I do?

    • Have you made a list of what you eat before testing? You may have impaired glucose tolerance, but as long as it’s under 200 after you eat, you’re probably okay. Mine has hit as high as 172 after a large carb meal, but it, too, drops back to 100 or less after two hours. We’re not getting any younger, so we have to be nice to our pancreas.

  38. I wonder if something like the new glucose monitor by Dexcom would work, it automatically monitors througho the day at 5 min intervals and sends data to your iPhone

  39. What does it mean when your numbers stay around 70-80 all day long even after eating? Breakfast with 44 carbs boosted me up to 77 one hour later. I got above 100 once during the day, I was 125 one hour after a 52 carb lunch, then felt extremely bloated later. I feel weak and hungry and tired most of the time, feeling like I need to eat but can’t because my stomach is full.

    • It sounds like you are crashing to me. Carbs only last 45 minutes to 1 hour as fuel. Eating fat with your carbs will slow down the release of glucose and you should no longer have the crash.

    • For a light and effective boost, try 1-3 TBSP of regular peanut butter with real whipped cream. Does wonders and may actually help delay a precipitous rise in BG.

      • Blood sugars below 70 start to get into the HYPOglycemic range. Are you worried about your blood sugar being too low or too high?

        • No. I just get hungry, every now and then. When I do, the PB and whipped cream works for me. My BG is actually in the 80-90 range, rarely goes below 80, and rarely goes above 90. You may respond differently. I believe in empirical data. Test, and re-test, till you find what works and what doesn’t. “Listen” to your body. Experience beats theory every time.

          • That sounds perfectly normal. What is your reason to test? Why would you believe I have a problem with “empirical data”?

  40. Hi,
    Here’s a little background, I’ve had PCOS since 2003. I’ve been on and off fertility meds since 2007. I do have insulin resistance. My glucose results have never been over 120.
    8/26/11 Results
    OGTT fasting was 80
    OGTT 1 hour was 98
    OGTT 2 hour was 107
    Doctor didn’t seemed worried. Fast forward to March 2014, diagnosed with candida (yeast overgrowth in digestive tract). Low carb, high protein & veggie diet, lost 50 lbs. Started clomid (fertility) and provera (synthetic progesterone) in October, Nov & Dec (no luck with pregnancy).
    Had my A1c tested on January 10 2015 as well as a full PCOS panel done…
    A1c is a whopping 11.8%!!!! I don’t know why, but I have a very strong feeling that this number is most definitely wrong!
    After looking at all my random and fasting glucose levels from 2006 until now, they range between 88-112. Now let me explain a little about my food schedule, my husband works swing shift 5pm-530am, bedtime is 7am-2 pm, I am also in that schedule as I am a stay at home wife.
    Breakfast/wake up readings
    Breakfast- 3pm 1/2 steak sandwich, 2 egg rolls, 2 oz pepsi, 6 oz milkshake
    1 hour after-120
    2 hours after- 110
    3 hours after- 89
    Lunch- 7pm- 87
    730 pm I ate Tri-tip, mashed potatoes, salad, and drank 8 oz pepsi…
    830 pm- 109
    930pm -100
    1030pm- 88
    Snack- 3am caramel popcorn, fiber one bar, tea
    1 hour- 93
    3 hour- 90
    So those are just yesterdays readings and the actual full day of testing, I will continue to test. But can someone please help me understand why they are low or “normal” but my a1c is outrageously high?
    Also the doctor put me on metformin 500mg in 2012 to help insulin resistance and I had to quit taking it because it would make me severely shaky, nauseous, sweaty, feel like I was going to pass out and weak. Could it be from it lowering my blood sugar to low? I did always take it with food, and within an hour or 2 I would start to feel the above symptoms. I have a call in to the doctor, waiting for call back… I appreciate any advice as to what I can do until we figure out what is truly wrong.. Thank you

    • How did your doctor determine you were insulin resistant? I have PCOS as well. My numbers are usually 75-85 throughout the day. I ate 60g worth of carbs of bananas and could only get my BS up to 120, and returned to normal about an hour later. So it’s seemingly normal numbers. Your initial numbers seem pretty normal as well, so how did insulin resistance get diagnosed?

      • Honestly I have no idea… I just know that in 2006 is when they told me I was insulin resistant. Possible blood test, yet I can’t find what test they used. I’ve been looking at all my results and nothing is popping up… My numbers are still normal, but a1c is high. My doctor called today and he wants to do another 2 hour glucose test, I also have an endocrinologist appointment the same day I see my ob/gyn. So until February 19th I will continue to test my blood sugars so the endocrinologist has something to look at… I’m just confused as to why the a1c is so outrageously high. If I can find the test the use to test for insulin resistance I will let you know…

        • iirc anemia can make A1c read falsely high. Pardon me for asking, but do you have very heavy menstrual periods, and when the doctor checked your A1c did they also do a CBC (complete blood count)?

    • They based ‘insulin resistant’ of ac1. But with your numbers that doesn’t make sense.
      Ac1 is the amount of sugar on blood – assuming your blood lives 90 days. But blood actually ranges from 87 to 140 days. Less if you are a diabetic, and longer if you are lower on the blood sugar end. Which you are.

      Request a fructosamine test instead.

  41. Been having dry mouth, thirsty and constantly urinating for the last month and a half, so checked my bg yesterday at drug store. First reading 547, second reading 529. Pharmacist very nervous and constantly asked me to go to my doctor. No insurance. I did a fast for 10 hours and took an a1c test at the same pharmacy the next day, 12.9%. Had salad for lunch waited 1hr did a accu check bg test, 278. All this in 36 hours. Background, in the last 5 month’s had a baby boy, got married and business partner embezzled money from me and now I’m on vacation in Michigan, currently around 4°, super stressed about money. My readings seem to be all over the board. Could the stress be affecting my readings that much? Or stress and diet together? My diet has been worst cause my wife is mid west so more meat and potatoes and I’m Asian, more used to little protein and lots of veggies. Any and all input would great, Thx

    • U need to take immediate action, to prevent irreversible damage to ur body. U need a doctor to give prescription, for immediate effect. Long term, think diet of ur ancestors and exercise, to prevent further damage to body. I spent ton of time reading net, and it helped immensely. Knowledge is power.

    • Jenga, those are the numbers of a Type 1 Autoimmune Diabetic. Diet alone will not help because if that is what you are your Beta (insulin producing cells) and dying. You cannot produce the insulin you need. If Type 1 you will need exogenous insulin. Please see an Endocrinologist ASAP.

  42. I have enjoyed reading the articles that Chris publishes; and so, i wanted to give back to this community. I have not read the comments in this blog, so this maybe repeat information. FDA requires only 95% of the results to be within 20% of the real blood glucose level. This explains why my ReliOn meter would give 125 and 145 for blood drawn from the same spot, within 20 seconds of each other, following all the guidelines that ReliOn publishes. 20 point (or even 40 point) difference in readings (from the same site, within seconds of each other) is still considered acceptable by FDA standards (assuming that 100 is the actual blood glucose level).

    So, the take-away is that, we don’t have to bother about reads too much, unless the reading is much different from what you expect (from your experience), at that given moment. Also note that BG level varies from finger to finger, moment to moment. ReliOn Confirm is acceptable to me, because i am not diabetic, and i accept the wide difference in readings at times. I will use few strips, if i wanted an average.

    What bothers me more are the studies that indicate that “test strips on the market” do not follow the FDA standards. Once a glucometer is accepted by FDA, there is no oversight on the quality of test strips. So, we have test strips in the market, that vary by more than 20% from the actual BG level. There is no telling how bad they are, until you start seeing unexpected results, consistently, and they are all wrong.

    • Dear Sam,
      Thank you for your last post!!!! Though not diabetic, I do have hypothyroidism so am closely monitoring my sugar levels. I wondered why my readings were all over the place. Thank you for your explanation.

    • Until the FDA adopts stricter standards, the 20% variation must be accounted for. Here’s more detail on just how inaccurate some meters are; at the same time, notice the rate at which some meters are accurate within 5% variation.

      Here’s my experience to confirm the issue. I have used multiple Nova Max Plus meters because they also measure ketones (I wanted a dual meter). I have found the variation with all brand new units with new non-expired genuine strips stored properly to be much wider than the Precision Xtra that I now use (it also measures ketones.) The Nova Max Plus is often 20+ mg/dL higher than what is determined to be the probable lab result (my best estimate based on my understanding of my glucose control and reference with some lab draws.) Not only is the Precision Xtra more accurate for me, the variation range is much narrower; I’ve done several side-by-side triple-strip tests with each.

      Before I realized this, it made the difference in fasting glucose being well over 100 mg/dL in some cases. Now I’ve adjusted how I use the data returned by a blood glucose meter. Combining it with the occasional lab, I can get what I want from the meter even knowing that it is always going to be inaccurate to some degree.

      I suspect a few things:
      1. Different meters may be more accurate for different people. You may have to try several and correlate with lab results if you want best accuracy for you.
      2. It may be best to use those with higher blood sample requirements. It’s trading inconvenience for accuracy.
      Nova Max Plus: .3 microliter
      Precision Xtra: .6 microliter (far more accurate for me)

  43. I did the 4 day glucometer test and I’m so confused. For a bit of background, my dad was a LADA diabetic dx’ed in his mid 30s. I’m having some symptoms so decided to monitor a bit. Here are the ‪#‎s‬:
    Day 1: fasting 12h:98
    Prior to lunch: 95
    Bagel w/cream cheese & mocha
    1h: 125
    2h: 143
    3h: 101

    Day 2: fasting 12h:85
    Prior to lunch: 94
    Fried foods and a Dr Pepper
    1hr: 143
    2h: 150
    3h: 109

    Day 3: fasting 12h: 88
    Forgot prior to…
    Salad w/apple cider dressing & cup chicken noodle soup
    2h: 117
    3h: 74 (boy did that feel horrid)

    Day 4: fasting 12h: 89
    Prior to lunch: 92
    Boiled potatoes
    1h: 103
    2h: 87

    Help?? Thanks

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

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

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

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

  46. Hi Chris,

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

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

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

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

    What do you suggest?


    • Dickey.

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

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

      • James,

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

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


        • Dicky: You sound like a monkey! =) How’s it going? I can’t imagine eating like that. Apart from the fact I don’t really like bananas, that’s a huge amount to cram in for a meal!!

  47. Chris Kresser,

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

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

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

    Thanks for an interesting post!


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

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

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

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

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

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

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

  50. I did the test as you suggested

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

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

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

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

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

      • The doctor says I am not diabetic. I have lowered the amount of sugar and carbohydrates I eat from all grains, but especially wheat. This has seems to help lower my fasting blood sugar. I am also working to lose enough weight first not to be obese , and then not to be over weight.

  51. I did the test as you suggested

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

  57. Chris,

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

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

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

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

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

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

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

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


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

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

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

    • Nice article, and thanks for posting the link. It presents an equally impressive argument, though i would have been more convinced if there were more scientific studies for reference point. The truth could be multi faceted, where many parties could be on the right track, and reach the peak truth, which is effective health.

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

  66. Hey Chris,

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

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

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

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

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

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

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

    Thanks so very, very much,

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

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

    • I’m the same way Kristin.

      My theory is this: Carbs cause insulin to spike, but we’re not testing insulin levels, we’re testing blood glucose.

      If I eat a lot of carbs, I won’t have enough insulin, so blood sugar goes high.

      If I eat medium to low carb, I have enough insulin, so blood sugar stays in normal range, but the insulin causes excess glucose to store as fat. So even if I’m low carb and at a calorie deficit, I fail to lose weight because of high insulin levels.

      If I eat very low carb (just vegetables), insulin stays low, blood sugar stays low and I’m able to lose weight.

  69. Chris,

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

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

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

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

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

  70. Dear Chris,

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

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

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

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

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

    Thank you very much for your time

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

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

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

  74. Chris,

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

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

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

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

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

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

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

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

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

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

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

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

    My 2C.

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

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

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

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

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

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

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

  80. Hi Bev,

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

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


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

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

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

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

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

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

    Does my thinking on this subject seem reasonable to you?

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

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

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

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

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

    Second hour about 116.

    Third hour about 100.

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

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

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

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

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

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

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

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

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

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

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

        • Ellen,

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

          • Hi Bev,

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

      • Hi Chris,

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

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

        Thanks for all that you do.

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

  84. Peter …

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

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

      • Hey, Peter –

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

  85. Hi Chris

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

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

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

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

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

    kind regards

  86. Hi Chris,

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

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

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

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

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

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

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

  90. Hi Chris,

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

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

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

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

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

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

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

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

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

  94. The journey continues….

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

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

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

    • Steven,

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

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

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

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

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

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

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

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

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

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

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

    “A LC eater has a FBG of 5.5mmol/l, technically pre diabetic, but blood insulin is 3.5 IU/ml. This is VERY low. Glucose is in very short supply but blood glucose is maintained by physiological insulin resistance, ie the muscles are full of triglycerides assembled from free fatty acids (NEFA) from lipolysis. The LC eater has breakfast, with enough protein from his eggs or particularly casein from his yoghurt to raise insulin from 3.5 IU/ml to 5.0IU/ml. This inhibits lipolysis enough to reduce NEFA in the bloodstream, intramuscular triglycerides fall and muscle insulin sensitivity returns. There’s minimal glucose coming from the gut and so plasma glucose drops to between 4.0 and 5.0mmol/l, probably nearer 4.0mmol/l. It fluctuates between 4.0 and 5.0 after and between each LC meal. In the early hours of the morning there is a growth hormone surge and NEFA from lipolysis peak early morning to give insulin resistant muscles and an elevated FBG. MEAN glucose over 24h will be in 4 point somethingish, HbA1c will be between 4 and 5%. INSULIN will probably average out around 5-10 IU/ml, averaged out over 24h.;%20Clarification%20of%20FBG

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

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

      • Steven, Chris –

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

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

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

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

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

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

  99. Hi Lynn

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

  100. Hi Stan

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

    We do not have raw dairy here though.

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

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

    Sorry for the long post.

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

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

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

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

  104. Hi Chris

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

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

  106. Hola, en mi última analítica tengo estos resultados:

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

    Tengo 33 años.

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

  107. Chris,

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

  108. Thanks Chris,

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

    Thanks for the continued education!

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

  109. Hi Chris,

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

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

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

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

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

  110. Thanks!!!

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

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

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

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

  112. Hey Chris,

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

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

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



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

  114. Hi Chris!!!

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

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

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

    Thanks a lot


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

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

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

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

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

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

      Could you expand on this or link to references?

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

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

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

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

  119. Hi Chris. Yes, I agree.

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

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

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

    • Hi Ned,

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

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

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

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

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

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

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

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

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

      Thanks for the site, I love it!

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

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

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

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

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

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

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

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

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

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

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


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

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

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

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

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

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

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

    Again, good job!

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

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

    Painless Blood Sugar Testing:

    Frequently Asked Questions:

    How to Lower Your Blood Sugar:

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

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

  131. Kim: thanks for the tip!

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

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

    I will get some new strips and go for it.

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


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

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