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 Walmart.com. (Note: as a rule I don’t like to support Walmart, but I haven’t been able to find this unit anywhere else at a similar price.) Even better, the test strips, which you’ll need on an ongoing basis to monitor your blood sugar, are relatively cheap for the Relion Prime. You can get 50 of them for $9.00 at Walmart.com ($0.18/strip).
If you’d like the option to sync your readings to an iPhone or iPod Touch, the Relion Prime syncs with the Glooko MeterSync Cable. The Glooko cable (with the free app on your iPhone/iPod Touch) allows you to sync all readings, as well as track factors that affect your glucose level, such as carbohydrate intake, activity level, and how you’re feeling. Though the cable costs $39.95 on Amazon, it’s a worthwhile investment if you plan on tracking your glucose levels over a long period of time.
I’m sure there are many other choices that work well, but this is the unit I have the most experience with, and in general it is very reliable. Another good choice is the TrueTrack meter drugstores sell under their own brand name (i.e. Walgreens, Sav-on, etc.). Other models to consider are the One Touch Ultra or one of the Accu-Chek meters. The problem with these, however, is that the test strips tend to be more expensive than the Relion Prime.
Step Two: Test Your Blood Sugar
- 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.
- Test your blood sugar again just before lunch.
- Eat your typical lunch. Do not eat anything for the next three hours.Test your blood sugar one hour after lunch.
- Test your blood sugar two hours after lunch.
- 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 to 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 through 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 one- and two-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 percent 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 one- and two-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.
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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.
Nutrient deficiency is another critical factor to consider if you’re struggling with high blood sugar. Studies have shown that inadequate intake of vitamin D, magnesium, biotin, chromium, thiamine, choline, vitamin C, and EPA/DHA may contribute to both diabetes and obesity and that correcting these deficiencies helps to maintain normal blood sugar.A nutrient-dense, whole-foods diet should always be the foundation of how we consume nutrients. Sadly, due to declining soil quality, a growing toxic burden, and other factors in the modern world, we can no longer rely on food alone to meet all of our nutrient needs. This is where smart supplementation can play a role. I formulated Adapt Naturals to add back in what the modern world has squeezed out and provide you with all of the nutrients you need to feel and perform you best.
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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.
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?
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.
Hi Chris
Thanks for all your work and making the knowledge available.
Ive taken your advise gone out and bought the meter and have been testing for the last 3 days after every meal for 3 hours. I eat using a paleo framework and dont eat dairy, carbs is on about the 50g 70g per day and ive been doing this for most of 2011. Im 6’3″ and weigh in at 277 pounds, i lift heavy 4 days a week with 10 to 15 minutes cardio thrown in 2 or 3 times a wk (crossfit football)
I still have a good amount of belly fat and think I have have high cortisol and not great testosterone levels. Im 43yrs old.
My fasting Bg has been between 92 and 99, after breakfast it drops and then at 2 hour mark is between 106 and 112. Over the 3 days the highest my bg went was 112 and lowest was 79. Does this sound normal considering a low carb diet?
Is this a 2nd stage insulin response?
Im hoping you can guide me as to what should i be asking my doctor to look at and what test would be appropriate?
Many thanks for any follow up and time you can give to answer this.
kind regards
Michael
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.
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.
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?
I agree Jenny is wonderful, but… if you only read one page about bg, it should be this one:
http://www.alt-support-diabetes.org/new.php
Also, the meters can be free, that’s not relevant to your pocketbook. The strips can cost a fortune! As such, I recommend the Walmart or Walgreens storebrand meters as the strips are half the cost of namebrand meters.
Hi Chris, Not sure if you still check this thread or not, but have a question for you. I’ve been testing my blood glucose for about a week now. I’m 28 weeks pregnant, and my midwife is requiring 2 weeks of testing fasting glucose and 1 hr after every meal in place of the oral glucose test. So far, all of my numbers have been great. I’m usually back to baseline or below an hour after meals, though I haven’t tested past that. One thing I haven’t totally been able to figure out: My fasting blood glucose is usually in the 80s, though I’ve had a few in the mid-90s. This is surprising to me since this is higher than my reading after dinner the night before. I’m on a low-carb diet if that makes a difference. I’ve also been getting to bed after midnight each night and seem to remember reading something about stress hormone levels and raised blood glucose in the morning. Overall, I’m not concerned at all since my 1 hr reading is usually back to baseline, but was just curious what causes the higher fasting levels… any ideas?
Thanks!
This is a very interesting blog post. The comments offer lots of great supplemental information too!
Thanks everyone.
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.
KW: I’m really glad this saved you from the OGTT and put the control back in your own hands.
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.
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.
If one does not want to punch a finger, there is an approximate, but still a good tool for Diabetes risk assessment at http://www.diarisk.com.
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.
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.
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 :-).
” 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.
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.
Actually, I have been working on the theory that my BG pattern results from the return of insulin sensitivity, particularly following the morning BREAKfast. By coincidence, I rediscovered this from Peter at Hyperlipid:
“A LC eater has a FBG of 5.5mmol/l, technically pre diabetic, but blood insulin is 3.5 IU/ml. This is VERY low. Glucose is in very short supply but blood glucose is maintained by physiological insulin resistance, ie the muscles are full of triglycerides assembled from free fatty acids (NEFA) from lipolysis. The LC eater has breakfast, with enough protein from his eggs or particularly casein from his yoghurt to raise insulin from 3.5 IU/ml to 5.0IU/ml. This inhibits lipolysis enough to reduce NEFA in the bloodstream, intramuscular triglycerides fall and muscle insulin sensitivity returns. There’s minimal glucose coming from the gut and so plasma glucose drops to between 4.0 and 5.0mmol/l, probably nearer 4.0mmol/l. It fluctuates between 4.0 and 5.0 after and between each LC meal. In the early hours of the morning there is a growth hormone surge and NEFA from lipolysis peak early morning to give insulin resistant muscles and an elevated FBG. MEAN glucose over 24h will be in 4 point somethingish, HbA1c will be between 4 and 5%. INSULIN will probably average out around 5-10 IU/ml, averaged out over 24h.
http://high-fat-nutrition.blogspot.com/search/label/Physiological%20insulin%20resistance%20(3);%20Clarification%20of%20FBG
This is me! So, I am going to retire my BG meter and give my sore old finger a rest for the time being unless somebody convinces me there is osmething wrong with this analysis.
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.