how to use your blood sugar meter as a fuel gauge

  • Chronically elevated blood sugar levels can be a sign that you are eating too much and/or too often.
  • You can use your blood sugar to help you refine your meal timing to optimise your weight and blood sugar levels.
  • Delaying your next meal allows your body to use up the stored energy in your bloodstream, liver and body fat stores.

Over the long term, a decreasing weight on the scale can be a good indicator that you are not overeating.  However, in the short term, blood glucose levels can be a more useful indicator of whether you really need to eat now or if you are just eating because out of habit, boredom, entertainment or comfort.

The below table outlines a protocol that will help you to use your blood sugar meter as a fuel gauge to reach your diabetes and fat loss goals.

blood sugar action
greater than average, well slept and low-stress delay eating and/or exercise to reduce glucose
 less than average if hungry, enjoy nutrient-dense foods that align with your insulin sensitivity
< 73mg/dL (4.0 mmol/L) if hungry, eat higher insulin load foods and delay exercise

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This approach is not intended for people who do not produce enough insulin (i.e. type 1 diabetes, type 1.5, LADA and MODY) but rather for people who are insulin resistant and produce large amounts of insulin but still have high blood sugar levels (i.e. pre-diabetes and type 2 diabetes).

Reducing insulin

Eating frequently will keep your insulin and blood sugar levels consistently high, particularly if you tend to consume foods with a high insulin load.

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By contrast, reducing meal frequency enables blood sugar and insulin levels to decrease.

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High levels of insulin keep fat stores from being used glycogen trapped in the liver while the energy in the bloodstream is used up.

When our adipose tissue can’t absorb any more energy, it becomes insulin resistant.  This makes it harder for insulin to get into our major fat stores on the body.  But your pancreas continues to ramp up insulin production in order to reduce high blood glucose levels in the blood and to keep the glucagon stores in the liver.  With elevated insulin levels and more insulin resistant adipose tissue the excess energy now starts to get stored in more sensitive parts of the body such as our liver, pancreas, heart, brain and eyes.

Delayed eating allows the energy in the bloodstream to reduce.  Once the liver glycogen stores start to be depleted, then the body finally turns to body fat for fuel.[1]

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Decreasing body fat, particularly from the liver, pancreas and kidneys leads to improved insulin sensitivity and eventually leads to normal blood sugar levels.[2] [3]

Eating larger meals with more carbohydrate causes your blood sugar to stay higher for longer.  Conversely, consuming smaller meals with a lower insulin load allows your blood sugar to return to baseline faster.

When to eat

Your blood sugar metre can be a useful tool to understand whether you really need extra energy or whether you could skip a meal or two or not eat for the day.

If you have some level of insulin resistance, then chances are your blood sugar levels will be higher in the morning due to liver glycogen being released as your body prepares for the day.  This is sometimes referred to as Dawn Phenomenon.

If you are insulin resistant the insulin secreted by your pancreas doesn’t keep up with the release of glucose into the bloodstream, and hence your blood sugar will be high.

If you test your blood sugar in the morning and it’s higher than your current average, then you might want to delay eating until your blood sugar comes back down.  This may mean eating your first meal early afternoon followed by an early dinner (i.e. 16:8 intermittent fasting).   Alternatively, if you consistently find your blood sugars are high in the morning you could skip dinner avoid eating later in the evening, which would help to lower morning blood sugar.

There is no perfect fasting routine for everyone.  Over time you’ll find one that suits you, and you will be able to calibrate your feeling of hunger with your actual need for food based on your blood sugar levels and reduce the frequency of testing.  Once you’ve established new habits you will no longer need to rely on the glucose metre.

Some people find that they can ‘eat to satiety’.  However, others find that they tend to overeat and ‘binge’ after a long period between meals, particularly on energy dense and nutrient poor hyper-palatable foods.  Using a metric like your blood sugars is useful to make sure fasting is providing the outcomes you want.  Tracking your glucose levels can help you ensure that your blood sugar levels are decreasing but not so much that you will lose control of food quality or quantity when you eat next.

Tailored just for you

Many people agree that intermittent fasting is a good idea, but many people get confused about what frequency is best for them.

How do you know whether you should be doing:

There are so many options!

How do you know which one is right for you?

How can you tell if it’s working?

How can you refine and tweak to reach your goals?

What if you just really feel hungry but it’s not “time to eat” yet!?!?

The advantage of using your blood sugar level as a guide versus a regimented intermittent fasting protocol or a fixed calorie intake is that it accounts for the energy your burn as well as what you’re eating.

You could argue that tracking your blood sugars could be more useful than calorie counting.  Ensuring that your blood sugars are decreasing by delaying eating will ensure that you are running at an energy deficit and pulling fuel from the energy stores on your body.

The body is a complex adaptive system, and our energy expenditure will vary based on many factors beyond our ability to measure and manage.

Eating is not bad.  You need to balance your intake with your energy expenditure while getting the nutrients you need to thrive.  This can be a challenge when we are surrounded by cheap hyper-palatable nutrient-poor foods.

Refining your feasting/fasting route around your blood sugars will help you to fine-tune when and how much you eat to your actual requirements.

Your blood sugar meter can help you understand whether your hunger is real and help you to refine your eating regimen.

If your blood glucose levels are lower than your average, then your insulin levels will be decreasing, and you’ll be using up your stored body fat and liver glycogen.

If your blood sugar levels are increasing, then it’s likely you’re overeating and/or too often which means you’ll be storing energy as fat on your body.

When using this approach, you can eat to eat to satiety.  But if you overdo your intake at this meal it will mean that you will be delaying your next meal a little longer.

You could even use this approach to make sure you don’t overdo the refuelling and keep the insulin load of your meals such that your blood sugar doesn’t go over say 120 mg/dL (or 6.7 mmol/L).  A blood sugar level above this is a sign that your liver glycogen stores are full and spilling over into your bloodstream.

Some people find that they tend to eat less overall when intermittent fasting compared to trying to eat numerous ‘small’ meals.  Saint Augustine wisely said:

“Complete abstinence is easier than perfect moderation.”

I think this also applies to our meal timing and portion sizing.

By choosing to eat only when your blood sugar is below YOUR target blood sugar level, you can tailor the approach to your current situation and metabolic health.

Waiting until your blood sugar reaches optimal levels (i.e. 83mg/dL or 4.6mmol/L) is not realistic for most people.  It’s best to start from where you are now and work towards optimal.

In the study Adherence to hunger training using blood sugar monitoring: a feasibility study[5], the researchers found that participants did much better when they set their own personalised blood sugar target rather than waiting until their blood sugar levels reached some optimal target before eating.

The other noteworthy observation from this study was that people who were obese lost a significant amount of weight!

Overweight participants achieved significant weight loss over the two-week period, with an average loss of 1.5 kg (95 % CI 2.2, 0.9) and a corresponding reduction in BMI of 0.6 kg/m2 (95 % CI 0.3, 0.8), p < 0.001).  By contrast, lean participants maintained their weight.

The end game

The long-term goal is to achieve an optimal HbA1c of 4.5% which equates to an average blood sugar level of 83 mg/dL (or 4.6 mmol/L).

There are plenty of excellent reasons to keep your blood glucose and insulin levels in check such as reducing your risk for cancer…[6]

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…heart attack, stroke[7] and a whole range of western diseases.[8]

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People with Type 1 Diabetes following Dr Bernstein’s protocol try to keep their blood glucose within ten points of the optimal target level of 83 mg/dL (4.6 mmol/l).  This means that they will dose with insulin when their blood glucose rises above 93 mg/dL (or 5.2 mmol/l) and then eat to bring their glucose levels back up when they drop below 73mg/dL (or 4.0 mmol/L).

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Someone who has a functioning pancreas but is struggling with insulin resistance, hyperinsulinemia and/or obesity can use a similar process to manage their blood glucose and insulin levels.  However, rather than dosing with insulin to bring their blood glucose down they simply delay eating until they burn through the excess glucose in their bloodstream.

Waiting to eat until your blood glucose levels are below your recent average will ensure that they are decreasing over time.  Most glucose meters will display the average glucose level for the last seven, fourteen and thirty days, so it is easy to tell what your current target is.

On the Freestyle Lite metre (our family favourite) you can show your 4, 14 and 21-day average blood sugar by pressing the ‘m’ button on the left-hand side of the metre.

If you’re eager, you could go to the trouble of graphing your blood sugar numbers, However, in the end, if your seven-day average is less than your fourteen-day average then you’re moving in the right direction.

Over time you want to see your average blood glucose levels coming down.  If you find your blood glucose levels drifting up, it’s a sign that you need to intensify your fasting regimen.

If working out your average blood sugar level is a bit complex you can just set an arbitrary target of say 10 mmol/L on waking.  If after a while you find you are mostly under waking under 10mmol/L you can change your target to 9.0 mmol/L, then 8.0 mmol/L, then 7.5 mmol/L, then 7mmol/L and so on.

Normalising blood sugar and insulin will often help people to lose weight, particularly if you’re insulin resistant.  However, some people will still need to pay attention to continuing to lose weight once their blood sugar and insulin is normalised.

Will optimal blood glucose levels guarantee weight loss?

While normalising blood sugars and insulin sensitivity will usually help you improve your body weight, it is possible to have excellent blood sugars and still be overweight (e.g. by eating a lot of fat that doesn’t raise blood sugar but doesn’t allow body fat to be burned).

The chart below shows Rebecca Latham’s blood sugar levels decreasing over a period of three months.  Once your average blood glucose level drops below 83mg/dL or 4.6mmol/L, then you may do better switching to using a weight target rather than a glucose target to drive your eating frequency.

2017-07-10 (5).png

If you have achieved excellent blood sugar and still want to lose weight, you can transition to using your target body weight as a trigger to decide whether to eat that day as detailed in the article How to use your bathroom scales as a fuel gauge.

Weight Gurus Bluetooth Smart Connected Body Fat Scale w/ Large Digital Backlit LCD, Precision/Accurate Measurements include: BMI, Body Fat, Muscle Mass, Water Weight, and Bone Mass

The chart below shows Rebecca’s weight loss to achieve her goal over twelve months and then transitioning to a maintenance regimen during 2017.

No automatic alt text available.

When not to use this approach

Exercise may raise your blood sugar in the short-term due to the body dumping glycogen from your liver into the bloodstream to fuel your activity.  If you don’t eat before or after exercise, your body will have to replenish the glycogen stores from the energy stores on your body.

There will be times when you’re hungry, or it will be appropriate to eat for social reasons such as a party, family gathering, etc.  Periodic fasting and then feasting is a regular part of our culture.  Tracking your blood glucose levels will help you get back on track after these indulgences.  Personally, I tend to employ this approach after feasting periods such as Christmas to recalibrate my appetite.

You should also keep in mind that other things affect blood sugar including stress, sleep, sickness, hormones and exercise that you will need to be mindful of when deciding whether to delay a meal due to your blood sugar being high.

Fasting may not be ideal if you’re stressed, sick, not sleeping well and/or are pushing the exercise envelope.  During these times, it may be better to focus on life maintenance and listen to your appetite and leave your fasting until the rest of your life is under control.

If you are taking insulin or other blood sugar lowering medications, you will need to make sure they are reduced to make sure your blood sugars don’t drop too low. Otherwise, you may have to eat to raise your blood sugar due to the excess medication.

The problem with injected insulin or many other diabetes medications is that, while it may help to reduce blood sugar levels, it also drives the energy back into the cells rather than allowing the stored energy to flow out of storage.

The more you reduce insulin (injected or produced from your own pancreas) to normal healthy levels the quicker the healing can occur.  However, at the same time, it would be prudent to reduce medications progressively to prevent your blood glucose levels from going too low.[10]

High blood sugar levels can be a sign that you’re stressed, exhausted or your hormones are out of whack (including time of the month for females), all of which will lead to insulin resistance.  You can use Heart Rate Variability to track your stress and exhaustion with an app such as Elite HRV which enables you to see when you’re exhausted and need to back off and rest.

2018-01-01 11.28.18.png

If you just don’t feel like fasting and your blood sugar levels are high it’s probably a sign that you need to rest, relax, sleep, meditate, see some real sunlight during the day and stop gazing into the artificial sun on your devices before you go to bed.   Using f.lux on your computer or blue blocking glasses after sunset is worth considering.

Image result for f.lux

While longer therapeutic fasts can be beneficial, a shorter duration feast / fast cycle that brings your blood sugar levels down to below your average is likely to be more useful to improve your metabolism while reducing the extreme swings in water weight or any concerns that you’re not getting adequate protein to support lean body mass.

Will monitoring my blood sugars help me enter ketosis?

The most straightforward approach is just to measure your blood sugar levels when you feel hungry and not eat until they drop below your target level.  You could still use this method even once you have improved your insulin sensitivity to losing weight by targeting even lower blood glucose levels before eating.

The chart below shows the sum of blood glucose and blood ketone levels for people on a low carb or ketogenic diet.  While a low carb diet helps to stabilise blood sugar and removes hyperpalatable foods when benefits a many people in terms of weight loss and energy levels, some of the major benefits are reserved for the periods when we are in a low energy stage (e.g. reduced insulin levels, autophagy, mitochondrial biogenesis, increase in NAD+ and increase in SIRT1).  It is in these periods of low energy that our body goes into cleansing and repair mode so it can survive through the famine to be able to reproduce in the next time of plenty.

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Zooming in on the left hand side of the chart, we can see that it’s the periods when we drive the energy in our blood down through delaying eating or restricting energy intake that we get the major benefits often associated with a low carb or ketogenic diet.

You will likely have some blood ketones in your bloodstream when your blood glucose levels are low, but they may not be at the levels that many consider to be ‘optimal ketosis’.  As shown in the chart below, if your blood glucose levels are at 4.5mmol/L or 80 mg/dL then you you might expect blood ketone levels to be somewhere between 0.3 and 0.7mmol/L.  If your blood sugars are at 4.9mmol/L or 88 mg/dL your ketones might be somewhere between 0.4 and 1.1 mmol/L.

While measuring ketones can be interesting, they tend to be a much noisier measurement.  As the glucose in your blood reduced your body will be forced to turn to your body fat stores, so you will increase your fat burning.  Part of the reason that you may not see high levels of ketones in your blood though is that they are being used efficiently for fuel and not backing up in your bloodstream.  So if you have limited funds for test strips and don’t want to be pricking yourself too often then I would focus on blood glucose levels.

Ketones and the glucose: ketone index

Monitoring your blood sugar will work whether you are insulin sensitive or insulin resistant, obese or healthy weight.

The body does a fantastic job of replenishing your glycogen stores and stabilising your blood glucose whether it be from carbohydrates, gluconeogenesis from amino acids or even gluconeogenesis of fat once you are highly insulin sensitive.

If you require therapeutic levels of ketosis, once you are starting to get your blood sugar levels under control, you could begin to track your ketones or the glucose: ketone index (GKI).  Decreasing glucose along with rising ketones is a sign that your glycogen stores are being depleted, your insulin levels are reducing and you your hunger is a signal that you really need food.[11]

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Tracking the ratio between your glucose and ketones (GKI)[12] and delay eating until your GKI is under a certain level could be a useful strategy if you are aiming for therapeutic ketosis for the management of chronic conditions such as cancer, Alzheimer’s, Parkinson’s or dementia.

Alternatively, you could simply not eat until your ketone levels were higher than a certain threshold.  You could start with a target ketone level of 0.4 mmol/L and keep winding that up till you achieve your desired results.

However, testing blood ketones every time you feel hungry could be expensive.  Many people also find that their blood ketone levels tend to decrease as they adapt to a low carb diet.

While all these things are relevant and useful, make sure to use them as tools to help you live life rather than taking over your life and stressing you out.  Your goals need to be realistic and tailored to your situation.  Hopefully, in time this ‘hunger training’ approach will help you build new habits around eating which will mean you won’t need to rely on the testing.

Fast well.  Feed well

Keep in mind if you are eating less food less often you will need to maximise nutrient density when you do eat, including ensuring that you are getting adequate nutrients to maintain lean muscle mass over the long term.

Some people advise refeeding with high-fat ketogenic foods after a fast.  While they may help keep insulin levels lower, it may not enable you to replenish the micronutrients that you lost during your fasting (particularly the minerals such as potassium, magnesium and sodium and the amino acids).  It also may not be optimal to refeed on very high-fat foods if you are trying to lose body fat.  Foods with adequate protein and high levels of nutrients will also be more satiating and enable you to be ready to fast again sooner.

I know personally, I tend to reach for the energy dense nutrient poor foods after a period of fasting.  That’s why I developed that Nutrient Optimiser to help you fine-tune your diet based on your current level of insulin resistance.

The chart below shows a comparison of the nutrients / 2000 calories in all the foods in the USDA foods database versus the most nutrient dense foods identified by the Nutrient Optimiser algorithm.  If our goal is weight loss, then these foods can be beneficial to ensure we get the nutrients we need with the minimum amount of energy.

nutrients - weight loss insulin resistant vs all foods.PNG

I think what we really want when we refeed is to maximise the nutrients : energy ratio of the food we eat so we can maximise our fat loss goals and be able to fast again soon without risking nutrient deficiencies.  After a period of fasting and autophagy, we want to refeed on nutritious food that will help us build back a strong, healthy body.

Best of luck if you chose to try this approach.  I look forward to hearing how you go.

 

 

references

[1] http://bja.oxfordjournals.org/content/85/1/69.long

[2] https://intensivedietarymanagement.com/fatty-pancreas-t2d-9/

[3] http://care.diabetesjournals.org/content/early/2015/11/29/dc15-0750?patientinform-links=yes&legid=diacare;dc15-0750v1

[4] https://intensivedietarymanagement.com/dawn-phenomenon-t2d-8/

[5] http://nutritionandmetabolism.biomedcentral.com/articles/10.1186/s12986-015-0017-2

[6] http://onlinelibrary.wiley.com/doi/10.1002/ijc.29917/epdf

[7] http://cardiab.biomedcentral.com/articles/10.1186/1475-2840-12-164

[8] http://diabesity.ejournals.ca/index.php/diabesity/article/view/19

[9] http://lowcarbbetterhealth.blogspot.com.au/2016/02/day-37-2016-weight-loss-and-blood.html

[10] http://optimisingnutrition.com/2015/08/17/balancing-diet-and-diabetes-medications/

[11] http://www.nature.com/articles/ncomms10580.epdf?shared_access_token=MUKioJXu6KVY753YIDoPVNRgN0jAjWel9jnR3ZoTv0NZFUsLxRRWAKMsrNHEbSj2q0khGxVdwhqgBvlELqp6rtnjRj5ppdqpqF9VFYO_6UzYPSf3Z5ZW4kFdG4GQIZ71IGlh7tQHXrGHJ2Nz7rN5iw-9csWuhb9uHxuz_-28FyOP6Tcmjd1H9Uxq9OwlIQTy

[12] http://optimisingnutrition.com/2015/07/20/the-glucose-ketone-relationship/

 

post last updated January 2018

  • Robert Lockridge says:

    Any age adjustments to make the goals reasonable? I’m 68.

    Robert Lockridge 407-620-9954

    >

    • That’s the point of using your current average blood glucose level. You start from where you are currently at. By eating only when your blood glucose us less than YOUR average you will make sure you are not over eating,

      • Wenchypoo says:

        Do you use the 7-day average reading on your meter (Precision Xtra/Freestyle Neo) for this, or go from logs?

      • I just use the average on my meter. I was also entering it into a spreadsheet for a while but it’s hard to do every day and takes time. Using the blood glucose meter is instant and current.

      • Danyelle says:

        If insulin is perpetually elevated the blood sugar would still appear relatively low. For people with metabolic syndrome a blood sugar of 90-100 might appear “not too bad” for them but could just be suppressed by their high basal insulin levels. This is why I think testing ketones is more useful. Higher ketones I think means low basal insulin levels in your body. Sometimes a slightly higher blood sugar of 100-120ish for a person with the metabolic syndrome who is attempting to improve via IF is more showing that basal insulin is coming down. The trouble with BG is that it could be high for many reasons, low for many reasons and it could be in flux either rising or falling. Insulin is the real issue and a BG meter does not tell you anything about insulin as most obese people although chronically hyperinsulinemic (they have body fat so they have too much insulin in their system) are not always diabetic! They may get T2 later in their lives but young obese people maintain normal or very close to normal Bs. Doesn’t mean they are healthy. They are insulin resistant and produce ever more insulin to maintain relatively normal BG. This is pre-pre-diabetic. It is my opinion that anyone obese is pre-pre-diabetic, even if they have normal blood sugars. I am not fat shaming. I am post obese myself. All the people who said “you are not unhealthy” and “you are the way God made you” and “we are all different” were totally wrong.

      • I agree Danyelle. If you do have high blood glucose levels I think it’s useful to use IF or LCHF to get those down to normal levels. I mentioned in the article, once you get your BGs to normal you can add ketones or better yet track your glucose : ketone ratio which is a really useful estimation of your insulin levels, not just blood glucose.

  • This comment from Raymund Edwards is worth repeating:

    “I FAST two days most weeks (last week I did 4) I consider up till 7 DAYS an intermittent FAST , over 7 days I consider a Therapeutic FAST ( I have done three of these , 12 DAYS , 21 DAYS and 43 DAYS – you get good at it by doing it)

    I do the short fasts every week mostly and longer fasts twice a year (that is 7 days or over)

    FASTING DAY = no breakfast go to bed FASTED
    FEEDING DAY = protein rich breakfast

    I FAST WELL (no breakfast go to bed FASTED)
    and I FEED WELL (focus on proteins and nutrients)

    FAST is about ketones and their signalling (get them HIGH) in context of LOW BG and INSULIN.

    FEEDING is about amino acids and their signaling .

    imv FASTING is FASTING (what people call IF is just skipping meals) in consecutive days fast – ketones very soon go over 5 /6 ( and even 7 – 8+)

    THAT is FASTING !!

  • Deb Baker says:

    Great article! Thanks Marty and all responders.

    I finally got a ketone/glucose metre (but only the ketone strips at this point).. I have just “fed” after a 3 day fast but my ketones only got up to .8mml even though I’ve been low carb for several months. 30min after my meal my ketones were at .5mml still.. I thought it would have been better than that whilst fasting and worse after eating.. Look forward to getting some glucose strips for my next fast..
    Cheers

  • Wenchypoo says:

    Deb–I’ve been keto-adapted for a couple of years, and when a snow storm blew over our town, my ketones DROPPED into the non-therapeutic range! We’re talkin’ .2 and .1–it happens sometimes, and without explanation. My only excuse was weather-related, which is backed up by Dr. Bernstein, who says that low pressure fronts cause the blood vessels to expand, leading to more total blood volume (and more sugar in that blood). I no longer sweat the weather–instead, I just keep on chugging with my meter, cooking and eating the foods that don’t cause much rise, fall reliably back to baseline, and give me the ketone levels I expect (usually 1.0 and above).

    Now Marty’s given me another use for my meter. If you were to combine Marty’s method above with his low-insulinogenic recipes, you’re sure to come out a winner!

    My problem: I fall asleep around 8 each evening, so delaying dinner is problematic, since I check my blood 1 hr. and 2 hrs. post-meal. The final blood check (and ketone check) would have to happen while I was asleep. I choose to delay (or skip) breakfast instead. Now I can put Marty’s method in place as another tool in my arsenal.

    • The weather thing is interesting. There’s been lots of talk lately about cold thermogenesis etc on metabolism.
      I also wouldn’t use this approach to delay your meal late into the night. Maybe skip dinner or breakfast and see how it goes.

    • Deb Baker says:

      Thanks – I’m in Aus, so no cold weather here – interesting stuff tho, thanks 🙂

  • Wendy G says:

    Marty, you know from my comments on FB that I’m concerned that this approach, when not used by diabetics (who it seems to be designed around) may be, or cause, disordered eating.
    And maybe I’m just prejudiced against it for that reason, but for me, I usually eat “lunch” (first meal of the day) after exercising. Exercising always affects my BG the same – BG stays stable or even goes up a few points (no surprise, glucose demand from exercising). I usually eat my first meal after exercising each day, and I am hungry to very hungry at that time. My BG meter tells me I have “adequate” BG, but so what? I’m physically hungry at that point. And, I’m in my eating window, coming off a 16-hour fast with exercise at the back end of it. It seems to me that waiting an hour or two (or -?), at great personal discomfort, is questionable value. This is especially true considering that, for me, eating at this point (LCHF) then always makes my BG go DOWN in the subsequent hours.
    Strong physical hunger to me simply trumps this approach, at least in the context of being LCHF long-term.
    So maybe this approach is not for everyone. Just sharing my own experience here. But, cheers and more power to those people empowered to improve their health with this approach.

    • Thanks Wendy. Fasting is certainly not for everyone. And the idea of this approach is to slowly and incrementally bring glucose levels down rather launching into a dramatic long fast that may be unrealistic. As noted in the article exercise will affect your blood glucose levels as will stress, sleep and a bunch of other things that are more important than intermittent fasting. Definitely important not to use it as an approach to starvation, but I do think paying attention to the blood glucose meter makes more sense than calories or scale weight.

  • Jan says:

    Marty, is there a recommended protocol for when to do BG readings? Should it be fasting, before each meal, after each meal (how long?).

    • Depends what your goal in doing the blood glucose measurements is. Taking your waking blood glucose is a good way to keep track of your overall insulin sensitivity. If you’re following this protocol you’d be taking glucose readings before your meals. If you wanted to find out whether what you just ate worked for you you would take a measurement an hour or two after your meal (obviously the lower the better). If you’re gunning for this approach the aim is for the overall average to be coming down over time.

  • Lori Carlson says:

    Reblogged this on My Fat Loss Journey on LCHF and commented:
    Fascinating article for anyone who is insulin resistant, diabetic, and following a LCHF diet.
    Comments are disabled. Please visit Optimising Nutrition to leave a comment. Thanks!

  • Wenchypoo says:

    Today on LC Conversations over at JM’s, they discussed hunger as a mood. I struggle with hunger out of boredom, but remind myself to go find something to do instead of standing in front of the open fridge looking for something to eat. Am I really hungry? My stomach says no, my meter says no, but my head says YES! So I go scrub, vacuum, or iron something…

  • Deb Baker says:

    Anyone in Aus – went to buy Glucose strips for my Optium Neo the other day and was asked for Medicare card.. was a bit confused, guess there is a “diabetes database” or something.. anyway, they were too expensive, so didn’t’ get them.. Do you have a fav place to buy the strips on line as I’m in a Regional Area. Will be in Adelaide in a few weeks if there is a chemist anyone there..
    Cheers

    • Christine says:

      I get mine off ebay. $70 at chemist too dear, $27 ebay for 100 much better. Shop around and they usually post free.

    • Lyn says:

      Deb, there is a Govt. subsidised scheme called National Diabetes Services Scheme which provides strips etc for diabetics at a cheaper price. So that would have been why they asked for a Medicare card or there is a NDSS card which has to be presented to get the cheaper price. The ketone strips are not subsidised and they are nearly a dollar each!

  • […] is the table that RD is really really really excited about (from the using your glucose meter as a fuel gauge […]

  • […] and BG levels I think this post focuses on BG influenced by Insulin Resistance. Marty Kendall's blog on using FBG/pre-meal BG as a guide to when to eat fascinated me. Mostly because I have been doing […]

  • […] also use shorter more regular fasting periods to keep his blood glucose down.    Check out the Using your glucose meter as a fuel gauge article for some ideas on how you can make sure your average blood glucose is trending in the right […]

  • Mark says:

    I’ve come across this new product called keyasmart. Blood glucose plus keytone both from same strip.
    Check it out at keyasmart.com

    • Looks like some interesting technology, though not yet available.

      • M says:

        It’s now available direct from the company.

      • Susie Foletta says:

        I understand breath ketones is the most accurate form of monitoring ketones is it not? Ketonix is a device I purchased a couple of years ago out of Europe….Diet Doctor now recommends this and I have found it to be excellent. An initial outlay of not a lot from memory, but once purchased, that’s it…no strips to buy!!

      • breath and blood ketones are different but related. blood is more of a buffer, breath is more of an indication that you are burning them. I like my Ketonix.

  • Eileen says:

    Marty, following on from our comments exchange just now on Reversing Diabetes, I didn’t want to totally hijack that thread so continuing here..😊

    I’m told by my (progressive) GP here that I am not T2DM …..yet.
    Looking at the work of Kraft which Ivor Cummins has so wonderfully brought to light, I would say I am definitely diabetic… what say you please looking at these my latest path results?
    HbA1c: 5.6
    Glucose fasting: 6.3
    Insulin fasting: 18.0 (down from all time high 35.3 July 2014)
    Trig: 3.25
    Cholesterol also problematic.

    TIA,thanks kindly
    Eileen Janeke

  • Eileen says:

    Thanks Marty. At 72yo, I’ve left it a bit late!

    • Marion says:

      Eileen, no you haven’t 🙂 My mom is 75 and she brought her blood sugar under control (HbA1c from 11 to 6.3, still a bit to go) with LCHF and a little bit of fasting within 3 months. She’s feeling so much better, more energy, clearer thinking. We thought she was going senile when she really suffered from glucose-induced brain fog!

  • […] detailed in the how to use your glucose meter as a fuel gauge article, it can be useful to track blood glucose or weight to help guide the frequency and duration of […]

  • Katrin Helmreich says:

    Hi Marty, I’m so pleased to have come across your blog. This is such interesting information. Awesome stuff. A question: when you’re talking about your ‘average’ blood glucose level; what time of the day or how many hours before or after food are you measuring this? Thanks for clarifying. Katrin, Canberra.

    • For me it’s just the average on my meter. I test a few times a day. It’s useful to eating in the morning and before or after meals. No need to get caught up on the number or timing though, just make sure the trend is in the right direction. So glad you like the blog and it resonates with people!

      • Susie Foletta says:

        Hi Marty….just found you! This is a terrific blog and site! I have been following LCHF and IF for a couple of years now and lost about 18kgs a couple of years ago….but am really having a problem shifting the final ten or so kgs. I was diagnosed with T2D four or so years ago and cured that very quickly by cutting carbs and reducing my weight….(early LCHF methinks!). My problem is that my oestrogen levels are high and I think that is what has me still be insulin resistant,which I am sure is what is preventing further weight loss – this from further research! I have been following IF for a couple of years now – 16 8 hour window protocol and have just now begun undertaking longer fasts – I’ve only done two so far – one 60 hours, the other 40 with the 16 8 hour on the other days. It was one of the first times my BSs got into the 4s! Question: should I just keep on with this protocol to get my BSs down lower? I guess it takes time? And given BS levels are not a real indication of insulin resistance,how do I check if I have overcome hypernsulinemia…or indeed if this is even possible? Many thanks….and GREAT blog!!
        Cheers
        Susie

      • My thinking is that you should eat the most nutrient dense foods you can while still maintaining excellent glucose control. Initially if you are T2D that will involve more added fats and you will lose as your insulin levels drop. In time you might able to reduce the added fat and allow more fat to come from the body. See the table at the end of https://optimisingnutrition.com/2015/03/22/cheat-sheets/ for more guidance.

  • […] made some great progress via tight blood glucose control (using the process outlined in the article how to use your blood glucose meter as a fuel gauge), avoidance of processed carbs and intermittent […]

  • […] note I have had some good results  recently following the intermittent protocol detailed in the how to use your blood glucose as a fuel gauge article.  My blood glucose levels are consistently lower, down from an average in the mid 5s to […]

  • […] how to use your glucose meter as a fuel gauge […]

  • […] your blood glucose and reverse your hyperinsulinemaia.  Hopefully in time though, along with some intermittent fasting and physically activity, you will be able improve your metabolic health and progress to a more […]

  • Robin says:

    Just discovered this post and although I’m not diabetic I just started taking my wake up blood glucose reading to determine how much my body is healing. I typically do a 3-4 day fat fast (~350 calories per day) every other week. I alternate those weeks with weeks that have two 24 hour fasts and one 42 hour fast. If I changed things based on my BG reading, how would it work exactly? I only do a reading once a day. If my reading is higher than my average I don’t eat for that whole day? Then I’d assume the next day I’d likely be below my average so I’d eat two meals that day? Am I understanding that correctly? I’d assume this method then wouldn’t have me doing multi-day fasts, correct?

    • I don’t think the exact routine matters as long as your glucose or weight at the end of the fasting period is lower than the period before. If you are not going in the right direction you would try to eat less when you do eat, extend the fasting period or fast more frequently. That way you can find the routine that suits you best. If you only want to test once per day you would make the decision to fast based on your glucose or weight at the same time each morning.

  • […] out the how to use your glucose meter as a fuel gauge article or Jason Fung’s blog for some more ideas on how to get started with fasting.   Rebecca Skvorc […]

  • Andrejka says:

    Thank you for this information. FYI: There is a typo “….People with Type 1 Diabetes following Dr Bernstein’s protocol try to keep heir…”

  • Dear Marty
    I’m doing an experiment to get into ketosis. But I’m finding it hard to lower blood glucose. Even following a ketogenic and doing intermittent fasting diet.
    Example:
    08/24/2016
    Dinner 8:00 pm
    –Gorduras: 95,60g (74%)
    –Carbohydrates: 8,75g (3%)
    –Proteínas: 68,63g (23%)
    08/25/2016
    After 26 hours of fasting Flashing: glucose 98 mg / dL
    08/26/2016
    After 42 hours of intermittent fasting: glucose 107 mg / dL
    After 48 hours of intermittent fasting: glucose 91 mg / dL (0.6 mmol ketones / L)
    End of fasting.
    I ask:
    – Will I have to increase the fast time to go into ketosis?
    – Where does this blood glucose, even fasting?
    – The liver or my own body fat?
    – Blood glucose is related to the circadian cycle, increases during the day and decreases at night?
    Thanks for listening.
    (This post was translated from Brazilian Portuguese by Google, sorry errors)

    • It can just take longer to drain your body’s glucose stores, so keep at it as much as feels good. Intense exercise will also help. Yes, the body can make some glucose from protein or fat if it really needs to.

  • […] of the most popular articles on the Optimising Nutrition blog is how to use your glucose meter as a fuel gauge which details how you can time your fasting based on your blood glucose levels to ensure they […]

  • TIM MCCARTHY says:

    this is great Marty…but im still confused on what time I would use to establish my 7 day average. If i use wakiing BG, that is dawn elevated, then that number will have me eating all the time as by 9 am the dawn thing has worn off. Should I use a number later in the morning but before eating to find a more accurate BG average?

  • TIM MCCARTHY says:

    ok thanks Marty…I wonder is it too much to ask to have a copy of the spreadsheet you used…Im hoping to do this and track my results. Im a cyclist and would like to fast and this approach seems it would better align with the energy requirements.

    • without worrying about spreadsheet the simplest way might be to just look at the average glucose level on your blood sugar meter for the past 7 days and then simply wait to eat until you BG is below that average. if that average every did drift up you could maintain the lowest levels your eating trigger if you wanted to be particularly disciplined.

  • […] article is a follow up to the “How to use your glucose metre as a fuel gauge” article, which has been quite popular, with lots of people reporting success in lowering their […]

  • David says:

    The chart you reference from academic.oup.com was done on rats. In vivo metabolism in humans shows that glucose is very rarely stored as fat; it only occurs in extreme (abnormal) carb overfeeding conditions. So the chart is misleading in that respect.

    Also, the statement above the chart (“Insulin keeps fat stores locked in storage”) is misleading. The whole theory by Taubes/etc of insulin being the enemy is wrongheaded. An energy deficit is the only absolute requirement for weight loss.

    In humans, insulin’s significant role is as a brake, so yes, it inhibits lipolysis. However, that also means that if insulin is not doing its job (whether due to lack of insulin, or insulin resistance), then lipolysis is really high and available to be burned off. In that sense, a diabetic person is actually in a prime position for weight loss. All they really need is a calorie deficit. (I just think too many people think losing weight is all about insulin, when it’s really not.)

    • Jim says:

      David,
      The insulin hypothesis lowers my weight and insulin. It explains the way my body works.
      The calories model just doesn’t seem to work for me and many others. It sounds good, but the results are not there.
      What should work is not something I think about. What does work gets my vote. Jim

  • […] detailed in the how to use your glucose metre as a fuel gauge article, waiting until your blood glucose levels drop can be a useful way to increase the timing between […]

  • Suzanne says:

    Hi there,

    I’ve been doing IF since the beginning of this year for 5 days a week. I’m following the 16:8 methodology. After listening to a podcast by Robb Wolf, I’m curious in testing my glucose levels. How should I go about this since I’m already doing IF?

  • suziet0502 says:

    Hi there,

    I’ve been doing IF since the beginning of this year for 5 days a week. I’m following the 16:8 methodology. After listening to a podcast by Robb Wolf, I’m curious in testing my glucose levels. How should I go about this since I’m already doing IF?

  • […] energy levels will decrease and you will get all the positive benefits of fasting.  The articles How to Use Your Blood Sugar Meter as a Fuel Gauge and How to Use Your Bathroom Scale as a Fuel Gauge can help you use objective measures to refine […]

  • […] fasting to reset insulin sensitivity and reduce overall calorie intake.  You can use your blood sugar or your weight to help guide your fasting […]

  • Jacki Moya says:

    Marty, what would you suggest, (for this method to be most effective) the frequency of testing BG levels? I’ve been only testing first thing in the morning (I’m not diabetic, although I think I may have insulin resistence and dawn phenomenon), not testing on days when I know I had too many carbs the day before and on fast days my readings are lower. So I see how I can Infuence my 7 day average depending on how often/when I test. I like the concept of this approach and really want to give it a try.

    • Just testing in the morning makes sense if you are going to skip eating for the day. You just need to keep winding down your target so you have as much fasting as you can reasonably tolerate.

      • Jacki Moya says:

        What about the days I eat? Record the BG testings that I use to see if I can eat? For example, yesterday after getting out of bed, I tested and the number was higher than my 7 day average, so I didn’t eat. I tested two hours later and it was lower than my 7 day average, so I ate. I should record all tests? and test every morning minimum? (normally I wouldn’t test this morning because I had some dessert with dinner last night, so I’m sure the number won’t be great). Sorry for the questions…

  • I have been eating LCHF for 3 months now, doing IF for most of it (because I am not hungry in the morning, it just happened without effort My first meal is usually between 12:00 – 14:00, with my last being around 19:00 – 20:00).

    I have been losing steadily (started with 25 kg to loose, and have lost 10 in 3 months).

    I eat 20-25 g carbs and keep my protein around 70-80 g and the rest of my calories from fat, to satiety (usually around 100g – it fluctuates). And my food sources are green veggies, meats and eggs. I have gone dairy free, and use olive oil, coconut oil, ghee (so not 100% dairy free) and coconut cream in my coffee.

    Anyway, my question is about my blood sugar.

    When I go to bed my blood glucose is 90-92, and when I wake up it is 96-99 (once it was 107, but that was after very little sleep and I was exhausted). And I don’t understand where the rise is coming from.

    After 3 months of eating LCHF surely my glycogen stores are reduced? If I am understanding what is quoted here from Dr. Fung, the rise is blood sugar in the morning is related to released glucose from glycogen stores).

    What am I am not understanding?

  • […] a simple graph from optimisingnutrition.com to give you a visual of your body’s response to […]

  • […] also use shorter more regular fasting periods to keep his blood glucose down.    Check out the Using your glucose meter as a fuel gauge article for some ideas on how you can make sure your average blood glucose is trending in the […]

  • Eddie says:

    Hello Marty – Thank you very much for this article. I have been disappointed to have elevated FBG (Dawn Phenomenon?) and A1c. I have been a long time IF (19:5) devotee. It was suggested to me to incorporate an earlier eating “window” which I did, and not eating after approx. 3 pm. Upon implementing this, I immediately experienced dramatic improvement, (i.e., lower avg. BG numbers and lower morning FBG as well), but these beneficial effects started to fade after a few weeks as the numbers began going upward. It was then suggested to me that follow the “glucometer as fuel gauge” protocol you have pioneered. My first serveral days of doing this were productive. Whereas in the past I might have eaten after X hours of my initial eating, (but still within my admittedly arbitrary time-duration eating-window) I now found myself waiting until my BG would drop below my 14 day avg or to some more desirable number. When I was wanting to eat hunger-wise, my BG might have been ~100 mg/dl, but waiting another 1-2 hours, it would drop to the mid or high 80s which, again, were numbers I had not typically seen for years. I have some issues I hope you will please be so kind as to opine on: 1) When I exercise my numbers go up, even if I’ve been fasting and the numbers were dropping before the exercise. I love to exercise and believe it is beneficial, but this effect results in me needing to fast so much longer. What to do about scheduling exercise? 2) I want to continue my early eating window “experiment” but with high morning readings and a tendency for those reading to ascend unless and until I eat, what would you suggest as far as the “conflict” between eating early and waiting for the BG to drop? 3) Finally, 🙂 eating this way ultimately creates timing where my window’s are much shorter even though I’d like to continue enjoying the non-BG benefits of IFing. Any thoughts on that? The courtesy of your time, attention and wisdom are greatly appreciated! Eddie

  • […] your total energy levels will decrease, and you will get all the positive benefits of fasting. (See How to Use Your Blood Sugar Meter as a Fuel Gauge and How to Use Your Bathroom Scale as a Fuel Gauge for objective measures to refine your balance […]

  • […] way to get a cost-effective and immediate understanding of whether you actually need to eat (see How to use your glucose meter as a fuel gauge for more details on this […]

  • […] article How to use your blood glucose meter as a fuel gauge can guide you through how to use a glucose meter to re-calibrate your eating routine based on when […]

  • […] have talked about using your bathroom scale or blood sugar readings to refine the frequency and quantity of your feeding to make sure you are moving towards your […]

  • […] a simple graph from optimisingnutrition.com to give you a visual of your body’s response to […]

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