HbA1c is the New BMI: Blood Sugar 101
Updated: Jan 16
by Kate Daugherty, MS, CNS, Functional Nutritionist
I won't go so far as to say we don't care about your BMI.. but I can't remember the last time we calculated a BMI. Instead, understanding your glucose regulation tells us SO MUCH MORE about your metabolic health. Here's my guide to Blood Sugar Management from the testing basics to lifestyle tips....
Why does BLOOD SUGAR CONTROL matter?
High blood sugar is very oxidizing to the blood vessels. We can think of oxidation like rust. It causes a lot of internal damage! It is this oxidative stress that leads to complications like kidney disease, heart disease, neurodegeneration, and other vascular issues in diabetics.
Blood sugar management has implications beyond diabetes. It’s relevant for neurological function, energy, mental health, hormone health, and body composition! Your blood sugar is a snapshot of your metabolic health, and metabolic health=overall health.
>> Managing your blood sugar is paramount for a long and healthy life <<
How does BLOOD SUGAR work?
Blood sugar (or blood glucose) is a measure of the amount of glucose circulating in your blood. Glucose isn’t a BAD thing.. it’s the primary energy source for our body. We want it available to our mitochondria inside cells, not floating around in our blood.
Glucose comes into our blood through our diet -or- glycogenolysis -or- gluconeogenesis. From there, it is shuttled into cells with the help of the hormone insulin. It’s a synchrony of events. When blood sugar rises, the pancreas releases insulin which shuttles the sugar into muscle and liver cells for use (ideally). If those cells are full, the excess blood sugar is stored in fat cells. When blood sugar dips too low, the pancreas releases glucagon which tells the liver to break down stored glycogen and release it back into the bloodstream. This should constantly happen to keep us in a happy state of homeostasis.
When blood sugar is chronically high, insulin has to work overtime. The pancreas kicks out more and more insulin; and eventually the cells stop responding. This is what we call “insulin resistance”. In the long run, the pancreas can’t produce enough insulin to overcome high blood sugar.
High Blood Sugar > High Insulin > Increased Fat Storage > Increased Inflammation
Testing Blood Sugar : Fasting Glucose, HbA1c, Fasting Insulin
The American Diabetes Association (ADA) uses two primary markers for classifying risk: Fasting Blood Glucose and Hemoglobin A1c (HbA1c).
In a functional medicine world, we also consider Fasting Insulin to be a necessary marker for assessing your blood sugar control. Our ideal ranges are much tighter than those used in the conventional medical world. We look for:
Fasting Blood Glucose below 88
HbA1c below 5.5
Fasting Insulin between 1-4
Why? Data shows a significant gap in risk from these ranges to what is considered “normal” and especially to what is considered “pre-diabetes”. Further, elevations in fasting insulin can show up even while the other markers are controlled. This means there’s a window to address it BEFORE it becomes a full-blown disease.
The Blood Sugar Rollercoaster: aka Dysglycemia
When our blood sugars swing high and low (spikes and crashes) it is sometimes referred to as the “blood sugar rollercoaster”. Instead, you want a smooth and steady ride with minor hills and valleys; one where your blood sugar levels stay within a fairly tight range. This means your “glycemic variability” is low.
The following are the generalized symptoms that indicate you need better glucose control:
You get irritable if you skip a meal
You feel hungry constantly
You have intense cravings for sweets
You feel spacey and find it hard to concentrate
You overdose on caffeine to compensate for feeling tired
You get drowsy in the afternoons
Your moods seem to have a life of their own
You feel edgy but with no apparent cause
You have a hard time losing weight
You struggle with sound sleep
>> The OPTIMAL daily variability (maximums/minimums) is a little different for every person. Some individuals may feel symptoms of hyperglycemia at a blood sugar level of 140 mg/dL, while others may not. A good rule of thumb is to keep post-meal blood sugars within 30 mg/dL of your fasted baseline.
Dietary Practices for Better Glucose Control
There are a number of things you can do to improve your glucose regulation beyond cutting out ALL carbohydrates. If you can be smart about HOW you are consuming food, you have a lot more freedom in food choice.
1. Put Some Clothes on your Carbs
No naked carbs... pair them with a protein and/or fat! When combined with protein and/or fat, the glucose from a carbohydrate is absorbed more slowly and evenly into the bloodstream. Protein and fat also help to delay digestion, keeping you fuller for longer.
What this looks like: When eating simple carbs (like fruit, rice cakes, oatmeal, or bread) add a handful of nuts, a tablespoon of nut butter, an egg, or avocado! <<Click here to get Kate's Blood Sugar Friendly Snack Ideas PDF for FREE!>>
2. Lean Into Savory Breakfast
Ditch the typical American breakfast. Breakfast foods like pancakes, waffles, toast, and cereal are typically carb-heavy and can set you up for a blood sugar rollercoaster. Instead, start your morning with a protein-rich meal. Protein consumption causes the release of peptide YY, a hormone that helps to increase satiety and regulate appetite. PLUS it can have an impact on glucose regulation at subsequent meals.
Simple Ideas: Eggs (when tolerated) make a great easy breakfast option. Otherwise, chicken/turkey sausage, smoked salmon, a protein-loaded smoothie, or chia seed pudding can work!
3. Get Some Movement After Meals
Plan in a 10 minute walk after eating. This is one of the easiest (and cheapest) lifestyle hacks for managing post-prandial blood sugar. Especially if your meal includes simple carbohydrates, a walk as short as 10 mins (or a 10 min dance session!) will have demonstrable effect without changing food choice at all.
4. Whole (Fresh) Fruits Only
Avoid fruit juices which contain concentrated amounts of fructose and are devoid of fiber. While dried fruit has the same amount of sugar as it’s fresh counterpart (as long as none has been added); you’re more likely to eat more of it. You likely will eat more raisins than grapes, for example.
What this looks like: Set a personal rule to only eat whole fruits. When making smoothies, include the whole fruit in a blender rather than a juicer. Avoid dried fruit unless strictly abiding by portion sizes— and still remember to add some clothes!
5. Start With Vegetables
When consuming meals, consider the proper order of eating. Fiber > Protein > Fat > Starches/Sugars. Eating vegetables first lowers the glucose response.. even when carbohydrate portions are unchanged. However, starting with fiber-rich vegetables also increases satiety so you are less likely to overeat hyper-palatable foods.
What this looks like: Add a simple green salad to lunches and dinners. When eating a well-balanced meal, make an effort to go for the vegetables first. (For example: Chicken+Sweet Potatoes+Broccoli: Eat the broccoli, then the chicken, then the sweet potato.)
6. Upgrade Your Smoothie
Smoothies are an excellent way to pack in tons of nutrients in a convenient meal. However, the same rules apply here- no naked carbs! A high-quality protein powder gives you bioavailable amino acids and better glucose management without adding significant calories. Adding healthy fats to smoothies gives them a more creamy, indulgent taste. Easy ways to sneak fat into smoothies include avocado, MCT Oil, coconut/coconut milk, and nuts/seeds.
Other relevant smoothie notes: Don’t be afraid to add vegetables! Frozen cauliflower, frozen zucchini, and greens all add bulk and micronutrients without altering the taste too much. Seeds (like hempseeds, chia seeds, flaxseeds, pumpkin seeds, sunflower seeds, and sesame seeds) can be important sources of micronutrients and fiber and are a total smoothie upgrade. >> Get Kate's Ideal Blood Sugar Control Smoothie Below <<
7. Stick To a Regular Meal Schedule
Fasting CAN be helpful for blood sugar management; when done in the right way. This looks like following a fairly low-carb diet most of the time and being very intentional about your breaking-the-fast meal.
However, most individuals with blood sugar dysregulation do better with frequent, smaller, balanced meals/snacks. If you go too long between meals, you may find yourself in a hypoglycemic state. Plan to eat every 3-4 hours while following all the above rules.
Once you dial in the pattern that works FOR YOU, stick to that day after day to avoid any big swings.
8. Build A Balanced Plate
When building a balanced plate, start by filling half your plate with non-starchy vegetables. Two large handfuls of leafy greens is a good base + any other in-season options. Protein portions can be estimated using the palm of your hand, and complex carbs should be about the size of your fist.
MORE RESOURCES FOR BUILDING A BALANCED PLATE
Beyond The Plate...
Your diet ABSOLUTELY is a major player in blood sugar management. Refined sugar, refined carbohydrates, high-fructose corn syrup, inflammatory proteins, and processed foods are a recipe for disaster when it comes to staying metabolically healthy.
However, blood sugar is also profoundly affected by stress, sleep quality, exercise patterns, gut health, and toxic burden. >> Addressing ALL of these areas is paramount for optimal glucose control.
ADDRESS YOUR STRESS
Stress hormones are intimately related to insulin, glucagon, and leptin. Chronic stress can impact blood sugar; even when you’re doing everything “right” when it comes to food.
Mindful practices like meditation, yoga, and deep breathing can decrease fasting blood glucose and post-prandial glucose.
If you want to be metabolically healthy, you MUST consider the HPA Axis function.
PRIORITIZE SLEEP
Inadequate sleep impairs satiety, increases cravings, and is correlated with an overconsumption of processed foods. It affects glucose management at the beta cells in the pancreas.
There’s no surprise that those with sleep apnea are at an increased risk of diabetes. Hypoxia (low oxygen) impairs insulin production. When there isn’t adequate insulin, glucose can’t be shuttled from the bloodstream into cells.
Aim for 6-8 hours of quality sleep per night. You can nurture circadian rhythms with light exposure, cold/heat exposure, and meal timing.
MOVE OFTEN + MOVE WELL
Exercise alone can reduce fasting blood sugar, HbA1c, and fasting insulin; even in comparable metrics to certain medications. (!!) Walking for just 30 minutes per day reduces the risk of diabetes by 50 percent.
While ten minutes post-meal is a good target for managing the immediate glucose response of carbohydrates…. A more appropriate target for overall health is an average of 3 hours of exercise per week.
GUT HEALTH = METABOLIC HEALTH (!!)
The health of your gut determines A LOT of your metabolism. Limiting inflammatory foods, balancing the microbiome, and addressing intestinal permeability are all important for managing systemic inflammation.
Prebiotic fibers (like inulin, psyllium, and guar) have been shown to reduce blood glucose. This is likely because they promote growth of “good” bacteria species and improve detoxification capacity. *Not all individuals tolerate fiber; so consult with a nutritionist if you’re experiencing gas or bloating after increasing soluble or insoluble fiber.
Consuming fermented foods or supplementing with probiotic species can also have an effect on metabolic health. Antibiotic therapy, infections, pathogens, and bowel habits can all impact the balance of bacteria within the gut environment. Sometimes, increasing ‘good’ bacteria can effectively rebalance / reinoculate the gut by crowding out the ‘bad’. Other times, a more advanced protocol is necessary.
Regular elimination (pooping) is an important part of the detoxification process. When we don’t get rid of metabolic waste, we can recirculate toxins through the enterohepatic system, increasing our overall burden. When we have a higher burden, we have less capacity for 'dealing with' the normal processes of metabolism.
ICYMI: GET THE COMPLETE GUT HEALTH PROTOCOL by THE FACILITY DENVER -
Ultimately, Blood Sugar Control comes down to managing not only your diet, but your lifestyle. Particularly when risk factors (like genetics) are unavoidable, YOU must take the control to live healthier, happier, and longer. If you need help assessing your baseline and implementing strategies towards better glucose management, REACH OUT.
Fasting blood sugar, HbA1c, and Fasting Insulin are included in our Comprehensive Bioscreen Bloodwork.. the basic foundation of our Functional Medicine Testing.
>>You better believe we're gonna hone in on Sleeping, Pooping, and Blood Sugar Control.
Want a free resource for managing your blood sugar? Click here to get Kate's collection of Blood Sugar Friendly Snacks!
CLICK HERE to shop our supplement store - products are also available in our Cherry Creek Clinic.
If you're curious about building a personalized supplementation protocol for controlling and managing your blood sugar, contact us to book a consultation! (This can be remote).
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Want to work with a functional medicine doctor to run labs and assess nutrient status? Struggling with hormone imbalance, IBS, weight gain, mood changes? Let's look at BIOCHEMISTRY. Read more about Functional Medicine at The Facility here.
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CLICK HERE to schedule a FREE 15-Minute Consult with Kate to determine your best course of action!
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