By Dr. Marie Andersson

Something that I have found consistently in my practice is that many people have blood sugar problems, insulin resistance, pre-diabetes and even full-blown diabetes — yet have no idea. Unless they are coming to me specifically for diabetes, the look of shock on their faces when I share the news never gets easier to see.

What Standard Testing Misses

The 3 tests folks typically get at their yearly checkup are:

• Basic Lipid Panel
• CBC (Complete Blood Count)
• BMP (Basic Metabolic Panel)

Sounds like a lot? It isn’t. These tests usually won’t show much of anything until there’s already a problem.

I’ve had patients tell me they were excited to get a CMP instead of a BMP — thinking a “Comprehensive Metabolic Panel” means they’re getting extensive testing. But despite the name, it’s not comprehensive in the way people assume.

These tests look at very basic functions, and even those are often noted as “normal” due to nothing being flagged by the lab. What if something is low-normal or high-normal?

I couldn’t even begin to count how many times people have told me that they were told they are “fine” even though they feel unwell. Or worse, they are offered an antidepressant as if their symptoms are all in their head. How is that OK?

The Goal: Correcting the Root Cause

We hear a lot about early intervention, but does it actually happen? The real opportunity is correcting imbalances long before full-blown disease develops. This is one of the key differences between conventional and functional medicine. It’s not just about treating symptoms — although that matters — but about addressing the underlying issues that created them in the first place.

How Blood Sugar Affects Your Whole Body

Something that is not commonly understood is how our blood glucose (sugar) levels affect immune function and the body’s ability to carry oxygen. If you know someone with type 2 diabetes, you may have noticed that they don’t recover well from illness, have extended wound healing time, lose circulation to their feet, develop neuropathy, experience worsening eyesight, and develop brain fog.

Why is that? When blood sugar rises, we become acidic. When blood pH drops below the optimal 7.4, the ability to carry oxygen becomes reduced. If your oxygen drops even a little bit, your brain and all body tissues are compromised. When blood sugar goes over 120, the white blood cells have reduced capacity to take up vitamin C — which they need to fight infection and disease.

In the early stages this results in brain fog, fatigue and the feeling that you never get well.

When blood sugar rises, hormonal responses occur that tell the body that there is an abundance of food, and it’s time to store it for later. The role of insulin is to take the available glucose from the blood and turn it into fat (triglyceride), so that when food becomes scarce, you’ll have fuel to survive. But when does food become scarce?

Many people believe that eating every couple of hours is the best way to “manage blood sugar,” but in reality, it often makes the problem worse. If you experience low blood sugar (hypoglycemia), the answer is not to eat more frequently throughout the day. Constant snacking can keep insulin elevated and may increase the risk of insulin resistance and eventually type 2 diabetes, an epigenetic expression. Instead, the goal is to improve the quality and balance of your meals so your body can regulate blood sugar more effectively.

Every time your blood sugar rises, your body releases insulin. Insulin is a storage hormone that helps move nutrients out of the bloodstream and into cells for immediate use or storage. When energy intake consistently exceeds what your body needs, excess fuel is stored — often as body fat, particularly around the abdomen and hips. Frequent blood sugar spikes can lead to chronically elevated insulin levels, making it harder to access stored fat and increasing the risk of weight gain and metabolic dysfunction over time.

A Deeper Look at Testing

Type 2 diabetes is a complex metabolic condition that goes far beyond blood sugar management. Emerging research in functional medicine reveals deeper biological drivers — including cellular aging, chronic inflammation, and mitochondrial dysfunction — that conventional medicine has historically overlooked. It’s a misnomer to call it a blood sugar issue. It is a blood fuel issue.

In other words, it’s not about stopping sugar or switching to artificial sweeteners. Not only does that not work, but it can also make things worse. Obviously, overdoing sugar is not a good idea, but what about other foods? Foods that spike your blood sugar? What are they? Is it just candy or ice cream? No, it’s much more complex than that.

To catch early metabolic decline before or during the progression of diabetes, we utilize targeted testing that goes beyond standard fasting glucose or HbA1c panels. While checking fasting glucose and HbA1c is important, they won’t fully show how far the disease has progressed. Advanced testing looks at glycemic control — meaning how your body handles your glucose levels.

These comprehensive tests evaluate insulin resistance, inflammation, glycated protein, adiponectin, HOMA-IR, HOMA-S, HOMA-B, leptin, beta cell function and more. By assessing the full metabolic picture rather than isolated values, we can identify dysfunction years before a formal diabetes diagnosis.

What You Can Do About It

Several lifestyle modifications and targeted nutritional interventions have been shown to improve glycemic control and enhance insulin sensitivity. These approaches work through multiple pathways, helping to reduce inflammation, support cellular energy production, and improve metabolic flexibility. Improving blood sugar regulation is about more than just avoiding sugar — it also requires limiting foods that cause significant rises in blood glucose and insulin levels.

Time-Restricted Eating and Fasting

Practicing time-restricted eating, such as fasting for 16 hours and eating within an 8-hour window (known as the 16:8 protocol), helps to support healthy glycemic control. However, following a 20:4 restricted feeding protocol is even better as it increases the chances of having some time in autophagy. Autophagy promotes cellular cleanup by allowing the body to clear damaged cellular components, including senescent cells, which directly address one of the root drivers of type 2 diabetes.

Extended fasting can be a powerful tool for improving metabolic health and is often an excellent place to start. There are several approaches to extended fasting, and it is important that any prolonged fast — especially your first — be undertaken with the guidance of a qualified healthcare provider. Over the years, I have guided hundreds of individuals through extended fasting protocols. Consistently, participants report improvements in how they feel, gain a greater appreciation for the benefits of fasting, and often choose to incorporate it into their health routine again in the future.

The Gut Connection

One of the primary drivers of insulin resistance is gut health. The digestive tract is much more than a tube for processing food — it is an active endocrine organ that communicates constantly with the brain, pancreas, liver, and immune system. Specialized cells lining the intestine produce hormones known as incretins, including Glucagon-like Peptide-1 (GLP-1). GLP-1 plays a critical role in blood sugar regulation by slowing stomach emptying, reducing appetite, enhancing insulin secretion, and helping prevent excessive glucose release from the liver.

The health of the gut lining directly influences how effectively these signaling pathways function. When the intestinal barrier becomes damaged or inflamed — a condition often referred to as increased intestinal permeability or “leaky gut” — inflammatory compounds and bacterial byproducts can enter the bloodstream. This chronic, low-grade inflammation interferes with insulin signaling and contributes to insulin resistance.

The trillions of microorganisms that make up the gut microbiome also have a profound impact on metabolic health. Beneficial bacteria help produce short-chain fatty acids such as butyrate, which support intestinal integrity, reduce inflammation, and improve insulin sensitivity. Diets low in soluble fiber and high in processed foods disrupt this delicate ecosystem, increasing the risk of metabolic dysfunction and type 2 diabetes.

This is why improving blood sugar control requires more than simply reducing sugar intake. Supporting digestion, restoring the gut lining, increasing fiber consumption, and promoting a healthy microbiome are all important strategies for improving insulin sensitivity and metabolic health. When it comes to glucose regulation, everything truly starts in the gut.

Targeted Supplements

The following supplements have been shown to improve metabolic health and insulin sensitivity. However, supplementation alone will not reverse or correct the issue. Correcting gut function and dietary changes are not just important — they are crucial. There is no magic pill.

• Berberine: Acts as a “metabolic adaptogen.” It improves insulin sensitivity, mimics the beneficial metabolic effects of fasting, and helps reduce age-related metabolic rigidity. Berberine has been widely studied for its glucose-lowering effects and is often compared to metformin in its mechanism of action.
• Alpha Lipoic Acid (ALA): A powerful antioxidant that helps to recycle other antioxidants in the body (including vitamins C and E) while actively improving insulin sensitivity. ALA also plays a role in mitochondrial energy production, making it particularly relevant for metabolic health.
• NMN (Nicotinamide Mononucleotide): A precursor to NAD+ — a crucial coenzyme for cellular energy production that declines with age. Preclinical studies have shown that NMN supplementation improves insulin sensitivity and vascular health, making it a promising area of research for age-related metabolic decline.
• Gymnema: An herb shown to reduce sugar cravings, balance blood sugar, and support beta-cell function in the pancreas.

You can order the supplements mentioned in this newsletter directly through our Fullscript dispensary — an easy, professional-grade option delivered to your door. Always consult your healthcare provider before starting any new dietary supplement.

Order Supplements Through Fullscript

Next Steps

Comprehensive testing — especially an evaluation of gut health — is an important part of understanding your glycemic control and overall metabolic health. With type 2 diabetes and insulin resistance now among the most common chronic health challenges in the United States, identifying problems early can make a significant difference in long-term outcomes.

Stay tuned for more information on optimizing your body’s fuel systems, improving metabolic flexibility, how to prevent epigenetic expression and strategies to support healthy aging and longevity.

If you have questions about your metabolic health or would like to discuss comprehensive testing options, we’d love to help. Contact us to get started.

Note: This content is intended for informational purposes. Always consult a qualified healthcare professional before making changes to your health management plan.