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

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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

  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 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:

MarkerIdeal*
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.

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.

Research Spotlight: Health Coaching and Diabesity

Lifestyle Counseling Improves Long-Term Clinical Outcomes in Type 2 Diabetes 

Merely dispensing facts and offering advice about diets to patients has proven ineffective for motivating long-term healthy behavior change in patients with diabetes. Instead, a growing body of research indicates that successful diabetes interventions should employ a health coaching framework to successfully institute behavior change and improve health outcomes. A retrospective study published in Diabetes Care suggests that more frequent lifestyle counseling (or health coaching) reduces the incidence of critical type 2 diabetes health issues.

Study Summary

  • This retrospective study included adults with type 2 diabetes treated at primary care practices between 2000 and 2014. It examined the relationship between the frequency of lifestyle counseling, determined through analysis of the electronic medical record (EMR), and cardiovascular events and death.
  • Patients who received lifestyle counseling more than once per month experienced an almost 2 percent decrease in hemoglobin A1c (HbA1c) compared to a 0.7 percent decrease in patients who received counseling less than once per month.
  • Patients who received counseling more frequently than once per month had a 10-year cumulative incidence of death and cardiovascular events of 33 percent, compared to 38 percent for those who received counseling less than once per month.

Key Findings

People with type 2 diabetes who receive more frequent lifestyle counseling (more than once per month) have a lower risk of cardiovascular events and death than people who receive infrequent counseling. The association of lifestyle counseling with reduced cardiovascular events and mortality was mediated by reductions in HbA1c, suggesting that lifestyle counseling helps to improve blood sugar management in those with diabetes.

Unfortunately, this study did not assess the quality of the lifestyle counseling provided to patients. It merely used machine learning to identify language in the EMR suggestive of physician-patient encounters in which diet and lifestyle were discussed. Clinicians may have used an authoritarian tone in these sessions, rather than more productive strategies such as motivational interviewing. As a result, this research may underestimate the real impact of lifestyle counseling on diabetes outcomes.

It is possible that the incidence of the primary outcomes, cardiovascular events, and death could be attenuated further by combining multiple health coaching sessions per month with a Functional Medicine approach to treating diabetes. This two-pronged approach addresses the underlying causes of type 2 diabetes and can help patients implement diet and lifestyle behaviors that beneficially alter the course of diabetes.

Reference: Lifestyle Counseling and Long-term Clinical Outcomes in Patients With Diabetes

Health coaches are facilitators of change. They empower their clients to tackle diet and lifestyle changes and offer unconditional support, which can help people take actions to manage or even reverse chronic conditions like type 2 diabetes. With the help of a health coach, clients are often able to better understand their diagnosis and treatment plan, as well as process the sometimes difficult emotions that come with chronic illness. What’s more, clients who have been through coaching often see additional benefits in their lives as they gain the confidence to take action and make changes. In the ADAPT Health Coach Training Program, we offer instruction on how to master the art and practice of health coaching from a Functional and ancestral health perspective. Our students learn how to help clients change their lives and adopt healthier habits. Find out more about what the ADAPT Health Coach Training Program has to offer.

306 Comments

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  1. 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.

  2. 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.

    example:
    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.

        • Vegetables. The sugar in fruit can actually be bad for you if you eat more than you can tolerate.

          • 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.

  3. 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.

  4. 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.

  5. 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.
    Results:
    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.

    Questions:

    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.

      • Thank you for your input! Already working on the diet. Not drinking anything with sugar has already made a difference.

  6. 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?

  7. 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.

  8. 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!

  9. 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.

  10. 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:

      http://www.livestrong.com/article/153932-reasons-for-elevated-a1cs-without-diabetes/

      http://www.clinicalcorrelations.org/?p=5190
      (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.

  11. 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?

  12. 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?

      Also:
      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.

  13. 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…

  14. 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.

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

  16. 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.

  17. 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: http://www.diabetes-warrior.net/

      • 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 (http://testyourbloodglucosesugarlevels.com/best-glucose-meter-with-cheapest-test-strips/) 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.

  18. 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) https://ihealthlabs.com/glucometer/ihealth-align/

    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.
    http://www.diabetesforecast.org/2015/mar-apr/images/glucose-meters-2015-revised8-7.pdf

  19. 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.

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