High Blood Sugar and Prediabetes

Which kind of high is it

Think about the last time you ate a big bowl of rice or pasta. Where were you an hour later? Alert, or looking for a couch?

A heavy, foggy slump an hour or two after a meal, or shaky hunger and irritability a couple of hours after that, is your blood sugar spiking and crashing, and it can happen long before any lab flags you. I wrote a page on the afternoon energy crash because it is often the first sign. A fasting glucose of 100 to 125 mg/dL, or an HbA1c of 5.7 to 6.4 percent, is what a doctor calls prediabetes. And a fasting insulin that is climbing while your glucose still looks normal is the earliest signal of all, because your body is working harder and harder to hold the line.

If you are very thirsty, peeing a lot, losing weight without trying, or your vision has gone blurry, read the doctor section at the bottom first.

What my glucose monitor showed me

I will tell you what I found, because it surprised me.

I ordered one of the two week continuous glucose monitors, stuck it in the back of my arm, and watched my blood sugar react to real life. The food that spiked me the highest was not a dessert. It was a Chipotle bowl. The white rice sent my glucose way up, even with all the guacamole and meat piled on top, the fat and protein that are supposed to soften the spike.

That is the thing about blood sugar. You can know every rule and still not know your own body until you watch it. Researchers who fed hundreds of people identical meals while tracking their glucose found that responses varied hugely from one person to the next. The same meal that barely moves one person can spike the next.

Some of what follows has strong science behind it and some of it is my experience. I will tell you which is which, because I am not going to hand you a claim I cannot stand behind.

My mains

If you only change a few things, change these.

Watch your own numbers. This is my number one, because it turned rules into something I could see. Wear a continuous glucose monitor for two weeks and eat your normal life. In a Stanford study, people whose standard tests called them normal still had glucose reaching the prediabetic range about 15 percent of the time once they wore a monitor. There is no trial showing that simply wearing one prevents diabetes, so treat it as a teacher, not a treatment.

Eat the Mediterranean way. Vegetables, clean protein, olive oil, nuts and fish. In the PREDIMED-Reus randomized trial, people eating a Mediterranean diet with extra olive oil or nuts developed diabetes about half as often as people on a low-fat diet, without counting calories and without losing weight.

Cut the white rice, the sugar and the bread. My monitor made this personal. A meta-analysis of seven cohort studies found each daily serving of white rice was linked with about an 11 percent higher risk of type 2 diabetes. That is an association rather than proof, but it matched what I watched happen on my own arm.

Apple cider vinegar with meals. A tablespoon in a glass of water with your biggest meal. A meta-analysis of clinical trials found vinegar taken with a meal lowered the rise in both blood sugar and insulin afterward. Always dilute it, and rinse or use a straw to protect your teeth.

Free, starting today

You start at the bottom. You do what you can, where you are, and you only climb if you need to.

Walk for ten minutes after each meal. In a randomized crossover study, people with type 2 diabetes who walked ten minutes after every main meal had about 12 percent lower blood sugar after eating than when they walked the same thirty minutes all at once, and after dinner the drop was about 22 percent.

Eat your carbohydrates last. Vegetables and protein first, rice, bread or potatoes at the end. In a randomized study, eating the carbohydrate last cut the after-meal glucose rise by about half compared with eating it first, with the same food on the same plate.

Lift weights. A meta-analysis of 47 trials found structured resistance training lowered HbA1c by about half a percentage point, and more than 150 minutes of structured exercise a week did better still. Muscle is where most of the sugar from a meal goes, so more muscle means more room to put it.

Sleep. In a randomized crossover study, four nights of sleeping only four hours made healthy young men insulin resistant, with higher insulin and higher blood sugar. One bad week of sleep is enough to show up in your numbers. I lay out my whole routine on the insomnia page.

Lose a little, move a little. In the Diabetes Prevention Program, a lifestyle goal of losing about 7 percent of body weight and moving 150 minutes a week cut the progression from prediabetes to type 2 diabetes by 58 percent over about three years. Metformin cut it by 31 percent. The lifestyle program beat the drug.

Your plate

Protein and vegetables at the center. Clean organic meat, fish, eggs and a pile of vegetables, with olive oil. This is how I eat most days.

Swap the starch. Cauliflower rice, extra vegetables or beans in place of white rice. Keep sugar, bread and juice for rare occasions rather than daily habits.

If you do eat carbohydrates, pair them. Eat them last, after the protein and vegetables, and go for a walk afterward.

If you want this way of eating laid out for you, recipes, shopping lists and all, it is the backbone of The Anti-Candida Kitchen.

About $10 to $30 a month: supplements

These are support, not the foundation. Nothing in a bottle beats a better plate and a walk after dinner. Check with your doctor first if you are pregnant, take medication, or have kidney or liver disease, and especially if you take anything that lowers blood sugar.

Berberine. A meta-analysis of 14 randomized trials found berberine lowered blood sugar and improved cholesterol when added to lifestyle changes, though the researchers flagged the trials as small and of low quality. Dihydroberberine is a form that is easier to absorb. It can stack with diabetes medication and push you too low, so read my page on berberine and blood sugar medication before you start.

Magnesium. A meta-analysis of randomized trials found magnesium improved insulin resistance, and taken for four months or longer it also lowered fasting glucose, in people with and without diabetes.

Apple cider vinegar. The cheapest one here, diluted in water with meals.

Want the basics in one click? Add dihydroberberine and magnesium to your cart.

Devices and testing

A continuous glucose monitor. Over the counter monitors now run roughly $50 to $100 for two weeks, no prescription needed. Two weeks is enough to learn which of your regular meals are the problem.

Fasting insulin. The early warning most standard panels skip. A fasting insulin test can show your body working overtime while your glucose still looks fine.

HbA1c. Your average blood sugar over the last two to three months. An HbA1c test is the number to watch as you make changes. Or add both tests to your cart.

Strength and support

Build the muscle. If you have never lifted, learn it properly. The Strength Upgrade teaches every lift, cue by cue, and the eight week program in The Anti-Candida Kitchen app builds your weights from your own max and climbs them each session. Get the course and the app together.

A lifestyle program. The Diabetes Prevention Program became a year-long lifestyle course now offered widely in the US, and many insurers cover it.

A good functional medicine doctor. Someone who will look at your insulin, your sleep, your stress and your food together, rather than waiting for you to cross the line into diabetes.

None of this has to happen this week. But today you can go for a ten minute walk after dinner, eat your rice last, and be in bed on time tonight.

When it belongs with a doctor

I am not a doctor and I am not diagnosing anyone. See one if your fasting glucose is 126 mg/dL or higher or your HbA1c is 6.5 percent or higher, which is the diabetes range, or if you are very thirsty, peeing often, losing weight without trying, have blurry vision, or cuts that heal slowly. Vomiting, deep fast breathing, fruity smelling breath or confusion with high blood sugar is an emergency. If you already take medication for blood sugar, never stop or change it on your own, and tell your doctor before adding berberine or vinegar, because together they can push you too low.

Your body is not broken

Your body is not broken. It is blocked. And for so many people with high blood sugar, the block is not bad genes or bad luck. It is a bowl of white rice, a meal eaten sitting still, a few short nights, and muscles that have been waiting years to be used.

Your body has been handling sugar your whole life. Give it a walk, a better plate and a full night, and watch the numbers answer.

Stay steady, my friend.