#52 - 3 Reasons Your Fasting Sugar Is Stuck (Even If You’re Doing Everything Right)

Your post-meal numbers are finally improving, your A1C feels like it’s heading the right direction, and you’re doing the work… so why does your fasting blood sugar still look the same every morning? If you’ve ever stared at that morning glucose reading and felt defeated, we want to take the blame and confusion off your plate and put a clear plan back in your hands.

In this episode, we break down why fasting blood sugar can be the slowest number to improve and what it actually tells you about what’s going on in your body.

We’ll explain:

• Why fasting glucose behaves differently than post-meal glucose
• The role of the liver and overnight glucose production
• Why improvement isn’t always linear
• What it means when other numbers are improving first

If you’ve been frustrated by your morning blood sugar numbers, this episode will help you understand what’s really happening, and why you might be closer than you think.

Ready to take control of your health and stop settling for “managed” diabetes?
  Grab your earbuds and listen in.

Brian & Cory
 Diabetes Remission Partners

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Transcript

Live Workshop Invite

SPEAKER_00 0:00

Quick note We're hosting a free live diabetes remission roadmap workshop on Thursday, April 23rd at 7 p.m. Eastern. If you've been looking to dive deeper into getting onto the road to remission, this is your chance to do it live with us. And if you show up live, you'll get our medication freedom self-advocacy cheat sheet free. So, again, we're hosting a free live workshop on Thursday, April 23rd at 7 p.m. Eastern, and we'd love to see you there. Registration link is in the show notes. Alright, let's hop into the show.

Why Fasting Lags Behind

SPEAKER_01 0:36

If you have type 2 diabetes and you're tired of being told it's chronic and something you'll just have to manage forever, if your A1C is controlled but your medication list keeps growing or stays the same, and you know deep down you're capable of more than this, you're in the right place. This is the Diabetes Remission Roadmap Podcast where Brian Bisher and Corey Jenks, two pharmacists who spent over two decades inside healthcare. And we started this show because we got tired of watching capable people stuck getting managed instead of rebuilt. Here's what most people aren't told. Type 2 diabetes isn't just a blood sugar problem, it's a muscle and energy storage problem. When your body loses strength and metabolic flexibility, blood sugar rises. And you can rebuild that. On this show we break the scripts and say more meds are inevitable, you're destined to just manage, remission isn't possible, and instead we teach you how to build muscle, eat in a way that keeps you full, and regain control of your health again. No extremes, no shame, just practical strategies to help you move toward remission and lead your health again. Let's get to work.

SPEAKER_00 1:32

Welcome back to another edition of the Diabetes Remission Roadmap Podcast. And hey, if your fasting blood sugar isn't improving and everything else is, there's usually a few specific reasons why. And today we're going to walk through three of the most common ones we see. Brian, welcome. That's what's called a teaser. I was just feeling a little airtime while you uh hocked a loogie into your cup because you're not feeling 100%. Thanks for sharing, Corey, the details that everyone just needed to know. He he muted himself at least. He did it before we went hot, so you didn't have to hear the sound of him lugieing it up into his mug. So you know, and this is this is where we're testing how strong the beginning of this episode is. You know, you want to hear those three reasons why, but you got to get through the Lukey stuff. And we've gotten through it. Okay, we're done. So uh Brian is a little under the weather. He's got a baseball game to coach tonight, but he's here recording as a public service to you. Thank you, Brian. You're welcome, Corey. All right. So one of the most frustrating things that we hear from our patients and our history, the clients we take care of is as they go through the process of diabetes remission, they're working on building muscle, they're satiety-centric eating, protein, fiber, moving strategically, crushing it, right? And one of the first things we see is an improvement in pre- and post-meal blood sugar. Hooray, that's great. We'd love to see that, right, Brian? We do. We count every win as a win. And so when we see those improve, sometimes the fasting blood sugar doesn't improve. And we hear, what am I doing wrong? And so we want to, the first thing we want to do is we want to normalize this for you. So it's it's pretty common that the fasting is the last to go down, even when the post meal numbers improve first.

unknown 3:12

Yeah.

Reason One Liver Makes Extra Glucose

SPEAKER_00 3:12

Why is that, Corey? Well, please enlighten us. Sure. I so the post-meal blood sugar is essentially how you handle incoming glucose. And this is where strategic movement, reducing the amount of incoming glucose that's coming to your body, the extra energy, can help with those post-meal sugars. Uh, when you're taking those walks five to 10 minutes after meals, you're doing squats a few times a day, air squats, activating those glute four receptors. Go back to the muscle master class episode with Dr. Ben to hear all about the nerdy part of Glute 4. But essentially, once you activate muscle, you're gonna get that blood sugar out of the blood and into your muscle. So you are actively producing, you're actively taking care of them. Now you're fasting blood sugar. This is often what your body is producing on its own. So you your liver has a process called gluconeogenesis, where it gluconeogenesis simply means making new glucose. And so uh what's actually happening is like at night, you're not eating, or hopefully, hopefully you're not eating at night. Uh, one of the one of the first things we clean up are those late-night snacks that uh some of our some of our clients are used to. I and Brian knows me, I'm guilty of some of those evening snacks too. But me too. Ideally, uh, you are not snacking overnight, but your body does need glucose to function, so it does make its own glucose. And this typically happens in the liver via the breakdown of glycogen, which is stored glucose, or creation of glucose through gluconeogenesis. So once you have type 2 diabetes, you're at a state where you are insulin resistant, which means the insulin your body produces doesn't send the sugar out of the blood into your cells. Now, also when you're in the state of insulin resistance, your insulin often it's you know, when your insulin's high, it means that sugar's high and we don't need to make more sugar, but in this resistant state, it doesn't always get that liver to stop producing new glucose. So if the liver keeps on releasing glucose, even if you don't need it, uh even if your sugar is already elevated. So your fasting number, although sometimes it can be about what you ate, it's not always about what you ate. It's about what your liver's doing when you're not eating. So this is why we'll have people say, I didn't eat for 10 or 12 hours, but my sugar's still high in the morning.

SPEAKER_01 5:22

Yeah. I definitely hear this a lot, Corey. So I like how you explained it in the form of what the liver is doing behind the scenes and how what I'm hearing is just essentially your liver in a healthy state should be able to see from or hear from insulin that I don't need to produce any more glucose. We have enough, but that's not happening because we have insulin resistance, and that insulin resistance is happening in the liver as well. Am I correct?

Reason Two Energy Tanks Still Full

SPEAKER_00 5:45

Okay, right. Now, this is one reason why. So the the first reason here, uh, as we as we discussed, is that your liver is still overproducing glucose. This is a list of three. Number one, your liver is still overproducing glucose. Now, one of the reasons it could be overproducing glucose, and now this is a side reason sidetrack to the overproduction at night, is that if you're not sleeping well, uh, or in my history, I've taken care of people who have nightmares, those situations where they're up late at night, unable to sleep, or having nightmares, and they have literal their body is going through stress, your body's producing uh cortisol, which tells your body to liberate glucose to fight or flight, to run away. Now, of course, if you're laying in bed having a bad dream, you're running in your dream, but you're not uh actually running anywhere. So your sugar's high. Um, fun aside, I actually had a dream last night, Brian. You and I were going to go to the sauna, and my friend had a sauna, and he would not let us in the sauna. So uh I need to text my friend today and tell him how angry I am about the fictitious dream sauna he doesn't own in real or fake life that he didn't let me in. So so to recap, reason one is is your your liver is still overproducing glucose. So uh number two, all right, unless you have anything more to add before we move on to number two. No, it seems like you got this. All right, yeah. Brian, Brian is sniffly McGee here. Uh, he's he's a trooper, he's tough. So reason two why your fasting glucose is still high is that your stored energy has not cleared yet. So in type two diabetes, you you are energy toxic, right, Brian?

SPEAKER_01 7:20

Yes. Thank you for letting me get a word in. Yep.

SPEAKER_00 7:22

Well, you know, the last time I tried to let you get a word in, you're like, you're good. I you're you did it all. So type 2 diabetes is a state of energy toxicity. There's nowhere for that energy to go. Your body's resistant to the insulin. Okay. As you improve your body composition, improve what's going on, you're you're gonna improve the energy toxicity. But when we start with this, oftentimes our liver is overloaded. It type 2 diabetes often is accompanied by fatty liver. So we have excess fat, we have uh we're we're filled to the gills with glycogen, which is glucose storage. So even as our meals improve, the energy in drops, we still gotta get rid of all that backlog in the liver. Yes.

SPEAKER_01 8:00

Yeah, yeah. I mean, it's it's like we talk about this in our webinar of our energy tanks are full. And so you got your basically you got three different energy tanks. You got your muscle, which is then form of glycogen, you got your fat tissue, which we took, we look at subcutaneous fat, and we got visceral fat.

SPEAKER_00 8:18

And then you also have visceral being like around our internal organs, daddy liver.

SPEAKER_01 8:22

So subcutaneous fat, everybody varies in their difference amount of how much subcutaneous fat they can store. So when you have more subcutaneous fat storage, you don't have to then put around your liver or your organs as much. So the less fat around your organs, the better in this case. So yeah, there's just an energy toxic state, way too much energy, and that's why we work on reducing the energy consumption over time and putting yourself in a negative balance.

SPEAKER_00 8:51

Yeah. Right. So we have our muscle glucose, glycogen, muscle, glycogen, which is stored glucose, we have our fat, which is broken into subcutaneous and visceral, and then we have our liver glycogen as well, which is where we store glycogen, glucose in the liver is stored as glycogen. And so even though you're improving your post-meals and you're doing the things to reduce the sugars after meals overnight, your liver is still energy toxic. And so uh even though you've improved the inputs, that system, those storage tanks, and especially in the liver, is is still full. So uh think of like if you have a full gas tank and there's still more energy coming in, because you are consuming energy, uh, we still have to drain that tank. And until you do, you're gonna have extra, extra coming out. And so this is a I want to kind of pause here, Brian, and because this is a point where a lot of people will quit. They'll be doing the workouts, they'll be changing their meals, they'll see the post-meals drop, they'll see the pre-meals drop, but the fastings won't budge, and they just assume I'm never gonna improve, I give up. And so this is sort of a little reframe. Um, it doesn't mean it's not working, it means it's working. You're just not done yet. And the reality is, in our experience, the longer you have had type 2 diabetes, the longer you've been dealing with insulin resistance, it takes longer to drain this internal liver storage tank. And it takes longer to get over those high fasting numbers, which could mean it could take longer to see those fastings drop and you might need medication longer. Now, our goal here, it's the remission roadmap, is to get you on less or no medicines with a controlled blood sugar. Everyone's gonna vary in how long it takes.

SPEAKER_01 10:29

So less medication score, would you then categorize supplements as that? Because I know there's I've been asked by people, I've even seen diabetes uh educators online who just tout berberine as this magic supplement that is for fasting blood sugar levels. So, should people just take that?

SPEAKER_00 10:49

Well, if you saw it on the internet from a random influencer, you absolutely should just listen to this person, right? So I guess my thought is if you're taking a medicine, and really the one I see this a lot with is metformin. When we reduce metformin, metformin reduces glucaneogenesis in the liver. When we reduce it, we'll see a bump in fasting sugars. Now, berberine can replace that. In my opinion, you're still taking a substance to lower your sugar. It doesn't mean you're a failure. It means one's a prescription item and one's an over-the-counter item. And I think people sometimes fall in love with supplements because they want to stick it to big pharma. And listen to me, like we're on this podcast because we want people to be less reliant on pharma. However, do know that there is big supplement. And in our experience, I'll speak for Brian. I'm sure you've seen someone walk in with a gym bag full of supplements and they're just like, I'm never gonna take a medicine. And then they put five five pounds worth of supplements on the on the counter, it costs them$500 a month, and you're kind of defeating the purpose. So we're not, we cannot give medical advice, right, Brian? We have a disclaimer at the end of this episode of every episode. If berberine is something you take and you like it and tolerate it better than a medicine for a prescription medicine for blood sugar, and it helps with these fastings along the way, working with your provider, then great. We're not gonna say, we're not gonna put in asterisk by your improvement. Uh, if you know, for many people, tolerating a drug like metformin is is really hard. But if they can take berberine and have similar results, great. Uh, we don't get kickbacks from from pharma, as you can imagine. So um, and I think it mat it also would matter, Brian. Like, how high are those fasting numbers?

SPEAKER_01 12:28

Yeah, I I agree. Is it worth just trying to make a number look good by taking a supplement? Or should you play the patient game and just go the slow and easy route of sticking with the big things at work, which we know are strengthening, so you can increase your muscle sensitivity to glucose? It is satiety, let eating, so you can reduce your total energy toxicity over time, aka lose fat. And it is sleep and stress reduction, so that you're you're optimizing your cut recovery and you're just putting your body in a good state where it can heal. I think those are the three. Would you add anything to that three?

SPEAKER_00 13:09

I think that's smart movement as well. Part of part of reducing that excess energy. Now, like the road advice has always been you know, eat less, move more. I think move more. Generally, most people could benefit by moving more. Now, doing this strategically around meals, which is why if you take that 10-minute walk after a meal, hey, my post-meal blood sugars are doing much better. Great, you're utilizing that glucose. But if you're sitting around the rest of the day, then we're not hitting and you're still seeing those high fasting numbers. It means that we need more total energy use uh to to get get get those energy. The I mean we oversimplify by saying energy tanks, but get that typically it's probably gonna be like the the liver fat uh improved so that you're not pumping out the the glucose at night. So yeah, um very very useful uh little tidbit there on the berberine, Brian. Thank you. You you definitely caught me off guard with that.

SPEAKER_01 13:57

Well, I only ask because we I've just been asked many times, should I take berberine? I'm like, well, do you like taking that formin? No, well, it's basically your supplement replacement of metformin. So you decide what you want to do.

Reason Three Dawn Phenomenon Explained

SPEAKER_00 14:11

Yeah, totally, totally your choice, uh, as long as you're working with a well-trained provider to guide you, uh, and we are not giving medical advice. So, all right, I think that people are clamoring for number three here. So we're gonna we're gonna hop right into speaking of for overnight Dawn phenomenon. And Brian, would you be so kind as to explain the Dawn phenomenon? And I'm not talking about when the soap really cleans your dishes good. Not that Dawn.

SPEAKER_01 14:34

Shout out to Dawn. Uh the Dawn phenomenon essentially, as it's as it says in the name, happens in the morning, and your body is essentially preparing for the day. You get what's called the cortisol awakening response. And so your body starts to naturally release cortisol like it should to help wake you up, get you ready, moving. In our ancestral days, go hunt and find and gather food. However, in these days, it's probably more take, drink some coffee, get the kids ready for school, pack their food, stress out about what they're getting at school, all these things. And so get their shoes on. Yeah, get their shoes on, find their foot, all that stuff. So it's the it's preparing for the day. The cortisol is our is our flight, fight or flight hormone. And so you essentially, you like Corey said before, cortisol signals the body to release glucose, and which is that immediate form of energy that our body can use. And so that's what the DOM phenomenon is.

SPEAKER_00 15:36

You get yeah, and when you're not insulin resistant, you have a little spike in sugar and your body accounts for it, and and you don't have a high sugar, but or or an overly high sugar. But again, when you're insulin resistant, any rise in sugar, uh, glucose is gonna be a challenge for your body to dispose of. So your your body's basically trying to wake you up and get you ready for the day. It just you kind of maybe overshoot. So it's just, you know, it's a part of neurophysiology that is not correctly managed by the body in the state that it's in.

SPEAKER_01 16:05

Yeah, and this is where I'll say that I think we talked about this in an earlier episode too about fasting and how you actually might see an increase, even with even if you're fasting, you're not eating, you're like, well, I'm gonna skip breakfast, but my blood sugar keeps going up, it's because you have not lowered your cortisol by taking in food and calories. So some of the right food and med, uh not medication, some of the right food can signal the right hormones to suppress cortisol release. Whereas if you're taking in a bunch of carbs, then you're basically just gonna give your body a bunch of extra sugar and it's gonna spike blood sugar up. But if you are taking in protein and nutrients, you are gonna signal to your body, hey, like we're fed. Now we can start to back off on that cortisol response. And you may even see a decrease in blood sugar, not just because of the because your body is starting to taper down on the cortisol release.

Progress Signs Beyond The Scale

SPEAKER_00 16:56

Yeah. So what what it will what we're trying to you know get at here is that even if your fastings are still high, if your other numbers have improved, it just means you're earlier in the process. Because as you make stronger food choices, utilize that muscle, you get a little bit better insulin sensitivity, you're gonna get better post-meal numbers. And then the fasting, because of the way your body produces glucose, the way it still responds to it overnight, it's just gonna take longer. And so you're not failing. You just have to continue the process. And so your your postmeal numbers will say, hey, this is what I'm doing today. Okay, and you're I'm doing well. Fasting numbers might be what the body's still working through. So uh even if you're you know, if your post meals are improving and your fastings remain the same, consider it progress. And I think Brian mentioned the the three places we store our energy, that the visceral fat. And this is I'll tie this into I'll tie this into weight because people do care about the number on the scale, is that as you as you start through the process, the first, and we see this quite a bit, the first four to eight weeks, you might not see the number budge on the scale a ton. However, if you notice an improvement in your waist circumference, that means your body's getting rid of the dangerous visceral fat and you're gaining muscle. So we love seeing a lower number on the scale if you're overweight. I totally feel you on that. However, your your body's number one priority is to get rid of dangerous fat. So that's that's what it's doing there. So um, you know, you know I'm out of words here, Brian.

SPEAKER_01 18:24

Well, that's why that's why I say when people tell me like they're trying to lose weight, and I just pause there and I say, well, hold on, we don't just want to lose weight, we want to lose fat, specifically visceral fat. So that's when you just look at the number and the scale and you focus on that, you're not getting the full picture of how you're recompositioning your body. Whereas it matters more if you are starting to notice your clothes fitting better around your waist than you are, but your your the scale stays the same. I mean, you can I saw an image the other day of like uh probably chat GPT generated, but essentially a 140-pound woman looking one way with one body composition, another way, and it's like three different ways. And they she weighed 140 pounds across the board, but one was like very muscular, one was like semi-muscular, and one was like mostly body fat. Well, body fat, yeah.

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SPEAKER_00 19:18

Yeah, so just weights not the full picture, right? So it's body composition. And so I think that what I have experienced as working as a clinical pharmacist, working as a diabetes coach, is having someone in your corner to remind you and guide you along the way so that when you come up against these roadblocks, you don't feel like you're failing. And it reminds me of specifically of someone I took care of in my clinical pharmacy practice. And it was it was a good six to eight weeks of seeing numbers not budging as much as they wanted, seeing weight not budging as much as they wanted. But it's like, well, I'm more energetic and my clothes fit better. I'm like, stick with it, stick with it. And then it was like the good kind of fall off a cliff where it was like magic. All of a sudden the numbers were better, the weight was down. So stay with it. If you're seeing other signs like the non-scale victories, the non-fasting sugar victories, stick with it uh, because it means you're on the right path. Yeah, I think it's a great way to end it. All right. So we hope you enjoyed the reasons why your fasting numbers are still high, even if your post meals are improving. If you've experienced this or want to share your story, send us a message on Instagram, send us an email. We love reading those. But until the next uh episode, keep it simple and do what works.

SPEAKER_01 20:28

If this episode gave you clarity or hope, share it with one friend who's been stuck in the diabetes trap. That's how this mission grows. One person, one family, one story at a time. And if you haven't yet, leaving a quick review helps more people find the show and realize they're not stuck with meds forever. It takes less than a minute and it means the world to us. Thanks for being here, and thanks for being part of this movement toward freedom. Thanks for listening to the Diabetes Remission Roadmap. The ideas discussed here are for general informational purposes only and do not constitute medical or nutritional advice. We are pharmacists, but we're not your personal health health care providers. Always consult your own physician or qualified clinician before changing medications, exercise routines, or nutrition plans. Results vary, and what works for one person may not work for another.