Your A1C Is Still High. Here’s What I’d Look for Next.
In the email, I gave you the first move I would make: stop adding random interventions and spend the next 30 days measuring how your blood sugar is actually responding.
If you’re using a continuous glucose monitor, now we can double-click.
Because collecting glucose data isn't the goal.
The goal is to use that data to figure out which lever I would pull next.
First, I’d look at what happens after you eat.
I want to know which meals are creating your largest glucose excursions.
Not because every rise in glucose is bad. Your blood sugar is supposed to rise after you eat.
I'm looking for patterns.
Does breakfast consistently produce a larger response than your other meals?
Does one particular meal send you much higher than meals containing different amounts or types of carbohydrates?
What happens when you eat carbohydrates alongside protein, fiber, and fat?
And just as importantly:
How long does it take you to come back down?
That starts telling me whether changing the amount, type, or composition of what you're eating might give us leverage.
If I repeatedly see certain meals producing responses we don't like, now I have something specific to modify.
That's very different from simply deciding:
"I guess I need to stop eating carbs."
Then I’d look at what happens when you use your muscles.
You told me you're walking.
Good.
Now I want to know what that walking is actually accomplishing.
What happens when you walk after a meal compared with when you don't?
Does your glucose come down faster?
Does the size of the post-meal rise change?
What happens on days when you exercise compared with days when you're relatively inactive?
This matters because doing an activity and creating enough physiological demand to change the outcome are two different things.
If a 10-minute walk barely changes the pattern, that's information.
It doesn't mean walking "doesn't work."
It tells me that the dose, timing, intensity, or even the type of activity may need to change.
Maybe I experiment with a longer walk.
Maybe I change when you walk.
Maybe resistance training becomes a bigger part of the strategy.
I'm no longer guessing about whether exercise is good for blood sugar.
I'm trying to determine how much leverage your particular body is giving us from it.
Next, I’d look at what happens overnight.
Now I want to know what your glucose is doing when you aren't eating.
If your fasting glucose is consistently elevated, that's important.
Because you haven't been eating all night.
So I wouldn't automatically respond by removing another food from breakfast.
I'd start asking what is keeping glucose elevated during a period when food isn't actively entering the system.
Your liver releases glucose between meals and overnight to make sure you always have fuel available.
Normally, insulin helps regulate that process.
If that regulation isn't working efficiently, fasting glucose can remain higher than we'd like even when you've already made significant changes to what you're eating.
That gives me a different problem to investigate.
Finally, I’d look at the direction of the whole system
I don't want to overreact to one meal or one strange glucose spike.
I want trends.
Over several weeks:
Is your average glucose coming down?
Are the largest excursions becoming smaller?
Are you returning toward baseline faster?
Is fasting glucose moving?
Do active days look different from inactive days?
Do certain meals repeatedly produce the same response?
Now we're learning something.
And depending on what I see, my next move could be very different.
If certain meals consistently produce the largest excursions, I may prioritize changing those meals.
If movement produces a strong response but you're simply not doing enough of it consistently, I may prioritize increasing muscular demand.
If fasting glucose remains disproportionately elevated despite improving post-meal patterns, I may want to investigate what else is contributing to that fasting glucose.
And if nothing is meaningfully improving, that's information too.
It tells me your current strategy isn't creating enough change and we need to widen the investigation rather than continuing to repeat the same advice.
This is the distinction I want you to remember
You can cut back on sugar.
You can take fiber.
You can walk every day.
Those are actions.
But the goal isn't to collect healthy actions. The goal is to produce a measurable change in your biology.
That's why I don't want you randomly guessing about what else you should eliminate or add.
Measure.
Look for patterns.
Change one of the levers you actually have reason to believe matters.
Then measure again.
Don't just ask, “Am I doing the right things?”
Ask:
“Are the things I'm doing producing the outcome they're supposed to produce?”
That's how you start turning a frustrating A1C into information you can actually use.
Not Sure What Your Numbers Are Telling You?
If you’ve been making changes but your A1C still isn’t moving the way you expected, you may not need another generic list of things to try.
You may need to figure out where you still have leverage.
Book a complimentary strategy session with me. We’ll look at what you’ve already been doing, what your numbers are telling us, and where I would look next.
