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Stubborn Fasting Blood Sugars

You’ve lost weight, improved your activity level, and changed your diet, but your stubborn fasting blood sugar won’t drop 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, an 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 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.

If your glucometer is reading 110 it’s a good idea to have a lab blood draw as well and compare it to that 110 read.

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? Did you ramp up your training too quickly?

We see too much cardio and not enough resistance training. Science has only recently pointed toward the importance of weightlifting.

6. Excess Fasting

What does time-restricted eating do to your blood sugar in the long term, not just in the short term?

Some people do great with fasting, but many experience glucose desensitizing during the fasting state and massive spikes upon waking, resulting in stubborn fasting blood sugars.

Understanding insulin resistance is an important part of the blood sugar equation. Some like to calculate their HOMA-IR, which is a good place to start. But the most important is making sure blood sugars don’t spike too far or crash too low, which can cause high morning blood sugars.

Improvement May be Enough

We remind clients that improving their blood sugar profiles may be more than enough. We rarely recommend the long-term use of handheld glucometers or CGMs for blood sugar measurement.

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.

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