Understanding Paradoxical High Fasting Blood Sugar in Low-Carb & Fasting Individuals

This podcast episode addresses a common and often confusing phenomenon where individuals, particularly those who are insulin resistant and adopting low-carbohydrate diets and intermittent fasting, experience paradoxically high fasting blood sugar levels that only normalize after they eat. Dr. Ekberg explains that while conventional understanding dictates blood sugar should drop during fasting, for these individuals, it remains elevated, sometimes in the diabetic range. This seemingly counterintuitive response is distinct from the 'dawn phenomenon' but is related to the body's hormonal preparation for waking, which is exaggerated in insulin-resistant states, leading to a more pronounced glucose spike.

A core argument of the episode revolves around the crucial distinction between blood sugar *level* (e.g., milligrams per deciliter) and the absolute *amount* of glucose circulating in the bloodstream. Dr. Ekberg reveals that even a 'high' fasting blood sugar level of 120-130 mg/dL translates to a very small absolute amount of glucose, typically less than half a teaspoon or 3-4 grams. This is contrasted with the massive 'mountains' of carbohydrates (hundreds of grams per meal) consumed in a typical Western diet, which truly overwhelm the body's glucose processing capacity and lead to dangerous, emergency-level blood sugar spikes.

Using a 'receiving department' analogy, the podcast clarifies that the body, being intelligent, does not perceive these small, elevated fasting glucose amounts as an emergency. When an insulin-resistant individual adopts a low-carb diet, the body gradually reduces insulin production and improves insulin sensitivity. Consequently, when a small, low-carb meal is consumed, the now more efficient metabolic 'workforce' can easily process the incoming glucose and simultaneously clear the previously 'high' fasting glucose, bringing levels into a normal range. This indicates that the body is adapting and moving in the right direction, despite the initially frustrating fasting glucose readings.

For practical application, Dr. Ekberg advises against obsessing over daily or hourly blood glucose measurements, suggesting they are best used as a learning tool to understand individual food responses and general trends. Instead, he recommends focusing on more reliable long-term indicators of metabolic health and insulin sensitivity. These include A1C (a 3-4 month average glucose), fasting insulin (highlighted as the best long-term indicator for insulin resistance), triglycerides, VLDL, and the total to HDL cholesterol ratio. Monitoring these broader metrics provides a more accurate picture of progress in reversing insulin resistance and improving overall health.

"for a lot of people the exact opposite seems to be happening and if you've noticed this you're not alone. That when you're fasting your blood sugar stays high even in a diabetic range, and it won't come down until you eat something."

"if you are insulin resistant and an extreme form of insulin resistance is type 2 diabetic then your fasting levels are too high typically about 130 or above but this could be two or three or 400 also"

"if you're insulin resistant now these same small hormone boosts is going to look like a dramatic increase in blood glucose levels because even a small change is going to show up bigger when you're insulin resistant"

"a lot of times we hear that in type 2 diabetes they give you insulin because you're not making enough well that's the wrong way to look at it because you're already making five to eight times more fasting and a whole lot more after a meal"

"the thing to focus on though is the fact that when you eat the insulin is actually working the insulin helps you get into the normal range now the question is then why does it stay so high before we eat"

"most people are shocked you have about 2.4 grams of glucose because we multiply out this 80 milligrams times 50 deciliters which is 5 liters that's the average amount of blood in a person"

"this high fasting level is not an emergency there is not enough incentive for the body to do something about this because things are working"

"this low amount of carbohydrate is allowing the body to reduce insulin production and to become less insulin resistant and therefore once you eat something now this work force gets to work and it has no problem at all processing through and getting the job done"

"don't measure it too closely and expect it to change and base your success and your expectations based on that because it could be very frustrating but use it as a tool to learn"

"your fasting insulin which hardly anyone does but it's your best indicator of a long-term trend for insulin resistance"