Normal Fasting Blood Sugar Does Not Rule Out Diabetes

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A new position statement from the International Diabetes Federation says that a blood sugar level greater than 155 mg/dL (8.6 mmol/L) one hour after eating a meal means that a person should immediately be referred to a diabetes prevention center and instructed to follow all the lifestyle rules recommended for diabetics (Diabetes Research and Clinical Practice, March 6, 2024). Those with a one-hour value greater than 209 mg/dL (11.6 mmol/L) are considered to be full-blown out-of-control diabetics and should be referred for immediate treatment for diabetes. This position statement was presented on March 6, 2024, at the annual Advanced Technologies & Treatments for Diabetes meeting.

A normal fasting blood sugar (less than 100 mg/dL) does not rule out diabetes. Up to 30 percent of diabetics do not know that they are diabetic because they are told that they have normal fasting blood sugar levels. A high blood sugar after meals increases risk for heart attacks, strokes and all the other effects of diabetes, even if the conventional fasting blood sugar test is normal (Diabetes Metab, 2022; 48101395).

HbA1c to Measure Cell Damage
High blood sugar after you eat is sign of serious cell damage. When blood sugar levels rise too high, sugar sticks to the outer membranes of cells and can eventually destroy cells. Doctors use a blood test called Hemoglobin A1c (HbA1c) to measure cell damage. It measures the amount of sugar attached to the outer membranes of red blood cells. If you have a lot of sugar attached to your red blood cell membranes, you also have lots of sugar attached to other cells in your body, and that means more cell damage throughout your body. An HbA1c over 5.7 means that you are at high risk for diabetes.

Risk Factors for Diabetes
• HbA1c greater than 5.7 percent (38.8 mmol/mol)
• overweight
• age over 65
• a family history of diabetes
• physically inactive
• sit for long periods of time
• had diabetes during pregnancy
• gave birth to a baby weighing nine pounds or more
• have a large waist circumference (male – greater than 40 inches, female greater than 35 inches)
• can pinch more than 2.5 inches of skin and fat next to your belly button
• have blood pressure greater than 135/90
• have LDL (bad) cholesterol greater than 100 mg/dL
• have HDL (good) cholesterol lower than 40 mg/dL
• smoke or live with a smoker
• take alcohol regularly
• do not get 7 to 9 hours of sleep regularly
• have high triglycerides (greater than 150 mg/dL)
• have polycystic ovary syndrome
• have psychiatric disorders (such as schizophrenia, depression, bipolar disorder)
• have obstructive sleep apnea

Lifestyle Changes to Prevent or Treat Diabetes
Everyone with any of the risk factors for diabetes should get a one-hour-after-eating blood sugar level and those whose levels are greater than 155 mg/dL should immediately start a lifetime program of active diabetes prevention. If you have any of the risk factors for diabetes listed above, you should start a diabetes prevention program that includes:
• avoid all sugared drinks including fruit juices
• severely restrict all sugar-added foods and other refined carbohydrates
• restrict fried foods
• avoid red meat (blocks insulin receptors)
• avoid processed meats
• avoid smoking and being around smokers
• avoid alcohol or take no more than one drink a day
• lose weight if overweight
• eat a wide variety of vegetables, fruits and other healthful plant-based foods
• keep hydroxy vitamin D above 30 ng/mL
• exercise

My Recommendations
If you have any of the signs of diabetes listed above, start the diet and lifestyle changes immediately. People who already have diabetes may be able to become non-diabetic if they follow these lifestyle changes rigorously and permanently. Whatever your age and weight, you can help to protect yourself from developing diabetes by following these same rules.