Maintaining normal blood sugar levels is essential to decreasing your risk for long-term health issues, managing a healthy weight, and feeling good overall. A wide variety of health problems related to glucose level imbalances are a rapidly growing burden for the healthcare system that is reaching epidemic proportions.
CDC's 2020 National Diabetes Statistics Report shows some alarming statistics:
With such a lack of diabetes management and awareness in the general population, it's easy for this illness to go untreated. Fortunately, there are more and more options in the market available to the public. Advancements in technology have made tools like continuous glucose monitoring devices more readily accessible to the every day person. This means less reliance on the healthcare system and the ability to take matters into your own hands.
You know your body best. We each have our own unique composition of genetics, diet, and lifestyle so it goes to say that our blood glucose levels react differently from one another depending on the combination of all these factors.
In this article, we'll take you through what metrics to look out for when measuring and evaluating your blood sugar levels. We'll also explain how a continuous glucose monitor helps track your data in real-time without fingerstick test strips.
You'll be able to know how to make better diet and lifestyle choices to maintain normal blood glucose levels.
According to the Mayo Clinic, a normal blood sugar level is less than 140 mg/dL or 7.8 mmol/L. Blood sugar levels less than 100 mg/dL after fasting for at least eight hours are considered normal. If your glucose reading is greater than 200 mg/dL or 11.1 mmol/L two hours after eating a meal, the high blood sugar level could indicate diabetes, which will need to be verified by your doctor. A glucose reading between 140 and 199 mg/dL or 7.8 mmol/L and 11.0 mmol/L could indicate prediabetes.
There are three general trends that are important to understand when measuring your glucose, whether you are using a CGM or doing fingersticks. By paying attention to these different glucose trends, you'll be able to get an understanding of how you are doing and where you can improve (everyone always has room for improvement!).
This is your glucose value when you are sleeping and without food for at least eight hours. Everyone's ideal range will be different, but a general guideline is to aim for a value of 70-90 mg/dL.
It will take some time, but focusing on trends will be very helpful here. After a few weeks of collecting data from your continuous glucose monitor, you will start to get a good idea of what your normal is. This will make it easier to identify abnormal days, such as elevated nighttime values after a night of drinking, poor sleep, or high stress.
Note: Sometimes the CGM is calibrated slightly higher or lower than true values (i.e. the values you'd get from a blood test through your doctor). Don't get too stuck on an exact fasting number. It's the trend that's the most important.
There are many different reasons why your fasting glucose values could be elevated. One factor to keep in mind is the calibration of the blood glucose monitoring device. The FDA allows CGMs to have up to a 15% variation versus what you would receive from a full lab draw at a physicians office.
So, your true fasting glucose value may be lower or higher than the CGM reading. The most important thing to consider is the overall glucose trend rather than an exact number. The change in glucose value using the CGM sensor is very precise and reflects real-time changes.With that being said, below are a list of the major factors that may be causing your fasting glucose levels to rise.
Peak glucose values are how high you "spike", which usually occurs right after a meal. Aim to to not spike above 140 mg/dL and to return to pre-meal glucose values within 2-3 hours after your meal. It's important to consider how high the glucose goes and how quickly it comes back to normal. You want to avoid dramatic spikes and prolonged increases. A spike every once in a while is not a big deal, but the goal is to minimize the overall occurrence and magnitude so that you don't enter into hypoglycemia or hyperglycemia.
Glycemic variability refers to the "swings" in your glucose level. This trend has the greatest implications for health and is especially important to monitor. It's normal for glucose levels to vary throughout the day, but you want to aim for these glucose "swings" to be gradual with moderate peaks, as opposed to dramatic highs and lows. So it may be possible that after a meal you only went to 130mg/dL (which is good!), but your pre-meal value was 70, so that would be quite a big swing. Look for a low standard deviation value when looking at your glucose analytics.
If you have elevated blood glucose or big spikes in your glucose levels, we recommend focusing on improving "The Big Four" to get back down to normal levels:
If you're using a continuous glucose monitor, you will have access to a large amount of real-time and historical data. As you gain a better understanding of what your glucose values and trends mean, the next step is to improve those values and get them to a healthier level.
The most effective ways to manage glucose levels, longevity, and health span can be grouped into what we call "The Big Four".
Your food choices are going to be the primary influencer on your health. This is the main pillar that simply cannot be neglected. There is no one-size-fits-all diet and many plans can fit into a healthy lifestyle. However, everyone can benefit from reducing their intake of refined carbohydrates, added sugars, and processed foods while focusing on consuming high quality foods.
I used to be scared of consuming too many carbs and avoided high-sugar foods like bananas. If I was craving carbs, I ate sweet potatoes because they are said to have a lower glycemic index.
However, when I started using NutriSense's continuous glucose monitor, I learned that my glucose response was the opposite of my initial thinking. Carbohydrate foods I thought were better for me, such as sweet potatoes, have a worse impact on me than bananas.
In my glucose graphs below, bananas lead to a minimal increase in glucose values. I also had low blood sugar levels with beans, legumes, and berries very well. To my great surprise, starchy vegetables (including sweet potatoes) rapidly elevate my glucose values.
Vs. sweet potatoes:
There could be several factors at play here, but in general, there is a lot of variability in glucose responses between person to person. We're all a unique compilation of genetics, epigenetics, environment, and microbiomes that cause us to react differently to the same food. Research has shown that when you give a standardized meal to people, almost everyone has a widely different glucose response with a standard deviation of 31. (Source)
Everyone’s carbohydrate tolerance is different, so that's why it's so useful to wear a CGM. You can find out where you lie on the spectrum of general diet advice.
After nutrition, physical activity is the next pillar to master. Include a variety of activities in your routine including stability and mobility, weight and strength training, aerobic exercise, and anaerobic high intensity exercise. Adequate activity doesn't stop at a hard workout though. Don't underestimate the importance of daily movement, walking, and limiting sedentary time.
Fasting can take on many forms, but experimenting with your eating schedule is a great way to improve your glucose values.
Here are some research-backed experiments to try:
Shorten the hours that you eat to less than 10 hours of the day. Shift your meals towards the beginning of the day, randomly switch up the times that you are eating, and avoid snacking. (Source)
Insulin functions according to a circadian rhythm. In general, most people experience the highest insulin sensitivity in the middle of the day, and the least insulin sensitivity in the middle of the night. In fact, insulin sensitivity peaks for most people at noon, and is 54% higher than insulin sensitivity at midnight. (Source)
I find that when I consume fewer carbs at dinner and more during the daytime hours, I improve my glucose responses to those foods. Glucose spikes are minimized and fasting glucose values are lower during the night. If I decide to eat any food, especially carbs, late at night, then I will see the effect on my fasting glucose values all night long.
The glucose graph below shows my glucose levels right before bed. At 11:45pm, I had a bowl of popcorn. As you can see, I experienced an initial glucose spike, and my glucose levels stayed high throughout the night during sleep. Generally, if I consume popcorn during daytime hours, it will give me a small glucose spike, but then come back to normal glucose levels within two hours of eating.
When I ate it right before going to bed, my nighttime glucose values stayed elevated until I woke up the next morning. Usually, my nighttime glucose values are between 70–80 mg/dL while I sleep. Imagine if this was happening every night and had no idea! With the CGM providing me with a continuous stream of data, it's easier to know how to lower my blood glucose back to normal levels.
Stress can be anything the puts the body in a physiological stressful state, which subsequently increases glucose levels. This includes mental stress, physical stress, poor sleep, and illnesses. Self-care cannot take a hit and it is important to focus on these basics so your body can perform at its best. Elevated cortisol (the stress hormone) can drive up fasting glucose values higher than any other factor. (Source)
When your cortisol levels are consistently high, the brain and liver make extra glucose and decrease your insulin sensitivity so that the excess glucose is available to treat the stress. If this behavior is consistent over time, it dramatically increases our risk of developing chronic conditions such as type 2 diabetes (Source)
In my glucose graph below, you can see a typical day for me. There is some glucose variability throughout the day, but most of the time, I am staying between 70–100 mg/dL.
The second picture is a day with similar food and exercise, but when my stress levels were very high. The stress caused my average glucose, fasting glucose, and postprandial glucose levels to all increase. With a CGM system, I'm able to visually see and quantify the effect that stress has on my body, and take action to decrease my glucose levels with a treatment plan.
Note that it's always best to check with your healthcare professional before experimenting with your CGM.
To figure out if a continuous glucose monitor is the right solution for you, learn about the NutriSense CGM program and subscription plans.
This article was written by Kara Collier, RDN, LDN, CNSC and Director of Nutrition at NutriSense