November is Diabetes Awareness Month – Know Your Numbers

Know Your Numbers – Blood Sugar

“Blood alone moves the wheels of history.”  -Martin Luther


A single drop of blood can provide the information you need to better understand your risk of diabetes and heart disease. Pre-diabetes can linger for decades before transitioning to the diagnosis of diabetes and yet during this time, history is being made, but not with the outcome you might desire. The leading cause of death in diabetics is cardiovascular disease. Even in the early stages of pre-diabetes changes are beginning to happen in the lining of the blood vessels that cause them to become inflamed and accumulate plaque through a process called atherosclerosis. Fortunately, it is during these early stages when history can be altered and the adverse health outcomes from both diabetes and cardiovascular disease can be averted.

Diabetes is a major risk factor for heart disease.

According to the American Heart Association:

  • At least 68 percent of people age 65 or older with diabetes die from some form of heart disease; and 16% die of stroke.
  • Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes.
  • The American Heart Association considers diabetes to be one of the seven major controllable risk factors for cardiovascular disease.

Diabetes is both preventable and reversible.

Diabetes is both treatable and reversible but even when blood sugar is controlled with medications there remains a persistent elevation of the risk for heart disease and stroke. Diagnosing the disease at earlier stages, especially during pre-diabetes, can often allow one to reverse the condition of insulin resistance and minimize the cardiovascular risk associated with diabetes.

The American Diabetes Association have set blood sugar targets to help reduce the burden of heart disease. Many feel these targets are too high so a new category has been created and referred to as “ideal level,”  which has been added to the chart below for your reference.

Understanding the Meaning of Blood Sugar Levels

MarkerIdeal LevelNormal LevelPre-diabetesDiabetes
Fasting blood sugar (mg/dL)< 86< 99100 - 125> 125
Oral glucose tolerance test (OGTT)< 120< 140140 - 199> 200
Hemoglobiun A1c (%)< 5.3< 6.06.0 - 6.4> 6.4

It can be costly and time consuming to have your blood sugar checked through your physician and general labs. Fortunately, there is an inexpensive option that helps put you in control of your own health. Wouldn’t it be nice to know what foods raise your blood sugar too much, so that, you can personalize your carbohydrate intake? Well, take charge and buy a glucometer. These devices are widely available and inexpensive. You can now safely and conveniently follow your blood sugars and see how you are responding to the dietary choices you make. The more “ideal” your blood sugars remain the less likelihood of developing diabetes and heart disease.

Four Step Action Plan

Step one: Buy a glucometer, lancets and test strips

A glucometer is a device used to measure blood sugar. These devices and the test strips are widely available at most pharmacies. You will also need some sterilized lancets which are often sold with the glucometer or as an additional purchase. After pricking your finger with a lancet then a small drop of blood is placed onto a “test strip” according to the directions provided by the manufacturer of the glucometer that you purchased.

There are many options available but companies such as Contour, One Touch, ReliOn and Accu-Chek. Some have the capacity to interact with your smartphone to help you store data. ReliOn Prime is found at for $9.00 and you can get an additional 50 test strips for $9.00 and 100 lancets for $1.48, for a total investment of less than $20.00.

A word of caution, these devices may not be as accurate as a laboratory determined blood sugar but can help you monitor trends in blood sugar. If you have elevated blood sugars then have you doctor confirm it with a fasting blood sugar and hemoglobin A1c done in a standard clinical laboratory.

Step two: Testing your blood sugar at home
  1. Fasting blood sugar: Test your blood sugar first thing in the morning after fasting at least 12 hours. You may drink some water just after arising, as you should always do. However, don’t eat anything or exercise before the test. Keep a dated record of these values. Optimal levels are less than 86 mg/dL and anything over 100 mg/dL needs attention.
  2. Glucose tolerance test at home.
  • Pre-lunch blood sugar: This is a pre-test to determine your baseline prior to eating your lunch meal.
  • Eat your lunch. Do not eat anything for the next three hours.
  • Post-lunch blood sugar: Test your blood sugar one-hour, two hours and 3 hours after lunch.

Create a chart such as this one:

Date/MealPre-Meal Blood Sugar1-hour Post Meal Blood Sugar2-hour Post Meal Blood Sugar3-hour Post Meal Blood Sugar
Day 1
(Regular lunch)
Day 2
(Regular lunch)
Day 3: Carb Load
(Eat 60-80 grams of starch with low-to-no fat)
Goals (mg/dL)< 86< 140< 120Back to Baseline

On days 1 and 2 you will eat a normal lunch and record what you ate for that meal. This will help you see how the foods you usually eat impact your blood sugars.

On day 3 you will add a carbohydrate challenge. Instead of eating a normal lunch this will be a low-fat meal with a highly digestible carbohydrate or sugar. You will want the equivalent to 50-100 grams of a rapidly digestible carbohydrate or sugar. Examples include:

  • 6 oz. Grape juice = 30 grams
  • 9 oz. apple juice = 40 grams
  • Slice of bread = 15 grams
  • cup of cereal = 30 grams
  • banana = 20 grams
  • cup of milk = 12 grams
  • two slices of bread = 30 grams
  • 16 oz. orange juice = 40 grams

Combine any of the above items to achieve 50-100 grams. This might be a combo such as 6 oz grape juice, a banana and two slices of bread or a cup of cereal and a 16 oz orange juice.

Step three: Interpreting the results

The goal is to have a fasting blood sugar less than 86 mg/dL while making sure that blood sugar doesn’t consistently rise higher than 140 mg/dL 1-hour after a meal and stays below 120 mg/dL two hours after the meal. Finally, you want to be sure that your blood sugar returns to baseline 3-hours after your meal.

A couple of caveats to note with this testing. Most reliable glucometers have a ~10% margin of error so this is not an exact science. This error is acceptable since we are only tracking patterns of blood sugar responses. Secondly, look for rapid drops in blood sugar suggesting reactive hypoglycemia in which the blood sugar drops below 70 mg/dL within 3 hours of eating and associated with symptoms such as sweatiness, shakiness, fatigue, lightheadedness, blurred vision, headache and confusion. This condition is associated with pre-diabetes.

Step four: Taking action

So, where are your numbers? If they are higher than the guidelines then you have impaired glucose tolerance otherwise known as insulin resistance. If your your blood sugar is rising higher than 180 mg/dL after 1 hour then I would recommend getting some help, especially if you are already eating a low carbohydrate diet. Dietary changes and exercise are always the first therapy in managing insulin resistance and pre-diabetes. However, in some cases these changes will be insufficient when there are other contributing factors such as beta cell destruction in the pancreas and autoimmunity. These latter two possibilities require evaluation by a health care provider.

If you blood sugar is > 180 mg/dL,  find a health care provider who will help you get your blood sugar under control

If your post-prandial blood sugar is between 120 mg/dL and 180 mg/dL then you are in position to make some simple dietary changes and monitor the results. Refer to my last post to learn Seven Steps to Preventing (or Reversing) Pre-diabetes and Diabetes. Eating a high fiber plant-rich diet is the most effective way of preventing and reversing diabetes. This may simply mean monitoring your added daily sugar intake and keeping it below 36 grams (9 teaspoons) in males and 24 grams (6 teaspoons) in women. Please read your food labels and note serving sizes.  The easiest way to think of this is minimizing or eliminating processed foods in favor of organic, whole plant-based foods including a wide variety of vegetables, legumes, whole grains, fruits, nuts and seeds.

Keep sugar intake less than 9 teaspoons (36 grams) a day in males and 6 teaspoons (24 grams) in females.

Focus less on the macronutrients such as carbohydrates, fats and protein and more on consuming a variety of nutrient dense whole foods. Increasing fiber is essential in achieving better blood sugar control.

I would suggest reassessing your blood sugar in this way in order to see how you are progressing. I hope you can see now how a single fasting blood sugar may be insufficient in determining your risk. An alternative route would be to work with a health care provider that is knowledgeable of insulin resistance and how to properly diagnose this condition. Often fasting insulin levels and other blood tests can be obtained, since, after all, insulin elevation is the first signal that the body is developing insulin resistance and can occur decades before the diagnosis of diabetes is ever made.

Next week I will discuss how foods can be used to fight diabetes.

To learn more about the prevention and reversal of pre-diabetes, or insulin resistance, and diabetes then make an appointment today. Contact my office to schedule consult to begin your journey towards optimal health and wellbeing.