Blood sugar
Prediabetes, a climbing A1c, and a prescription for Metformin. But did anyone look for what’s actually driving your blood sugar up?
Abnormal blood sugar isn’t on-or-off — it runs on a spectrum, from normal at one end all the way to Type 2 diabetes at the other, and most people are further along it than they’re told. Reaching for Metformin treats the number while leaving everything that pushed it up untouched. Read on to see how I’d actually look at it, and why the only durable way to lower your A1c is to lower your blood sugar consistently — at the cause.
What we actually look at
Your A1c is a four-month report card — not yesterday’s snapshot.
Two blood-sugar markers usually get tested, and they aren't the same thing. FBS — fasting blood sugar — is your level at the moment of the draw. It basically tells us what you did yesterday. A1c is different: it reflects your blood sugar over the roughly 120-day lifespan of a red blood cell, so it tells us what you've been up to for the last four months.
A1c — hemoglobin A1c — is a sub-type of hemoglobin that binds to excess sugar in your blood. The higher your blood sugar, and the longer it stays high, the higher your A1c climbs. So there's only one way to bring it down: lower your blood sugar consistently, day after day.
It also means a single “normal” fasting number can be misleading. Abnormal blood sugar runs on a spectrum — from normal at one end all the way to Type 2 diabetes at the other — and you can be well along it before anyone says a word. Metformin can push the number down, but it leaves the diet, sleep, stress, and lifestyle drivers underneath it completely unaddressed. That bill will eventually come due, whether you take Metformin or not.
What actually moves your blood sugar
- It starts with what you eat and drink
- Healthy protein and fat are your friends — grassfed beef, pastured poultry, eggs and dairy, wild fish and game — at every meal. Avoid refined sugar and processed carbs like the plague. Graze: smaller meals, more often (I eat five a day, about every three hours) keeps blood sugar steady. And lean on above-ground vegetables for carbs — root vegetables like carrots, beets and parsnips are very high in quickly-absorbed sugar.
- The glycemic index is half the battle
- Cutting sugar is only half of it. The other half is avoiding quickly-absorbed sugar — the glycemic index (like golf, lower is better). Alcohol is the worst: fermentation gives it an extremely high glycemic index, and it skips your digestive tract straight into your bloodstream — a massive spike. Skip juice and anything with high-fructose corn syrup, and treat fruit as dessert, only after a healthy meal.
- Lifestyle moves the needle too
- Sleep early and sleep more — late nights wreck blood sugar and stoke cravings. Resistance exercise beats cardio (if you do cardio, follow the 180 Formula). Manage stress, because stress raises cortisol and cortisol raises blood sugar — as does caffeine. Even screens and artificial light after dark matter: one doctor induced prediabetes in a patient after a single night under artificial light.
Common questions
What people ask about blood sugar labs.
- What’s the difference between fasting blood sugar and A1c?
- Fasting blood sugar (FBS) is your level at the moment of the draw — it basically tells us what you did yesterday. A1c reflects your blood sugar over the roughly 120-day lifespan of a red blood cell, so it tells us what you’ve been up to for the last four months. A1c is a sub-type of hemoglobin that binds to excess sugar: the higher your blood sugar, and the longer it stays high, the higher it climbs.
- How do I actually lower my A1c?
- There’s only one way — lower your blood sugar consistently, day after day. That starts with what you eat and drink: healthy protein and fat at every meal, avoid refined sugar and processed carbs, graze on smaller meals more often, choose above-ground vegetables over root vegetables, and keep to low-glycemic foods. Then sleep, resistance exercise, stress management, and light habits do the rest. Be the tortoise, not the hare.
- Do I need Metformin?
- I don’t like the idea of reaching for Metformin. It only treats the symptom while leaving all the underlying causes unaddressed. That bill will eventually come due, whether you use Metformin or not. Far better to spend your energy on improving your diet and lifestyle and fixing what’s actually driving the number up.
- How long before my numbers change?
- Longer than you’d like — this is a tortoise’s game. You won’t see the effect of new habits until at least three months from now when your doctor tests next, and maybe not even then. One of my mentors, the late great Charles Poliquin, said it can take years to reestablish normal blood sugar regulation. But if you’re consistent every day, it pays off. Follow the system and the score takes care of itself.
Robert is a functional health consultant, not a licensed physician. Nothing here is medical advice or a diagnosis — it’s education, and not a substitute for your own doctor.
Stop taking (insert your blood sugar med here) for an answer.
Metformin pushes the number down, but it doesn’t touch what pushed the number up. That’s treating the symptom and leaving the cause — and that bill will eventually come due, whether you take it or not. Let me help you get to the cause.