I want to thank Carlee Hayes and Molly Downey from NutriSense for their immense help in writing this post. 

The most effective treatment for chronic conditions is diet and lifestyle intervention, which help restore normal hormonal and metabolic function. Even mildly abnormal glucose levels are an early warning sign for many chronic conditions, such as insulin resistance, diabetes, metabolic syndrome, mitochondrial health, blood vessel damage, heart disease, strokes, and brain health. 1,2,3 Blood glucose measurements are one of the best ways to assess metabolic function and overall health. A fasting blood glucose test and the hemoglobin A1c level are two of the most common measurements doctors look at to evaluate your metabolism. 

Fasting Blood Glucose and Hemoglobin A1c

According to the American Diabetes Association (ADA), normal fasting blood glucose is less than 100 mg/dL, prediabetes is between 100-125, and anything above 126 is considered Type 2 diabetes. High blood glucose is called hyperglycemia. Incidentally, one teaspoon of sugar equals five grams, about the amount that 100mg/dl represents. We can only carry one teaspoon in our blood safely; it is potentially damaging otherwise.

The accepted lower end for blood glucose is 70. If your blood sugar gets too low, it is known as hypoglycemia and can lead to lethargy, unconsciousness, and even coma. People that are good fat burners will tolerate lower blood sugars. I am one of them, as we will see later in this post.

Your A1c measures the average amount of sugar that is bound to an individual red blood cell at any given time. Because the average lifespan of a red blood cell is three months, an a1c tells you on average how much glucose has been in your bloodstream for the past three months. Readings should be under 5.7 for healthy individuals. Both of these measurements have limitations. Because they are one-time measurements, they fail to consider the bigger picture, miss fundamental problems, and are unreliable (specifically a1c). 4,5

My Latest Glucose and A1c: Am I Diabetic?

My latest blood test had my fasting blood glucose at 135 and my A1c at 5.7. This sounds alarming considering the allowable levels as per the ADA. My A1c is usually highish, and my blood sugar is usually around 100 when I get it tested. On my last test, I had to deal with very poor and borderline hostile treatment from the staff. My functional medicine provider orders numerous vials of blood for testing, and the office did not want to do all of it in one draw because it would take too long. I even had to speak with a supervisor on the phone to get them to run my tests. It was a battle, but in the end, they did all of my tests that day. As a result, my adrenaline was pumping at a maximum which raises blood sugar substantially. The explanation for my A1c is that it varies from person to person and is more of an indicator for individual blood sugar control. For instance, if you are normally around 6.6 and you get it down to 5.5, you can reasonably assume you are doing a better job at controlling your blood sugar.

Continuous Glucose Monitors

A better way to understand the dynamic nature of our blood glucose is a continuous glucose monitor, also called a CGM. A CGM is a small device about the size of three stacked American quarters that you wear on the back of your arm that you scan with your smartphone at least every eight hours to an app. It is applied painlessly with a special applicator, you hardly notice its presence, and it does not limit your daily activities in any way. I just finished my first month using the one from NutriSense. It costs $350 for just one month, which I consider well worth it. If you have longer-term goals like weight loss, they offer multi-month subscriptions at less than $200 per month. What is easier, preventing diabetes and all of its associated monetary and health costs, or having diabetes with all of its associated monetary and health costs?

I did accidentally purchase an additional month because I did not cancel in time. The cancellation date is from the purchase date, not the day you start wearing the product. Since medical devices can’t be returned, you should be mindful of their cancellation policy. The company recommends that you purchase one month and cancel it immediately if you want it for a month only. The app will still work, and you will have all of the benefits of the product. Most importantly, I was very impressed with their product, app, and support staff. They even provide a nutritionist who actively monitors your readings during the first month for free! I would like to give thanks to Kasey B., who helped me understand what I was seeing. She also explained everything going on and provided articles.

Glycemic Variability

Everyone has very personal responses to food, with one healthy person spiking from starchy vegetables and another healthy person tolerating them just fine. The routine ups and downs your blood glucose takes is called glycemic variability. Glycemic variability is strongly linked with health outcomes, and a CGM is one of the only ways to monitor it. 6, 7, 8 Prevention and early detection of metabolic abnormalities are easier and cheaper to reverse than treating a disease like type 2 diabetes. If you are not measuring, you can never know your individual responses to food and which foods are best for you. 9 The smartphone app lays out your glucose level as a continuous graph where it is easy to see how meals and activities like sleep and exercise relate to your glucose level. This way, you and your nutritionist from NutriSense can determine how you can best make healthy lifestyle and diet changes. 

Changing Lifestyles and Diets is Difficult

The lead nutritionist at NutriSense, Carlee, stressed that continuous, real-time data drives behavior change much better than following a generalized nutrition plan or medical advice. She states that preventative health is challenging to implement because there is a disconnect between our actions (saying no to dessert) and their long-term outcomes (optimal metabolic health). Real-time feedback provides a direct window into the body's metabolism, highlighting the short-term benefits of healthy choices and making them easier to sustain. 10

NutriSense Meal Score

One of the best features of the NutriSense app is its meal score. The team created a meal score in their app for each time you enter the food you ate. The app scores from 1 (poor) to 10 (excellent). The meal is scored from when it is logged until 2 hours later. The four measurements that make up the meal score are peak, exposure, stability, and recovery.  Here is a sample meal I had of an 11-ounce chuck steak from August 10th. Because I received all tens, it was a perfect meal for me. It is possible if I ate the same meal right before bed, I may not have gotten such a good score. With a CGM you can figure out the subtleties of your diet. Plus you have a nutritionist working directly with you to help.

Peak

The peak or maximum of your blood glucose meal score is how high it goes over the next two hours after you eat. The nutritionists at NutriSense prefer that you don't spike your glucose above 140. However, eating meals high in processed carbohydrates like bread, pasta, and sugary drinks can cause very high spikes in your blood glucose, so stay away from those foods if you want better peak scores. Pushing your glucose up to 160 means that it will be harder to lower it to a safer level. But if you can get it lower quickly, it is better. In the meal I had above, I only peaked at 87, which is even good for a fasting blood glucose level.

Exposure

Your exposure, or area under the curve is the area under the spike on your graph after you eat. Their ideal size should be under 25. So basically, they are looking for a peak under 140 that is short. Thus, a quick peak of 150, as in the example above, that lasts twenty minutes is better than a peak of 140 that lasts four hours. My exposure in the meal example was 16.5 which is way below their allowable 25. In other words, I did not expose myself to too much blood sugar, which can be damaging to my health.

Stability

How much your glucose changed in the 2-hour window is known as your blood glucose stability or delta. So you might have started at 70 and jumped to 130, and that would be a change (delta) of 60. They want to aim for a shift in the glucose of 30 or lower most of the time. Mine was 21 which is much lower than the allowable 30. Think of stability as a calm body of water, the fewer big waves the better.

Recovery

Finally, recovery or 2-hour delta is how close your 2-hour glucose value is to your pre-meal glucose value. This shows us how well your body responded to the meal and returned to baseline values. In healthy individuals, our cells readily react to insulin and quickly take up glucose out of the blood. When we eat a meal containing carbohydrates, we convert them to glucose, stimulating us to secrete insulin from our pancreas. Poor recovery is a sign that we may not be responding to the insulin spike after a meal, and the glucose remains in the blood. This is known as insulin resistance. For more information about how vital your insulin level is to measure, read this post. 

Causes of Poor Meal Scores and High Fasting Blood Glucose

What and when you ate the night before. The content of the food, portion sizes, and consumed time can impact fasting values. We tend to not process food as well later in the evening.

Alcohol. Alcohol consumption can have drastic effects on blood sugar readings. It likely comes with no surprise that higher carbohydrate beverages, such as cocktails or beer can lead to an immediate rise in glucose. Other types of alcohol, such as liquor or dry wine, can result in a slight reduction in glucose or no effect at all afterward.

Industrialized diets. A bagel contains fifty grams of processed carbohydrates and is broken down rapidly into ten teaspoons of sugar in our blood. More than one around one teaspoon of glucose in our entire bloodstream is dangerous, so ten is pushing it. But eating bagels and large sandwiches, not to mention donuts and chips, is common in the industrialized West, so many of us have wildly high glucose spikes, which over time, can cause health issues.

Physical inactivity. If we are inactive, our liver and muscles do not use their stored glycogen and remain at full capacity, therefore we must store excess carbohydrates as fats in our fat cells. Thus, inactivity eliminates two out of our three options for energy storage, effectively causing our liver and muscles not to take up extra blood glucose, potentially leaving it to concentrate in our blood, or causing weight gain from excess fat storage.

Sleep deprivation. Sleep deprivation causes high cortisol. High cortisol leads to high blood sugar. Chronically high blood sugar leads to numerous health problems. (Is this a Yoda quote?)

Chronic stress. Chronic stress causes high cortisol. High cortisol leads to more elevated blood sugar. Chronically high blood sugar leads to insulin resistance. If this sounds familiar, realize that lack of sleep is a stress on the body.

Disrupted gut germs. Disruptions in our gut and urinary microbiome (dysbiosis) may reshape our protective gut barrier and energy metabolism, causing insulin resistance. 11 I covered this subject in more detail here.

My Monthly Score

For the most part, my scores are very good. I have perfect scores for daily average, meal average, the time within range, and mean. In one study, the standard deviation of all healthy subjects was under 20. 12 My standard deviation was much better at only 11. By all accounts, I am metabolically fit.

My morning average is a bit high for NutriSence, but I believe it is because I am on the carnivore diet, and mornings are when I make my own glucose, as I eat few to no carbohydrates. This is known as the dawn phenomenon. Also, my highest peak was over 140. It hit 152 after doing an intense CrossFit workout called Cindy. Spikes in glucose are expected after such an intense workout. I peaked rapidly and fell to my record low of 53 about an hour after the exercise. My body was freeing up glucose to be replaced in my depleted muscles. An expected phenomenon. Since I was feeling fine with a reading of 53, I was very likely burning fats and ketones for fuel instead of glucose. In most individuals, low blood sugar is dangerous as it can lead to foggy thinking, poor reaction time, lethargy, unconsciousness, and even coma.

What You Can Do Now

• Eat paleo-type whole foods devoid of processed carbohydrates and industrial seed oils.

• Time your meals so that you don't eat close to bedtime.

• Heal your gut. Diets high in sugar, processed oils, and artificial sweeteners can threaten the livelihood of our gut germs. On the other hand, fermented foods, fiber, or carnivore diets can help establish good gut germs. 13

• Exercise. 

• Sleep enough.

• Take care of your stress.

If you are interested in more information or want to order a CGM from NutriSense, click here.