Managing blood glucose levels is becoming a key component to managing health, a topic both Food Pharmacy and Nordic Clinic are passionate about spreading. Though commonly associated with managing Type 2 diabetes, it’s becoming increasingly more common for healthy people to use blood glucose testing as a marker for their own health and to develop a personalised diet. As Mia and Lina were embarking on their health measurement and optimisation journey with us at Nordic Clinic, I decided to offer them a personalised glucose measurement. Of course, as per normal, their reply was “bring it on”! So I attached the monitor to their arms and told them what to look out for – read on to see what we found out. But first, just to explain, there are several options available to measure blood glucose, each with their own pros and cons:

• Fasting blood glucose (FBG) – Most common and accessible, FBG uses a glucose meter with test strips to test blood glucose. The test is normally taken in the morning after an overnight fast by pricking your finger and placing a drop of blood on a test strip, with normal levels being under 5.6mmol/L. Though frequently used, FBG does not give an accurate assessment of how your body responds to food. This is also done in common blood tests with your doctor, but when this elevates, you have already developed diabetes. 
• Oral glucose tolerance test (OGTT) – Fairly accessible (some doctors will perform this test on you) and it can be performed with a simple blood glucose monitor. The test begins with a FBG measurement followed by consumption of a sugary drink containing 75g of sugar. Repeated tests are given every 30 minutes for 2 hours. Blood glucose should remain below 7.8mmol/L and return to fasting within 2 hours. May be used to assess your response to specific foods, but repeated skin pricking is a hassle. Also, you may not want to spend two hours at your doctors clinic if they are administering the test.
• Hemoglobin A1c (HbA1c) – Calculates a 3 month average of your blood glucose levels from a blood sample. HbA1c is based on damage caused to red blood cells (RBCs) by glucose, a process called glycation. Normal levels are considered under 6.5mmol/L, although depending on your location, this might be even lower. While useful, it’s not appropriate for some individuals due to varying replacement rate of RBCs (your body may turnover RBCs faster than others and this impacts the accuracy of the test).  Another drawback is that average blood glucose doesn’t inform you of how blood glucose varies based on specific foods or how high the peaks or low the troughs are.
• Continuous glucose monitoring (CGM) – CGM is a new technology that takes 24/7 blood glucose measurements every 5 minutes, or when you ask it to (by holding the reader or your phone next to the sensor). It uses a patch worn on the skin with a tiny probe that penetrates the skin, sending data to your smartphone. Ease of use, direct measurement of glucose, and only replacing the sensor every ~14 days (depending on the model used), CGM is the current gold standard.

While the older technologies have proven useful in the past, CGM is light years ahead of the competition for using blood glucose data in healthy populations.

Every one of us responds differently to specific foods. While one person may have a perfectly normal blood glucose response to a food such as oatmeal, another may experience hyperglycemia. Many factors go into how your blood glucose responds to food: Genetics, sleep, physical activity, stress, meal timing, meal frequency, and the microbiome all play a role.

Continuous Glucose Monitoring on Mia and Lina

What did we learn with Mia and Lina? We gave them a challenge to try as many foods as possible – some they would not eat regularly, as well. To give some brief background, ideally our fasting blood sugar should be around 4 mmol/L – 5.5 mmol/L. After eating foods in general, blood sugar should naturally increase of course, but the less it increases and faster it returns to below 6.0, the better and lower the risk of diabetes.    

We saw that on average Mia had a higher glucose level more above 5.0 than Lina (below 5.0) and we wanted to work on lowering hers a little especially. Both actually did not respond well to oats – some of the highest glucose levels readings for both of them were due to oats. Mia changed to oat rice, which had little impact on her glucose and was a better choice. Mia’s blood glucose was also raised above 9 mmol/L from banana and ice cream made from pea, so sometimes suspected healthier versions are actually not that helpful for blood sugar. Mia, when sticking to one glass of red wine, had little impact on her blood sugar.

Lina’s blood sugar seemed to be really impacted and increased by grain based products in general, more so than Mia. Pasta and wine were the worst, elevating her levels to a massive 11 mmol/L. So overall, some not so astonishing results and some really surprising results. 

The key to managing your health might well just be continuous glucose monitoring. It is easy and helps you to understand how your blood sugar is impacted by different foods – personalised nutrition at its finest to help promote a healthy glucose level. Learn here and here why blood glucose is one of the best things to keep in check for gut health, COVID-19 response and more. The freedom of simply attaching a sensor and forgetting about it, along with 24/7 measurements, makes CGM the best option for using glucose levels to make healthier choices.

If you would like to learn more about measuring blood glucose using CGM and do this on yourself, please contact info@nordicclinic.se. We can support you taking control over your blood sugar levels. 

This article was originally published as a guest editor post at foodpharmacy.se

By: Graeme Jones, clinical physiologist and CEO at Nordic Clinic Stockholm.

Published: 17/01/2021