Unlike cholesterol or fat, blood sugar is a health metric typically discussed only in the context of people with diabetes or kids on a “sugar high.” Unfortunately, the same is true for many physicians, who may not focus on your glucose levels until dysfunction—like prediabetes—has already set in.
That was the case for 64-year-old Charlette Plinneke, who had a healthy weight, exercised regularly, and spent lots of time outdoors. So she was surprised when a recent glucose test showed levels at the high end of optimal. Her doctor said not to worry about the higher numbers at her age—indeed, some studies have suggested that prediabetes in older adults is less likely to lead to diabetes compared to younger people.
But Plinneke had read enough about metabolic health to know that preventing full-blown diabetes wasn’t the only reason to mind her blood sugar—stable energy, cellular health, and even skin conditions are all tied to glucose levels. She took steps to monitor it herself and learned lifestyle changes she could make to keep it more stable. The result: she lost excess visceral fat (which can drive insulin resistance) and found ways to get a better night’s sleep.
Even if your doctor is initially resistant to looking at blood sugar as a health improvement metric, you can still try to make her part of your metabolic health journey. You can talk to her about why blood sugar is essential even in healthy people and advocate for additional testing—like fasting insulin or HbA1c—to help paint a fuller picture of your metabolic health.
Here is why your doctor may not focus on blood sugar, some basic information you can share with them, and additional tips for having that conversation.
4 reasons why blood sugar matters, even if you’re healthy
Glucose is a fundamental fuel source for the body. However, serious health issues can ensue if cells can’t use it properly or levels are too high for too long. And the fact is, you don’t need to be a specific size or weight or live a particular lifestyle for blood sugar to make a mark on your physical health.
Nearly 20% of people with a “normal” body weight are diagnosed with metabolic syndrome, a collection of conditions that increases the risk for things like coronary heart disease, diabetes, nerve damage, organ failure, and memory problems.
Even if your doctor has given you a clean bill of health, here are just a few of the reasons why blood sugar is still something to track.
1. Helps prevent prediabetes
The precursor to Type 2 diabetes, this condition is marked by high blood sugar and can go unnoticed for years. Almost 80 million American adults have prediabetes, and more than 84 percent don’t know they have it. Along with elevating the risk for Type 2 diabetes, prediabetes is also linked to cardiovascular disease, dementia, and cognitive decline. The good news is that prediabetes is reversible with the proper diet and lifestyle changes.
2. Lowers the risk of chronic disease
Over time, consistently high blood sugar damages blood vessels, making the body more vulnerable to health problems like diabetes, cardiovascular disease, kidney disease, vision loss, and more. In addition, high glucose levels can drive oxidative stress and other cellular damage, which can contribute to conditions like cognitive decline, cancer, stroke, and even arthritis.
3. Improves mental well-being
We’ve all experienced the inevitable crash after a sugar spike. The sharp drop in glucose can make us tired, anxious, and moody. And there’s a good reason why, says Robert Lustig, MD, Professor Emeritus of Pediatrics in the Division of Endocrinology at the University of California, San Francisco. “The brain normally runs on glucose, and when it falls rapidly, it can change central nervous system functions,” Dr. Lustig says. “This can result in unwanted psychological changes like fatigue and irritability.”
Managing blood sugar prevents it from spiking, which can help stabilize moods and reduce feelings of anxiety. Not only does this have short-term benefits, but maintaining stable glucose can prevent spikes in the future. That’s because, over time, healthy glucose levels increase insulin sensitivity, which allows the body to use glucose most effectively.
4. High glucose may affect sleep and stress.
We all know that getting quality sleep is critical to healthy functioning. And it goes both ways. Prediabetes is linked to poor sleep, and not getting enough sleep is a risk factor for obesity and Type 2 diabetes. Sleep interference, especially long-term, also impacts cortisol levels, which may make you more prone to anxiety. Beyond cortisol, metabolic dysfunction affects other chemicals in the body, including sex hormones. This could create or compound sexual health problems, as well as trigger skin issues like acne or accelerate skin aging.
Why don’t doctors focus on blood sugar in healthy people?
Studies continue to find that prediabetes is underdiagnosed, despite its link to more serious conditions like heart disease, stroke, and Type 2 diabetes. You might be wondering: if blood sugar is so important, why has my doctor never brought it up with me?
There are several reasons. It’s not that healthcare providers don’t care or don’t want to help––the opposite is typically true. The problem is many physicians face constraints or barriers around time and resources, which can push prediabetes screening further down the priority list.
Here’s a closer look at why your doctor might not bring up blood sugar with you:
- Inconsistent recommendations: National screening guidelines from the American Diabetes Association (ADA) recommend anyone 45 and older get tested for diabetes and prediabetes. It’s also recommended that people with overweight or obesity, plus one or more risk factors for diabetes, be screened. Many have suggested widening the criteria for screening to all adults, as many people can have prediabetes but are asymptomatic or appear perfectly healthy. That’s one reason why the U.S. Preventive Services Task Force recently lowered screening to start at age 35. But because national guidelines vary, it can impact if or when a physician does testing.
- Not adhering to guidelines: Many physicians also don’t adhere to national guidelines for diabetes prevention, primarily due to the number of barriers around it. The time it takes to educate a patient, motivate them to make (and maintain) healthy lifestyle changes, and a patient’s economic resources are among the top roadblocks doctors report to diabetes preventive care. Studies have also found that even when patients did get screened, even those who tested positive for prediabetes rarely got a formal diagnosis or treatment.
- Lack of nutritional training: Assessments of U.S. medical schools found that 71% did not provide the 25-hour minimum recommended for nutritional education. Less than half of institutions taught any food science in clinical practice. “Most doctors trained in the past aren’t up on this because it wasn’t presented to them,” says Dr. Lustig. This means that from the get-go, many physicians aren’t adequately prepared or equipped to work with patients specifically on diet and nutrition, which are the most significant levers of glucose.
- Problematic medical system: There are a lot of issues that hinder patient care in the U.S. medical system, but a significant one is time. Doctors simply don’t have enough. Hospitals and primary care centers are chronically understaffed and overworked, leaving physicians limited time for standard appointments, let alone additional testing.
- More research is needed: While there is plenty of research on glucose testing for people with diabetes, there is less on its benefits for people without diabetes. What studies do exist have limitations or small sample sizes. If there aren’t enough large trials or landmark studies, a doctor might be reluctant to test, especially if the test is only for preventative care. “Here’s what they teach at medical school: they teach how to treat disease. They don’t teach people how to keep healthy,” Dr. Lustig says. “Most doctors trained in the past aren’t up on this because it wasn’t presented to them.”
- Glucose has limitations: Lastly, focusing on blood sugar alone isn’t enough to optimize health. For example, even if your doctor uses standard glucose screening tools (like a fasting glucose test), they still may not see the more significant issues as things like insulin resistance can crop up years before a test shows any irregularities. Metabolic dysfunction is incredibly nuanced, and while glucose can provide a snapshot of our metabolic health, it’s only part of the picture.In an ideal world, Dr. Lustig says the gold standard would be testing for insulin resistance as it’s a driver of more serious conditions, such as metabolic syndrome. For now, he says monitoring blood sugar is the next best thing.
“Glucose isn’t insulin, but it’s a reasonable proxy,” Dr. Lustig says. “By keeping glucose constant, it’s likely to keep blood insulin constant, which helps mitigate diseases. In addition, insulin is correlated with mortality. If you can keep it down and stable, you might live longer.”
When to talk to your doctor about blood sugar
The big question is, how do you know when it’s time to talk to your doctor about all this? It’s recommended anyone aged 35 and up who has overweight or obesity start screening for prediabetes or diabetes. Adults with healthy test results are advised to get screened every three years, but you can also ask your physician to perform a baseline test during annual check-ups. You can also look for subtle signs of metabolic dysfunction, such as low energy, trouble losing weight, or brain fog.
What you need depends on your circumstances, but here are some tests and interventions you can ask for:
- A1c test
- Fasting plasma glucose test
- Oral glucose tolerance test
- Fasting insulin test
- Nutritional advice
- Lifestyle change programs
- Prescription for a continuous glucose monitor (CGM)
How to talk to your doctor about blood sugar
Once you’ve decided on your goals, the next part is having the conversation. This process can feel intimidating, especially if you’re unsure how to broach the subject with your doctor or have been met with resistance in the past.
Here are some scenarios where you might want to have a deeper discussion with your doctor about blood sugar––plus practical advice for how to have the conversation.
Scenario A: Your test results show higher-than-optimal numbers
Say you’re in good health and have no known metabolic issues. You’re surprised when a routine blood panel returns with higher glucose levels than expected. Your doctor says, “Don’t worry about it; your numbers are still in a normal range.”
You’re not convinced. Over the past few years, you’ve noticed gradual hikes in blood sugar and want to look further into it. Here is some sample language from Sara Gottfried, MD, author of The Hormone Cure, on how to politely push back.
“I’ve read a lot about blood sugar and am trying to make myself an educated consumer. I’ve read in this study that it’s important to look beyond standard tests to really understand what’s going on. Because my test results are continuing to get higher, I wonder if you’d be able to order a test for me.”
You can then ask them for further blood testing or something like a CGM prescription. CGMs may be helpful as they provide a personalized real-time view of a person’s glucose levels so you can connect specific meals or behaviors to blood sugar spikes.
Fasting glucose levels classify into 3 categories: normal, prediabetes, and diabetes. To be considered “normal,” fasting glucose must be under 100 mg/dl.Read the Article
Scenario B: You have symptoms of high blood sugar
Lately, you’ve been feeling off. You’re jittery, getting headaches, and having trouble sleeping. Your mid-morning crashes might be nothing, but you worry they could be something. If you feel nervous about asking or your physician brushes it off, have some backup literature ready.
You can use similar language to Scenario A or try a version like this: “I’ve been reading a book about hormone imbalance and how it relates to blood sugar. I have these symptoms [be specific]. Would you be willing to order a test for me?”
Seemingly unrelated symptoms––like hair loss and acne––can be due to insulin resistance, so a fasting insulin test may be more beneficial than further glucose testing. There isn’t a consensus yet on the best way to test for insulin sensitivity, so Dr. Gottfried recommends asking for a blood panel that measures glucose and insulin.
Scenario C: You have a family history of diabetes
Say diabetes runs in your family. You’re in reasonably good health and don’t have any other risk factors you’re aware of, but you want to test more regularly to keep an eye out for changes.
Your doctor says it isn’t necessary to test more often than every three years. If your physician declines, be polite but stand your ground. Here is some sample phrasing.
“Can you explain why it’s not worthwhile to test? I have references here that show a strong link between family history and developing Type 2 diabetes, so I’d prefer to test.”
It depends on your individual needs, but examples of what you can ask for include a more comprehensive blood panel, testing more frequently, or helping to interpret tests you perform yourself at home.
Scenario D: Prediabetes prevention and lifestyle advice
You’ve done some recent reading on metabolic health and were alarmed learning that things like insulin sensitivities can start up to six years before a diabetes diagnosis. You decide you want to be proactive and screen earlier. You also want to clean up your diet but aren’t sure where to start. Here’s how to kick off the conversation with your doctor.
“I just read a book about blood sugar and learned a lot. I know we don’t have much time today, but I would like to discuss it at my next appointment. Would you be willing to discuss it next time?”
Whatever your source material is, bring it with you to the appointment. Essential parts of prevention to ask your doctor about include advice on nutrition, exercise, and weight management. If you’ve done prediabetes screening and the results indicate you’re high-risk, you can talk to your physician about if you qualify for a diabetes prevention lifestyle change program. These programs are effective at helping you make healthy changes to reverse prediabetes and prevent diabetes from developing.
The bottom line is you want a doctor who will work with you to prevent problems before they happen. And the best way to start is by talking about it.
“You should be able to bring up your metabolic health with your doctor, and they’ll understand,” Dr. Lustig says. “Have the conversation and see whether they are willing to listen.”