The most common thing I hear in a Blood Sugar Audit, by some margin, is some version of this:
My GP says everything’s fine. I don’t feel fine. I don’t know which of us to believe.
It’s a strange place to be. Because on one hand, someone with medical training is telling you there’s nothing measurably wrong. And on the other hand, your own body is sending you a steady stream of information (the energy that’s gone, the sleep that doesn’t restore, the cravings that arrive on a schedule, the weight that’s settled somewhere it didn’t used to) that’s saying loudly that something is.
Both can be true at the same time.
The reason for this isn’t that your GP is wrong, and it isn’t that you’re imagining it. It’s that the test most often used to assess blood sugar — HbA1c — was designed to do a specific job, and it does that job well. But the job it was designed to do is “tell us whether this person crosses a clinical threshold for diabetes.” It isn’t really “tell us whether this person is metabolically well.” Those aren’t the same question, and the gap between them is where an enormous number of people end up living for years.
A couple of reasons the test can quietly miss what’s going on in your body. The first is that it gives you a three-month average, and averages hide a lot. Two people having very different days in very different bodies can produce the same result, because the highs and the lows can cancel each other out on paper. The second is that the clinical thresholds themselves are quite conservative. They were drawn to catch diabetes, not to flag the slow climb that comes before it. And the slow climb is where almost every long conversation I have begins.
The single most useful question to ask about your HbA1c, in my view, isn’t what is it. It’s which direction has it been moving over the last few years? A number that’s gone from 35 to 38 to 41 across three annual check-ups is doing something quite different to a number that’s been steady at 41 for a decade. Both look the same in this year’s letter. They’re not the same story. Nobody is having that conversation in a ten-minute appointment, because there isn’t time, but it’s the conversation that matters.
If you want a fuller picture, three things help, and they’re worth knowing about even if you never act on them.
The first is a continuous glucose monitor, worn for even a couple of weeks. It shows you what your blood sugar is actually doing in your specific life, with your specific meals, your specific sleep, your specific stress. Most people stop being confused by their own data once they’ve seen it.
The second is honest symptom tracking. The energy across the day. The sleep. The cravings. The brain fog. The bloating. These are all metabolic information, even when nobody is calling them that.
The third is a test most GPs will only run if you ask explicitly — fasting insulin. It can catch insulin resistance years before HbA1c starts to move. Worth asking for. Some will. Some won’t. But it’s worth asking. There are simple private testing options for this too.
What I want you to take away from this, if nothing else, is that the absence of a finding is not the absence of a problem. The number on your blood test result describes a small slice of what your body is doing. It doesn’t describe all of it. And it doesn’t describe you.
If you’ve recently been told your numbers are creeping up and you’re not sure where to start, my free guide Pre-Diabetes: What Your GP Didn’t Have Time to Tell You walks you through what the diagnosis actually means and where to begin. Download it at francesnorgate.com/prediabetes-guide.
If you’d like a proper conversation about your specific numbers and what they might be missing, feel free to book a free 30-minute Blood Sugar Audit. Book at francesnorgate.com/blood-sugar-audit.
Frances x
