Is This You?

You get that crash after lunch where all you want to do is lie down. You have headaches, or mood swings, or anger that seems to come out of nowhere when you haven't eaten. You feel hungry all the time, or you're eating low-carb and the weight still isn't coming off.

Maybe your doctor mentioned that your A1c is creeping up and told you to watch your diet and come back next year. That's not much of a plan, and you probably left with more questions than answers.

Why I Look Beyond A1c

A fasting glucose is a single snapshot from one moment. An A1c is a three-month average. Both have their place, but neither one shows you how a specific meal, a walk after dinner, or a stressful afternoon actually moves your blood sugar.

So I look at more. I check your fasting insulin, which can show us that your body is working too hard to keep your blood sugar in range well before your A1c changes. I also look at your triglycerides, your HDL, and your liver enzymes, since fatty liver often travels with insulin resistance.

The Tool I Reach For: A Continuous Glucose Monitor

A continuous glucose monitor, or CGM, is a small sensor you wear on the back of your arm that reads your glucose around the clock and sends it to an app on your phone. Personally, I think everybody should do this at least once or twice.

Almost every patient has the same experience. They find out a food they eat all the time is spiking their blood sugar, and they had no idea. For me, it was a matcha latte. I would not have believed it if I hadn't watched it happen. I walk through the exact protocol I use in this article on CGMs.

What Could Be Driving It

Specific Foods You Wouldn't Suspect

It's usually not the obvious dessert. It's a sweet sauce, a drink, or a "healthy" snack. Most people find the two or three things that make up the bulk of their problem.

Muscle and Movement

Your muscles are where a lot of your blood sugar goes. Resistance training and a walk after meals are two of the most effective things we can add.

Sleep and Stress

A bad night of sleep or a stressful stretch at work can push your numbers up even when your diet hasn't changed. Seeing that on your own data makes it real.

Hormones

Cortisol, thyroid, and sex hormones all influence how you handle sugar, which is why I look at your hormones too.

How We Work on It Together

We start with your history and labs, and oftentimes two weeks on a CGM. Then we review your data together and make changes that are small and completely doable. From there, your plan may include nutrition changes, strength training, better sleep, targeted supplements, and medication when your biology needs the extra help. For some patients that includes GLP-1 medications, which I cover on my weight loss page.

I can't promise a specific result. What I can tell you is that this is one of the most actionable areas in all of medicine, because you get to see what's working. Michael and Otto are two patients who turned their numbers around, and you can read their stories.