“Normal” blood sugar levels
From a Naturopaths perspective, high blood sugar levels are always a concern. I am going to tell you three markers to order to accurately assess blood sugar levels and why that so-called normal blood sugar, as dictated by the ADA, can double your risk of heart disease and lead to all kinds of complications down the road.
Fasting blood glucose:
This is still the most common marker and is often the only one that gets tested. The fasting blood glucose (FBG) test measures the concentration of glucose in the blood after an 8-12 hour fast. It only tells us how blood sugar behaves in a fasting state. It tells us very little about how your blood sugar responds to the food you eat.
Up until 1998, the ADA defined FBG levels above 140 mg/dL as diabetic. In 1998, in a temporary moment of near-sanity, they lowered it to 126 mg/dL. (Forgive me for being skeptical about their motivations; normally when these targets are lowered, it’s to sell more drugs – not make people healthier.) They also set the upward limit of normal blood sugar at 99 mg/dL. Anything above that – but below 126 mg/dL – is considered “pre-diabetic”, or “impaired glucose tolerance” (IGT).
Oral glucose tolerance test (OGTT):
The OGTT measures first and second stage insulin response to glucose. Here’s how it works. You fast and then you’re given 75 grams of glucose dissolved in water. Then they test your blood sugar one and two hours after. If your blood sugar is >140 mg/dL two hours later, you have pre-diabetes. If it’s >199 mg/dL two hours later, you’ve got full-blown diabetes.
Keep in mind these are completely arbitrary numbers. If your result is 139 mg/dL – just one point below the pre-diabetic cut-off – you’ll be considered “normal”. Of course, this is perfectly absurd. Diabetes isn’t like catching a cold. You don’t just wake up one day and say, “I’m not feeling so well. I think I got a bad case of diabetes yesterday.” Diabetes, like all disease, is a process. It goes something like this:
malfunction > disease process > symptoms
Before your blood sugar was 139, it was 135. Before it was 135, it was 130. Etcetera. Would you agree that it’s wise to intervene as early as possible in that progression toward diabetic blood sugar levels, in order to prevent it from happening in the first place? Well, the ADA does not agree. They prefer to wait until you’re almost beyond the point of no return to suggest there’s any problem whatsoever.
The other problem with the OGTT is that it’s completely artificial. I don’t know anyone who drinks a pure solution of 75 grams of glucose. A 32-oz Big Gulp from 7-11 has 96 grams of sugar, but 55% of that is fructose, which produces a different effect on blood sugar. The OGTT can be a brutal test for someone with impaired glucose tolerance, producing intense blood sugar swings far greater than what one would experience from eating carbohydrates.
Hemoglobin A1c, or A1c for short, has become more popular amongst practitioners in the past decade. It’s used to measure blood glucose in large population-based studies because it’s significantly cheaper than the OGTT test.
A1c measures how much glucose becomes permanently bonded (glycated) to hemoglobin in red blood cells. In layperson’s terms, this test is a rough measure of average blood sugar over the previous three months. The higher your blood sugar has been over the past three months, the more likely it is that glucose (sugar) is permanently bonded to hemoglobin.
The problem with the A1c test is that any condition that changes hemoglobin levels will skew the results. Anemia is one such condition, and sub-clinical anemia is incredibly common. I’d say 30-40% of my patients have borderline low hemoglobin levels. If hemoglobin is low, then there’s less of it around to become bonded to glucose. This will cause an artificially low A1c level and won’t be an accurate representation of your average blood sugar over the past three months.
Likewise, dehydration can increase hemoglobin levels and create falsely high A1c results.
The “normal” range for A1c for most labs is between 4% and 6%. (A1c is expressed in percentage terms because it’s measuring the percentage of hemoglobin that is bonded to a sugar.) Most often I see 5.7% as the cutoff used.
Dr. Andrew Arnold says, ‘our Naturopaths never use any single marker alone to determine whether someone has a blood sugar issue.’
I run a full blood panel that includes fasting glucose, A1c, fructosamine, uric acid, and triglycerides (along with other lipids), it is also a good idea to do post-meal testing at home over a period of 3 days with a range of foods.
If they have a few post-meal spikes and all other markers or normal, I’m not concerned. If their fasting BG, A1c, and fructosamine are all elevated, and they’re having spikes, then I’m concerned and I will investigate further.
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