|
This week's topic: Glucose Dynamics
Have you seen situations that didn't make sense?
- Elevated fasting glucose in someone who leads a very healthy lifestyle
- A hemoglobin A1c of 5.7% that doesn't make sense with fasting glucose of 85
- Weight gain in a patient whose metabolic labs look "perfect"
Overview of today's email:
- Glucose Dynamics
- Clinical tips
|
|
|
Save the dates!
If you've ever attended a webinar, but struggled to apply what you learned in practice, join me for a 2-week intensive where we'll do more than just learn about MCAS—we'll build a clinical reference guide you can use for years!
Instead of passively watching lectures and taking notes you'll never look at again, you'll collaborate with fellow clinicians to create a comprehensive, practical MCAS guide tailored for real-world clinical application.
What you'll get:
- Expert guidance on MCAS diagnosis, pathophysiology, and management
- Support for creating a complete, organized clinical reference document
- Peer insights from other clinicians managing MCAS patients
- A resource you can actually use in clinic
Dates: March 1-14 (live webinars Sunday, Tuesday, and Thursday at 3pm MST)
Cost: $99
Stop collecting information. Start building a tool that you can use! More details and registration in future emails
|
|
|
1. Glucose Dynamics
Hyperglycemia (and hypoglycemia) are at the root of many symptoms and conditions, including psychiatric conditions, fatigue, cognition, weight maintenance, and more. But glucose levels fluctuate, and evaluating glucose imbalances requires more than just a fasting glucose or HgA1c.
The tools we currently have available for evaluation include:
- Fasting serum glucose
- Fructosamine
- Glycomark
- HgA1c
- Fasting insulin
- C-peptide
- Continuous glucose monitor (CGM)
- Oral Glucose Tolerance Test (OGTT) - ideally including insulin measurements
- Symptom history
I will touch on each of these in detail in the extended version of this email on Substack...
|
|
|
2. Clinical Tips
When I evaluate for glucose imbalances, I look at patterns in the markers noted above.
But there will be cases when all tests noted above are normal, but fasting glucose or HgA1c is higher than "optimal" (and I trust the patient has a balanced diet and exercise habits), I ask: If the elevation isn't from external glucose (food), what is causing the body to increase glucose?
The two primary things I consider are:
- Hyperadrenal function (cortisol and catecholamines increase glucose levels)
- Anemia, especially iron deficiency (leads to decreased RBC turnover)
I'll touch on other factors in my Substack, but check out one of my favorite references on this topic: Pitfalls in Hemoglobin A1c Measurement: When Results may be Misleading (2013)
|
|
|
I hope this was clinically useful!
To see more of my deep dive into the literature, as well as my clinical insights, on this topic, subscribe to my paid Substack ($8 a month) to see the extended version of this email!
Meg
P.S. These emails take a lot of time to create (and I don't receive a lot of feedback on whether they are useful to those that receive them), so I've moved to Substack for an extended version of these at a low monthly cost (available within 24 hours of releasing this email). Why Substack? It has the benefits of being able to comment and ask questions about the posts, you're not bombarded with ads, I'm using the platform as a "micro-mentorship", and it's low cost!
Additional resources that may be helpful:
Every time one of you chooses to support me financially, it tells me my effort and words matter. It’s validation. It’s fuel.
Thank you for believing in this work — and in me.
|
|
|
Did you know my mentorship has two tiers: one with mentor calls, and one with platform and discussion access only? In this (intentionally) small collaborative community, I aim to get to know each member and their unique challenges as we navigate the nuances of real-world functional medicine. Click on one of the buttons below to learn more about the options at FMC and/or apply!
|
|
|
I do my best to share information you find helpful, but if it's not to your standards, please let me know what I can do better by replying directly to this email (it's my personal email). No worries, too, if you need to unsubscribe via the link below.
600 1st Ave, Ste 330 PMB 92768, Seattle, WA 98104-2246
Unsubscribe · Preferences
|
|
|
