Chronically Elevated OR Large Fluctuations of Glucose?

Sep 27 / Drs. Bryan & Julie Walsh

Here’s a quick question for you.

If you had to choose between one of the following, which one would you choose?

Chronically elevated glucose



 Large fluctuations

of glucose

The first option has an elevated hemoglobin A1C. The second one, a normal A1C.

If you're like most people, you chose door number two - large fluctuations of glucose. But according to research, that might be the wrong option.

Just about every research study on the topic of excess glucose fluctuations, or glycemic variability as it is typically called, suggests excess glucose fluctuations are far more damaging to the body than chronically elevated glucose.

Even when the total glucose load is lower, glycemic fluctuations still appear to be more damaging than chronically elevated glucose.

Glycemic variability seems to lead to more oxidative stress, vascular complications, endothelial dysfunction, and cardiovascular issues than does chronically elevated glucose.

Even mood, obesity, and quality of life are associated with glycemic fluctuations.

But that’s not even the worst part.

Excess glycemic variability often occurs well before glucose regulation starts to deteriorate and therefore standard glucose markers, such as fasting glucose and hemoglobin A1C, will be completely normal.

In case you missed that - excess glucose fluctuations precede insulin resistance, are more damaging to the body than chronically elevated glucose, but don’t show up using standard glucose markers.

That’s a huge problem.

How many patients, or even practitioners, have slowly deteriorating metabolic and glucose regulation that could be identified earlier, if only we were looking for it. 

Testing for Glycemic Variability

There are a few ways of testing for glucose variability.

One of them is an analyte called 1,5-anhydrogluctiol, which can be measured in blood or urine. The lower this marker is in blood, the more glycemic variability someone has and the less glucose regulation they have after eating.

And the converse is true – the higher serum 1,5-anhydroglucitol is, the better glucose and metabolic regulation one has after meals, and less glycemic variability.

As a quick note, for whatever reason, this marker seems to be most accurate in the general population, and not athletes or keto/Paleo folks.

If glycemic variability precedes insulin resistance and type II diabetes, is more damaging to the body than chronically elevated glucose, and is not identified using standard glucose markers, the question is, why are more practitioners not testing for it?  

Self Assessment Time:

  • Are you still recommending small, frequent meals to fix hypoglycemia?
  • Do you still believe insulin's primary job is to get glucose into cells?
  • Are you still using A1C as your best marker of glucose regulation?
  • Do you still think chronically elevated glucose is the worst glucose dysregulation pattern?
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