Blood Glucose Basics
What's the ideal range for me? What should I be shooting for?
Around 100 is usually an ideal goal +/- 20 points but that can vary by the patient, and it can change based on our goals, and each person’s body.
How high is too high?
It’s relative, but to keep things simple, if you’re over 150, that’s too high. Spikes, average or otherwise. Some people get up to 200, 300 even over 500! We want to bring that down quickly and safely. So high can be relative and 150 can be far away for some people, but with patience and following directions, you will have a higher likelihood of bringing it down.
Spikes and peaks in the night?
It’s possible to experience steep peaks and valleys in readings during the night while you’re sleeping. Sometimes it's related to nighttime digestion, but more often it’s an inaccurate reading from laying on the sensor; false reading, “false highs” or “false lows”. It should be adjusted for inside the program over time. It's recommended that you turn off the alarms while you’re sleeping for high and low glucose so that it doesn't wake you in the night. The easiest way is to turn off Bluetooth in the evening and turn it on in the morning.
What do I do if my blood sugar spikes?
Pay attention to what made it spike, and try to avoid that in the future. If you were laying on the sensor and it was a false low, then don’t worry too much about it.
What is KETO/Ketosis?
Simply, ketosis is a state that the body enters after a prolonged lack of extra carbs/sugars (under 20g/daily usually). The body starts to burn “ketones” to use as sugar when it realizes that no new sugar is coming in. This state is useful for weight loss and re-creating insulin sensitivity, though not a requirement for either
What is a CGM?
A CGM is a continuous glucose monitor. It is a chip and a motoring filament that checks the amount of blood in the interstices (space between stuff) and reports back to a Bluetooth device/smartphone.
This device gives 1440 daily readings compared to the finger prick method, which provides I reading per jab, with a significant pain-to-data ratio - high pain, low amount of data, high accuracy to the data). The CGM has high data, with little pain/discomfort, and is less accurate than the finger prick result, by design, but is still VERY useful. It is not perfect or 100% accurate, but it has however been INCREDIBLY effective in understanding blood sugar in ourselves and our patients.
What’s the goal of using a CGM?
1). Understanding - we seek to understand how our blood sugar acts about how we eat.
2). Manipulating - By changing the foods we eat, the time we eat them, and the order we eat them, we can affect our blood sugar/glucose.
3). Accountability - This tool is AMAZING at showing you when you’re being naughty, and keeping you honest about your diet through the observer effect. We tend to behave “good” when we know someone’s watching, and we can see the cause and effect of our actions - which is often hidden from us by food myths bad science, and things we think we’re “supposed to” do.
Am I supposed to keep the line in the CGM application as flat as possible?
The CGM displays a graph of your blood glucose over time. The goal is to understand the trends and, slowly, over time, bring the high peaks down, bring the super low troughs up, and create a gentle trend that averages relatively low - around 100 is usually an ideal goal but that can vary by the patient.
Flatter is better in most cases.
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CGM Glucose monitor instructions!
After the practitioner orders the CGM for you, the pharmacy will contact you when it's ready to pick up.
Here are some notes regarding what your ideal targets are and tricks about using the app so it doesn't wake you up at night.
The practitioner will send an invitation to LibreView so you can share the data with us.
The more notes you enter, the better it is for us to look back through the data and identify triggering foods, and beneficial practices.
Ideally, check your blood sugar before you eat, enter a note about what you're going to eat, and then check your levels periodically over the next 90 minutes to see how your body responds.
The more information you add to the note, the better. It’s helpful to include your glucose reading at that time because it’s hard to tell the exact number when you look back at the graph. You should also check your sugar when you don’t feel well. Examples would be: “90, chicken and rice”, “145, felt dizzy”, or “walked 20 mins”.
Ideally, we're looking for fasting blood sugar between 70-90 and your blood sugar not to increase by more than 15 points after eating. This is the ultimate goal and it will take time, so don't be disheartened if you're not there, it will take time.
I find it usually takes about 2 weeks to just observe how foods affect you, and another 2 weeks to start implementing changes and seeing how those change your numbers.
Goals:
⁃ To have as flat a line as possible.
⁃ Average glucose around 100.
Note: Intense exercise will increase your blood sugar as your body makes glucose out of its stores, whereas gentle exercise, like walking, should bring your blood sugar or help stabilize it.
App settings:
⁃ Menu —> Settings —> Change the report settings to 70-100.
⁃ Alarms —> Turn off the low glucose alarm, high glucose alarm, and signal loss alarm. You cannot disable the urgent low glucose alarm. This can erroneously go off during the night and will not stop until you turn it off. To prevent this, turn off your Bluetooth at night. The data will backfill when you reconnect in the morning.
Hacks to try:
⁃ Eat the protein and fat before eating the carbs.
⁃ Have 1T of apple cider vinegar before eating carbs to curb the blood sugar spike.
⁃ Going for a 10-15 min walk after eating.
Things to pay attention to:
⁃ Sleep quality: dysregulated sleep sugar often causes spikes and drops during the night which will affect sleep. Poor sleep can cause dysregulated blood sugar the next day.
⁃ Energy levels
⁃ Mood
⁃ Feeling irritable with missed meals
⁃ Dizziness (generally and upon standing)
⁃ Mental clarity
⁃ Pain levels
Costco low-carb options:
⁃ Nutzo (nut butter)
⁃ Almond flour (great replacement for baking)
⁃ NuTrail Blueberry Cinnamon Nut Granola
⁃ Whisps Parmesan Cheese Crackers
⁃ Healthy Noodle (refrigerated section)
⁃ Erythritol & Monk fruit sweetener (use in moderation)
Keto-friendly ice cream:
⁃ Enlightened Keto ice cream bars (we get these at Safeway but they probably have them elsewhere too)
⁃ Rebel ice cream (I prefer this to the KETO and HALO brands)
Other low-carb options:
⁃ Zevia soda
⁃ Monk fruit sweetener
How to read food labels regarding sugar content:
Total carbs - dietary fiber - sugar alcohol = net carbs
Usually, if you keep the net carbs under 3 g in a sitting, your blood sugar should stay pretty even.
Keeping total net carbs under 20 g per day should put and keep you in ketosis but some people can tolerate more or less.
Our goal isn't necessarily to put you into ketosis (unless discussed), but rather just to keep your blood sugar even.
Be careful with sugar alcohols - too much will cause digestive upset and possibly diarrhea!!
If you're interested in reading more about how blood sugar plays into many chronic diseases, I recommend the book "Outlive" by Peter Attia, MD. “Glucose Revolution” by Jessie Inchauspe
has some helpful blood sugar hacks that you can test out.