The Blood Sugar Tests Worth Asking For (And How to Start Rebalancing Yours)
Over the last two posts I've walked through how blood sugar regulation works, and what it looks like when that system starts to slip, whether that's running too low or developing resistance to insulin. Today I want to make this practical: how do you actually find out where you stand, and what helps once you know?
Why a single glucose reading doesn't tell you enough
A fasting glucose test on its own is a snapshot, and a fairly limited one. By the time fasting glucose is clearly abnormal, insulin resistance has often been developing quietly for years. What I'm far more interested in is looking at a small panel of markers together, because read in combination, they tell a much richer story.
I like to think of this using an image I share often in clinic: imagine a duck on a pond.
C-peptide is the duck's legs. When insulin is made in your pancreas, it's produced alongside a connecting piece called C-peptide, released in equal amounts but with a much longer half-life in the blood. This makes it a more reliable marker of how much insulin your pancreas is actually capable of producing, your reserve capacity, essentially whether the duck still has legs to paddle with. A healthy range sits around 0.9 to 1.8. Below 0.8 suggests declining beta cell function, meaning the pancreas is losing its capacity to produce insulin long term.
Fasting insulin is how hard the legs are paddling. A level above 10 suggests your pancreas is having to work much harder than it should to keep glucose in range, an early sign of insulin resistance even while fasting glucose still looks normal. Ideally, we want this closer to 3 to 4.
HbA1c is how muddy the pond water is. This reflects how glycated your blood has become over the preceding two to three months, in other words, how much glucose has been floating around unused, binding to proteins instead of getting into your cells properly.
HOMA-IR pulls fasting insulin and fasting glucose together into a single calculated score, and it's currently the most accessible way to estimate insulin resistance. Under 1 suggests good insulin sensitivity, 1 to 2 is borderline, above 2 suggests likely insulin resistance, and above 3.5 indicates significant resistance.
Together, these four markers tell you not just where your blood sugar sits today, but how hard your pancreas is working to keep it there, and how much longer it can keep doing so.
The wider metabolic picture
It's also worth understanding metabolic syndrome, a cluster of markers that, when three or more are present, signal a significantly higher risk of cardiovascular disease and type 2 diabetes. The five markers are abdominal obesity, raised triglycerides, low HDL cholesterol, raised blood pressure, and raised fasting glucose.
One ratio I find particularly useful is triglycerides to HDL. A ratio above 2.5 is a strong indicator of insulin resistance and a pattern of small, dense LDL particles, which are more easily able to lodge in artery walls and contribute to cardiovascular risk, even when total cholesterol looks unremarkable on paper.
The encouraging news in all of this: insulin resistance typically takes around fifteen years to progress to type 2 diabetes. That's a long runway, and a great deal can be done within it.
What actually helps
Eat protein first. This is one of the simplest, highest-impact changes available to you. Starting a meal with protein, before the carbohydrate-heavy elements arrive, triggers your body's own GLP-1 release, slowing gastric emptying and blunting the glucose spike that follows. It's the same pathway that drugs like Ozempic work on, except this version is free and available at every single meal.
Build in an overnight fast, gently. Aiming for around 14 hours overnight, finishing dinner reasonably early and having a protein-containing breakfast, activates a cellular pathway called AMPK, which supports mitochondrial health and improves insulin sensitivity. I'd stress the word gently here. This is not the same as prolonged or extended fasting, which I don't recommend for most women, as it can place additional stress on hormonal balance.
Prioritise fibre. Fibre is fermented by your gut bacteria into short chain fatty acids, which are one of the strongest natural triggers for GLP-1 release. This is a direct, practical link between gut health and blood sugar regulation.
Consider targeted nutrients, where appropriate. Several show genuinely good evidence for supporting insulin sensitivity:
Berberine activates AMPK in a way that's comparable to metformin, and has particularly strong evidence in PCOS. It's best suited to those with more weight to lose and genuine insulin resistance, typically used in cycles of twelve weeks on, four weeks off.
Myo-inositol supports glucose transporters moving to the cell surface where they're needed, and supports glycogen formation. It's commonly used in a specific ratio with D-chiro inositol.
Taurine supports AMPK activation and fat metabolism.
Bitter foods and formulas stimulate the bitter receptors found throughout your gut, which in turn support GLP-1 release, the same pathway triggered by protein and fibre.
As ever, I'd always recommend discussing supplementation with a practitioner who can tailor this to your specific picture, rather than taking a generic approach.
The bigger picture
Blood sugar regulation isn't a niche or specialist topic. It sits underneath so much of what brings women into my clinic: fatigue, mood, sleep, skin, fertility, weight. The encouraging part is that, unlike many hormonal puzzles, this is one of the most responsive systems in the body. Small, consistent changes to how and when you eat genuinely move these markers, often within weeks.
If you'd like to understand exactly where your own blood sugar regulation stands, book a consultation here and we'll build a picture together, with the right testing and a plan that actually fits your life.