When "Keep an Eye on It" Turns Into Years

At a lot of annual physicals, the blood sugar comes back a touch high, and the plan is "let's keep an eye on it." Nothing more than that. Come back next year. For plenty of people, that's how a borderline number quietly becomes a decade of borderline numbers, until one year it isn't borderline anymore.

Sitting in that in-between isn't nothing, and wanting to do something about it while it's still early isn't overreacting. It's one of the more sensible things a person can do with a lab result.

It's also common. By the CDC's count, more than two in five American adults have blood sugar in the prediabetes range, and roughly eight in ten of them don't know it. It usually comes with no symptoms you'd notice, which is exactly why it slides by.

What's actually happening

The plain version first. When you eat, carbohydrates break down into glucose, a sugar your cells burn for fuel. To move that glucose out of the blood and into the cells, the body uses a hormone called insulin. Picture insulin as a key that unlocks the cell door so the fuel can get in.

With insulin resistance, the locks get stiff. The key doesn't turn as easily, so the body makes more insulin to force the door open. That works, for a while. Blood sugar can read normal for years because the pancreas is quietly compensating, putting out extra insulin behind the scenes. The trouble starts when it can't keep up. Blood sugar begins to climb, and that's usually the point where it finally shows on a standard test. By then the pattern has often been building for a long time.

Why the usual check misses it early

Most routine panels measure fasting glucose, the sugar in your blood after an overnight without food. That's useful, and it's also the number that stays normal the longest, thanks to all that behind-the-scenes insulin. It's a little like judging an engine only by whether it's stalling right now. A lot can be going wrong before it stalls.

A fuller picture looks at more than one thing. A1c reflects your average blood sugar over roughly three months, and fasting insulin can show the compensation happening well before glucose ever moves. Someone can feel the swings for years, tired and foggy and hungry at odd hours, while a glucose-only check keeps reading "fine."

Those swings aren't a willpower problem, either. When blood sugar spikes and then drops, the drop itself drives the cravings, the shakiness, and that flattened, need-a-nap feeling. Reaching for something sweet at three in the afternoon is the body doing what the chemistry is telling it to do. Physiology, not weakness.

Reaching for something sweet at three in the afternoon is the body doing what the chemistry is telling it to do. Physiology, not weakness.

— Dr. Thomas Rottet, D.C., CFMP

Where it connects, and where the hype runs ahead

I stay careful here, because blood sugar gets blamed for everything, and that's overselling it.

What's fair to say is that it doesn't stay in its lane. Steady blood sugar tends to mean steadier energy and mood, and big swings tend to mean the opposite. Insulin resistance and body-wide inflammation feed each other, which is part of why blood sugar trouble and inflammation so often turn up together. Over time, elevated blood sugar puts strain on the heart and the liver, which is one reason it's worth taking seriously long before a diabetes diagnosis. Extra weight around the middle both drives insulin resistance and is driven by it, a loop that feels impossible from the inside and makes a good deal more sense once you can see the mechanism.

None of that means every symptom traces back to sugar. It means blood sugar is a real, measurable thread worth pulling on, and one that happens to respond unusually well to actual change.

The part I find encouraging

Here's what keeps me interested in this. Few things in the body respond to everyday changes as clearly as blood sugar does.

The evidence is strong and it isn't new. In a landmark trial, people at high risk for type 2 diabetes who made real lifestyle changes, modest weight loss and regular activity, cut their risk of developing it by well over half, and did better than the group taking a common diabetes medication. That wasn't a supplement or a shortcut. It was food, movement, sleep, and consistency doing the heavy lifting. The CDC puts it plainly too: for people with prediabetes, everyday changes can cut the odds of it progressing roughly in half.

How I work through it, here in Orwigsburg

We start by measuring properly: comprehensive blood work that looks past fasting glucose to A1c, and where it helps, fasting insulin, so we're reading the whole pattern and not just the last chapter. From there we build a plan around the actual person, using food as medicine, movement that fits a real life, better sleep, and targeted support where it's warranted. Structure and biochemistry together, the way I approach most things.

I'm honest that this asks something of the patient, and that it works best with people who want to be part of it. Blood sugar didn't drift over a weekend, and it doesn't reset in one.

A word on medication, because it matters here more than almost anywhere. If you take metformin or anything else for blood sugar, my aim is not to talk you off it. Plenty of people need it, and that decision belongs to you and your doctor. What I'll say honestly is that for some people, over time and in partnership with their physician, improving the underlying picture can change what they need to rely on. I won't promise that to anyone. It runs the other way too: making big diet changes while on certain blood sugar medications can push your levels too low, so that's exactly the kind of thing to coordinate with your doctor rather than freelance. We work alongside your care, not around it.

This article is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment. Never stop or change a prescribed medication without talking to your physician. Always consult a qualified healthcare provider about your own results.