Try This: Manage Your Blood Glucose Levels

Last updated on May 31, 2023 • 8 min read
Evidence Based

When we think about blood sugar, we don’t usually think of it as something we should be concerned with unless we’re diabetic. When you get routine blood work done, it’s not uncommon for the doctor to send you on your way with a fasting blood glucose of less than 100 mg/dL—what the American Diabetes Association defines as “normal”—even if your levels are 97, 98, or 99 mg/dL. You see, as long as your blood sugar is below the 100 mg/dL mark, there’s rarely any mention that your levels are borderline high. Meanwhile, if you have a fasting blood glucose of 100, 101, or 102 mg/dL, you might be sent home with a pre-diabetic diagnosis. Those are very different outcomes for such a slight difference in numbers. 

In conventional medicine, reference ranges are given for every metabolic parameter of the body, and as long as we fall within the “normal” range, we are considered healthy. Contrarily, if we fall outside of the reference range, we are considered “at-risk” for any one or more diseases and usually prescribed medication to manage it. Unfortunately, this model discredits that we are all genetically unique, and what’s considered “normal” for one person might not be normal for someone else. What’s more, if we are borderline on the reference range, is that really optimal? Shouldn’t we start taking action sooner to prevent chronic disease from progressing? 

Our risk of inflammatory diseases increases dramatically with poor blood glucose control—and I’m not just talking about obesity and type 2 diabetes—although these put us at risk for many other chronic diseases. For example, the risk for cardiovascular disease and certain cancers are about twofold higher in type 2 diabetics [1,2,3]. And mood imbalances like schizophrenia, bipolar disorder, and depression are linked to insulin resistance, high blood glucose, and metabolic syndrome [4,5,6]. Research linking insulin resistance to cognitive decline and Alzheimer’s disease is so strong that experts are calling it “type 3 diabetes”. My friend, and insulin resistance expert, Dr. Ben Bickman, and I dive deep into the topic of insulin resistance and brain health in a recent podcast episode you can check out here. Additionally, insulin resistance is a significant risk factor for digestion complications like gallstones and acid reflux [7,8,9].

Keeping your blood glucose under control is essential for metabolic and mental health, both of which are deeply intertwined and dependent on each other. This week, my Protocol contains small, sustainable changes to stabilize your blood glucose levels using food, movement, and mindset techniques. I also include a “Splurge!” section this week with my favorite wearable to track my glycemic variability throughout the day. Try my Protocol and take your metabolic health into your own hands to prevent and lower your risk of chronic disease.

The Protocol

I. Make a healthy swap. They call it the “SAD” diet for a reason, because sadly, most carbohydrates in the standard American diet are refined, which tend to send our blood sugar on a roller coaster ride. The good news is, choosing foods that keep your blood glucose in a desirable range doesn’t have to come at the cost of food FOMO. We can still check off all the boxes of a satisfying meal (taste, smell, texture, satiation) without having to ride the blood glucose wave in the hours that follow. That’s why I put together this list that highlights key foods and potential replacements you can explore. Remember, it’s not about avoiding these foods forever, we just want to make sure they don’t become staples in our diet. 

Instead of this…

Try This
Rice, pasta (gluten-free or regular), potatoes  Cauliflower rice, broccoli rice, zucchini, or carrot noodles. Soba noodles (made from buckwheat—high in protein and fiber and make a great substitute for ramen or pho).
Smoothie bowls made from high GI tropical fruits (mango, pineapple, papaya, passion fruit) Smoothie bowls made from low GI fruits (blueberries, raspberries, blackberries, cherries) paired with 1 tbsp nut butter, raw nuts, and/or chia seeds.
Sandwich on bread or tortilla wraps Wrap up your sandwich using napa cabbage leaves instead—they’re super firm, portable, and nutrient-dense! Or, try lettuce wrap-style (Boston or romaine work great!)
Potato chips, tortilla chips, crackers, pretzels Chop up fresh veggies to eat with guacamole or hummus instead of chips or crackers.

Carrots, cucumbers, bell peppers, broccoli, and cauliflower are great for dipping!
Rolled oats (quick-cooking oats), granola Steel-cut oats with cinnamon, nut butter, chia seeds, and berries. 
Oat milk, flavored nut milk, or dairy-free milk Even unsweetened oat milk spikes my blood sugar because it’s still highly refined and processed. 

Aim for unsweetened organic almond or macadamia nut milk without any gums or preservatives. 

Malk Organic Unsweetened Vanilla Almond Malk is my favorite because it only contains water, sprouted almonds, and is flavored using organic vanilla beans and Himalayan salt—that’s it!

I’m definitely not perfect, I still eat these foods when I’m traveling, or when I’m craving something sweet out with my friends. The difference is—and this is one of my favorite hacks—I just have enough to satisfy my senses, and more often than not, that’s all I really need. That way, I don’t feel like I’m missing out, but I also don’t feel guilty (or physically sick) from overdoing it. 

II. Eat protein and fat first. Here’s a blood sugar hack anybody can try, especially if you’re in a situation where you have no control over the food that’s available. It’s also helpful if you want to indulge a little at parties or when you’re eating out with friends. Having the protein and fat on your plate first and saving the carbohydrates for last, helps keep your blood sugar stable and your insulin from spiking after mealtime [10]. 

Another spin on this would be if you’re eating out and you order chips and guacamole for an appetizer, ask your server for a side of vegetables, too. Use the veggies for dipping before your main course (that contains protein and fat). Then, after your main course, go for the chips with the guacamole. The idea is: if you’re in a situation where there are refined carbs around and you want to have some, don’t deprive yourself. Consciously planning to eat refined carbohydrates after protein and fat keeps your blood sugar from spiking so you can still enjoy them without feeling the negative consequences. 

III. Eat a bigger breakfast. Research shows benefits for better blood glucose control and energy stability throughout the day when the majority of calories are eaten for breakfast, or earlier in the day (large breakfast, medium-sized lunch, small dinner) [11]. This also leads to less late-night eating, better weight control, weight loss, less hunger, insulin sensitivity, lower inflammation, improved circadian rhythm, and gut microbiome composition [11,12,13]. Stay tuned for my Breakfast Protocol coming out next week that provides more details on what the right kind of breakfast is.

IV. Apple cider vinegar before or with meals. ACV has made headlines as being an “all-cure” for everything from immunity to weight loss. Typically, anything that falls under the umbrella of “too good to be true”, usually is. However, there’s evidence that shows 15-30ml of ACV per day (1-2 tbsp) can have a significant impact on lowering fasting blood glucose, insulin, and HbA1c levels (a measure of blood sugar control over time) [14,15,16]. 

The mechanism on how ACV helps regulate blood glucose isn’t exactly clear, but Levels does an amazing job at diving deeper into the research behind a few theories in this blog post as well as provides strategies for how to incorporate vinegar into your meals. 

V. Find ways to lower your stress.  Aside from food, there are so many other factors that spike blood glucose. One that is often overlooked is stress. When we feel stressed, our hypothalamus-pituitary-adrenal (HPA) axis is switched on. The hypothalamus (the control center of our brain) perceives stress and signals our pituitary gland to tell our adrenals to start making stress hormones like cortisol and epinephrine. These hormones mobilize glucose stored in our liver and muscle tissue and release it into the bloodstream for a “fight or flight” response. 

You see—our bodies are still set in the million-year paradigm of our evolution as humans. Our biology hasn’t caught up to modern-day stressors, and therefore can’t distinguish the difference between life-threatening stress (i.e. running from a tiger or losing our tribe) and non-life-threatening stress (i.e. being stuck in traffic, or our Amazon package arriving a day late). As a result, our biology is left to play catch up, releasing glucose into the bloodstream to save our lives from (perceived) life-threatening situations. 

It’s pivotal that we find ways to manage our stress to reduce stress-induced blood sugar spikes, which cause a surge in insulin. Over time, stress can take a serious toll on blood glucose regulation, insulin sensitivity, and metabolic health. In fact, studies show that high stress in healthy women is linked to more than double the risk of developing type 2 diabetes [17]. 

Try This:

  • Yoga Nidra: I’ve talked about Yoga Nidra before, but I want to emphasize it again here because it’s really helped me through some of the most stressful times in my life. Meditation is great, but sometimes it’s hard to get into a routine to feel its benefits. That’s why I love practicing Yoga Nidra—it requires minimal effort and I can feel the benefits almost instantly. Plus, it gives my brain and body a chance to lie down for a quick rest, one that I truly feel restored after.
  • Here’s a 20-minute Yoga Nidra practice on YouTube that I’m loving. 

VI. Get good quality sleep. Sleep had to make its way into my Protocol this week because it’s critical for blood glucose control. Sleep is a pillar of health that applies to everyone, not just adults—kids and teens need to make sure they’re getting enough quality sleep, too. Even one night of sleep deprivation in a healthy person can decrease insulin sensitivity by up to 25% [18]. The good news is, this can be corrected just as easily with a good night’s rest. 

Moreover, lack of sleep offsets hunger and satiety hormones, causing an increase in appetite and junk food cravings the next day. Over time, lack of sleep hijacks our blood sugar which leads to insulin resistance, inflammation, weight gain, and increased risk for chronic diseases like type 2 diabetes, obesity, cardiovascular disease, depression, pain disorders, addictive behavior, and cancer [19,20]. 

Check out my Step-By-Step Sleep Protocol for some easy and actionable tips anybody can try to help optimize their sleep health. 

VII. Go for a walk after meals. In general, daily movement is key to long-term health. Physical activity offers a wide spectrum of benefits ranging from increased bone density, muscle mass, and mobility to weight loss, longevity, and decreased risk for chronic disease. However, it appears that movement after mealtime has an additive effect on improving blood glucose control and metabolic health. 

Light to moderate-intensity exercise (walking, biking, dancing) 30-45 minutes after a meal for at least 20 minutes can significantly improve blood glucose and insulin levels from being used up by muscle to power movement [21,22,23]. What’s more, post-meal aerobic exercise increases adiponectin—a hormone responsible for enhancing insulin sensitivity, glucose control, fat metabolism, lowering inflammation, and a therapeutic target for treating metabolic diseases [24]. 

Splurge!

I. Continuous Glucose Monitor (CGM). Wearing my continuous glucose monitor has been life-changing for me—and incredibly empowering. I’m now aware of what foods I can eat without spiking my blood sugar, and what foods I need to avoid or limit to the occasional treat. Plus, the data I get using my CGM is in real-time so that I can make the best decisions for myself based on my feedback. I can also monitor how my workout type and intensity, stress levels, and intermittent fasting impact my blood glucose.

My friend Dr. Casey Means is the founder of Levels and a leader in the wearable technology movement. She’s working hard to put the power into people’s hands by making continuous glucose monitors available to the public. That way, we can collect data on our blood glucose daily, and gain insight to make changes to our diet and lifestyle instantly, instead of once a year. To learn more about why CGMs are such a useful tool, check out my podcast with Dr. Means where we go deep into why it’s important to know your levels.

Try This:

  • Levels. The Levels app is fantastic because it syncs with your CGM and you can log the food you eat, workouts, and stress levels to see how it impacts your blood sugar. With this, it assigns each entry a metabolic score from 1-10, depending on how it affects your blood sugar. It also compiles comprehensive reports each month of your best and worst foods and feedback on ways to improve your metabolic health. 
    • Use my link levels.link/dhru to skip the waitlist and sign up for their early-access program.

Conclusion: Managing your blood glucose is foundational for metabolic health. Once you get that under control, everything else tends to fall into place (i.e. energy, mood, weight loss, lower inflammation). Try my Blood Glucose Management Protocol and see if you notice any improvements in how you feel. If nothing else, taking these steps can help lower your risk of developing insulin resistance and related chronic diseases. That way, we can spend less time focusing on our health and more time focusing on what really matters, like our relationships, passion projects, and using our talents to make a difference in the world.  

If you tried any of the recommendations from my Blood Glucose Management Protocol, I would love to hear from you! Text me your feedback at 302-200-5643.

  1. Czech MP. Insulin action and resistance in obesity and type 2 diabetes. Nat Med. 2017;23(7):804-814. doi:10.1038/nm.4350
  2. Emerging Risk Factors Collaboration, Sarwar N, Gao P, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies [published correction appears in Lancet. 2010 Sep 18;376(9745):958. Hillage, H L [corrected to Hillege, H L]]. Lancet. 2010;375(9733):2215-2222. doi:10.1016/S0140-6736(10)60484-9
  3. Giovannucci E, Harlan DM, Archer MC, et al. Diabetes and cancer: a consensus report. Diabetes Care. 2010;33(7):1674-1685. doi:10.2337/dc10-0666
  4. Łojko D, Owecki M, Suwalska A. Impaired Glucose Metabolism in Bipolar Patients: The Role of Psychiatrists in Its Detection and Management. Int J Environ Res Public Health. 2019;16(7):1132. Published 2019 Mar 29. doi:10.3390/ijerph16071132
  5. Mitchell AJ, Vancampfort D, Sweers K, van Winkel R, Yu W, De Hert M. Prevalence of metabolic syndrome and metabolic abnormalities in schizophrenia and related disorders–a systematic review and meta-analysis. Schizophr Bull. 2013;39(2):306-318. doi:10.1093/schbul/sbr148
  6. Pearson, S., Schmidt, M., Paton, G., Dwyer, T., Blizzard, L., Otahal, P., Venn, A. Depression and insulin resistance: a cross-sectional association in young adults. Diabetes Care. 2010. 33(5):1128-1133. https://doi.org/10.2337/dc09-1940
  7. Tsai, C.J., et al., Macronutrients and insulin resistance in cholesterol gallstone disease. Am J Gastroenterol, 2008. 103(11): p. 2932-9; Mendez-Sanchez, N., et al., Metabolic syndrome as a risk factor for gallstone disease. World J Gastroenterol, 2005. 11(11): p. 1653-7.
  8. Nakeeb, A., et al., Insulin resistance causes human gallbladder dysmotility. J Gastrointest Surg, 2006. 10(7): p. 940-8; discussion 948-9.
  9. Hsu, C.S., et al., Increasing insulin resistance is associated with increased severity and prevalence of gastro-oesophageal reflux disease. Aliment Pharmacol Ther, 2011. 34(8): p. 994-1004.
  10. Shukla, A., Iliescu, R., Thomas, C., Aronna, L. (2015). Food Order Has a Significant Impact on Postprandial Glucose and Insulin Levels. Diabetes Care. 2015;38(7):e98-e99. https://doi.org/10.2337/dc15-0429
  11. https://www.endocrine.org/news-and-advocacy/news-room/2018/highenergy-breakfast-promotes-weight-loss-helps-reduce-total-daily-insulin-dose-for-type-2-diabetes
  12. Leidy HJ, Hoertel HA, Douglas SM, Higgins KA, Shafer RS. A high-protein breakfast prevents body fat gain, through reductions in daily intake and hunger, in “Breakfast skipping” adolescents. Obesity (Silver Spring). 2015;23(9):1761-1764. doi:10.1002/oby.21185
  13. Galgani JE, Moro C, Ravussin E. Metabolic flexibility and insulin resistance. Am J Physiol Endocrinol Metab. 2008;295(5):E1009-E1017. doi:10.1152/ajpendo.90558.2008
  14. Gheflati A, Bashiri R, Ghadiri-Anari A, Reza JZ, Kord MT, Nadjarzadeh A. The effect of apple vinegar consumption on glycemic indices, blood pressure, oxidative stress, and homocysteine in patients with type 2 diabetes and dyslipidemia: A randomized controlled clinical trial. Clin Nutr ESPEN. 2019;33:132-138. doi:10.1016/j.clnesp.2019.06.006
  15. Mitrou P, Petsiou E, Papakonstantinou E, et al. Vinegar Consumption Increases Insulin-Stimulated Glucose Uptake by the Forearm Muscle in Humans with Type 2 Diabetes. J Diabetes Res. 2015;2015:175204. doi:10.1155/2015/175204
  16. Cheng LJ, Jiang Y, Wu VX, Wang W. A systematic review and meta-analysis: Vinegar consumption on glycaemic control in adults with type 2 diabetes mellitus. J Adv Nurs. 2020;76(2):459-474. doi:10.1111/jan.14255
  17. Harris ML, Oldmeadow C, Hure A, Luu J, Loxton D, Attia J. Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PLoS One. 2017;12(2):e0172126. Published 2017 Feb 21. doi:10.1371/journal.pone.0172126
  18. Esther Donga, Marieke van Dijk, J. Gert van Dijk, Nienke R. Biermasz, Gert-Jan Lammers, Klaas W. van Kralingen, Eleonara P. M. Corssmit, Johannes A. Romijn, A Single Night of Partial Sleep Deprivation Induces Insulin Resistance in Multiple Metabolic Pathways in Healthy Subjects, The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 6, 1 June 2010, Pages 2963–2968, https://doi.org/10.1210/jc.2009-2430
  19. Spiegel K, Knutson K, Leproult R, Tasali E, Van Cauter E. Sleep loss: a novel risk factor for insulin resistance and Type 2 diabetes. J Appl Physiol (1985). 2005;99(5):2008-2019. doi:10.1152/japplphysiol.00660.2005
  20. Institute of Medicine (US) Committee on Sleep Medicine and Research; Colten HR, Altevogt BM, editors. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press (US); 2006. 3, Extent and Health Consequences of Chronic Sleep Loss and Sleep Disorders. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19961/
  21. Reynolds AN, Venn BJ. The Timing of Activity after Eating Affects the Glycaemic Response of Healthy Adults: A Randomised Controlled Trial. Nutrients. 2018;10(11):1743. Published 2018 Nov 13. doi:10.3390/nu10111743
  22. Frampton, J., Cobbold, B., Nozdrin, M. et al. The Effect of a Single Bout of Continuous Aerobic Exercise on Glucose, Insulin and Glucagon Concentrations Compared to Resting Conditions in Healthy Adults: A Systematic Review, Meta-Analysis and Meta-Regression. Sports Med (2021). https://doi.org/10.1007/s40279-021-01473-2
  23. Chacko E. Exercising Tactically for Taming Postmeal Glucose Surges. Scientifica (Cairo). 2016;2016:4045717. doi:10.1155/2016/4045717
  24. Achari AE, Jain SK. Adiponectin, a Therapeutic Target for Obesity, Diabetes, and Endothelial Dysfunction. Int J Mol Sci. 2017;18(6):1321. Published 2017 Jun 21. doi:10.3390/ijms18061321
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