04/29/2026
1️⃣I run fasting insulin alongside fasting glucose and calculate HOMA-IR. Because insulin resistance shows up here 10 years before glucose flags. Fasting glucose alone is not a blood sugar assessment.
2️⃣I run a 4-point salivary cortisol or DUTCH test. Because if cortisol is driving the glucose dysregulation, no dietary intervention will produce lasting results without addressing the adrenal picture.
3️⃣I look at thyroid function comprehensively. Not just TSH. Free T3, free T4, reverse T3, thyroid antibodies. Hypothyroidism reduces glucose uptake in peripheral tissues and slows metabolism in ways that profoundly affect blood sugar behavior.
4️⃣I assess gut health. Short-chain fatty acid-producing bacteria directly support insulin sensitivity and GLP-1 secretion. Dysbiosis impairs both. A blood sugar protocol without a gut component is incomplete.
5️⃣I look at the triglyceride-to-HDL ratio and fasting triglycerides. Elevated fasting triglycerides above 100 mg/dL alongside low HDL is one of the strongest surrogate markers for insulin resistance. It tells me what the standard glucose metrics often do not.
Two people sitting in front of me with identical fasting glucose values and identical HbA1c readings can have completely different root causes and need completely different approaches.
That is what investigation reveals. And it is the difference between a protocol that works and one that helps a little for a while.
Which of these 5 have you never heard of? Finish the sentence: I had no idea that...