You’ve lost weight, improved your activity level, changed your diet, and that stubborn fasting blood sugar won’t get below 110.
In this article, I’ll share how we approach such outcome discrepancies in our Heart Health Coaching practice. The most important caveat is that any improvement is a massive step in the right direction and that perfection is the enemy of progress.
In other words, a FBS of 110, if brought down even to 108 is a major step in the right direction.
Elevated Fasting Blood Sugar Troubleshooting
In this case presentation, we assume that you are actively involved in improving your blood sugars whether you are a non-diabetic, prediabetic, or type 1 or 2 diabetic.
For some reason, your actions have made a huge improvement in your A1C percentage and your postprandial sugars but the morning fasting sugars remain high.
1. Data Error
The CGM (continuous glucose monitor) our client is wearing might show elevated morning sugars, but is it accurate?
Confirming any values with a handheld glucometer and serum fasting blood sugars is best. As a bonus, we also recommend our clients check their fasting insulins.
2. Body Composition Issue
Some of our clients are underweight, and others are overweight. Is there excess visceral fat in the body?
Fat inside the muscle cells will decrease the cell’s ability to respond to insulin which would help clear excess serum glucose.
A DEXA scan will tell us if the client has too little muscle mass or too much visceral fat.
3. Stress & Sleep
If there is undiagnosed sleep apnea or elevated stress levels, the fasting blood sugar will be hard to control.
Managing sleep and stress is just as important, if not more, than diet or exercise levels.
4. Dietary Extremes
A few clients, especially those in their 70s, seem chronically undernourished. A low dietary protein content combined with androgen deficiency leads to rapid loss of muscle mass, which is necessary for proper fasting blood sugar regulation.
5. Exercise Balance
Are you doing too much cardio and not enough resistance training?
We see too much cardio and not enough resistance training. It’s only been in the last decade that science has pointed toward the importance of weight lifting.
6. Excess Fasting
What does time-restricted eating do to your blood sugar long-term, not just short-term?
Some will do great with fasting, but many will experience glucose desensitizing during the fasting state and experience massive spikes upon waking, resulting in stubborn fasting blood sugars.
Improvement May be Enough
We remind clients that improving blood sugar profiles may be more than enough. Rarely do we recommend long-term use of blood sugar measurement via handheld glucometers or CGMs.
Even with some elevated values, health improvement is exponential as long as the changes are happening in the right direction.
Instead of obsessing over the last 10 mg/dl we encourage our patients to figure out their Heart Health Risk Score and aim to minimize other health risk factors.