The Blood Sugar Tests That Actually Matter: What Your Doctor May Not Be Checking - Part I

You went to your doctor, got your blood work back, and everything looked "normal." But you are still exhausted. Your cravings are relentless. The weight will not budge, and something just feels off. Sound familiar?

Here is what Dr. Steven Katz and Dr. Loreena Ryder of Naturopathic Physicians Group want you to know: a normal A1C does not tell the whole story. There is a critical blood sugar test that most conventional doctors never order, and without it, early warning signs of diabetes and metabolic dysfunction can go completely undetected. In this episode of Your Health Is Wealth, the doctors walk through everything from Type 2 diabetes symptoms and metabolic syndrome criteria to the full range of blood sugar tests and conventional treatments, including what actually works and what simply manages numbers without fixing the problem.

Key Takeaways:

• Fasting insulin is one of the most revealing blood sugar tests available, and most conventional doctors do not order it.

• Metabolic syndrome is diagnosed when three of five specific markers are present: waist circumference, triglycerides, HDL cholesterol, fasting glucose, and blood pressure.

• Sugar activates the same dopamine and adrenaline pathways in the brain as cocaine, making cravings a physiological issue, not a willpower issue.

• Going at least four hours between meals supports blood sugar regulation by allowing the body's internal cleaning mechanism, the migrating motor complex, to do its work.

• Treating the blood sugar number is not the same as treating diabetes. Root-cause care requires a fundamentally different approach.

What Is Type 2 Diabetes and Why Does It Matter So Much Right Now?

Type 2 diabetes mellitus is one of the most common chronic conditions in the United States. Unlike Type 1 diabetes, which is an autoimmune condition that typically develops early in life, Type 2 is primarily a lifestyle-driven condition. It develops over time, usually in adulthood, and in most cases is preventable and, when caught early, highly treatable.

That last point is important. If you have not explored our Why Can't I Lose Weight series yet, that is a great companion read that covers the metabolic and hormonal factors behind stubborn weight gain, many of which connect directly to blood sugar dysregulation. Dr. Katz and Dr. Ryder were direct about Type 2 diabetes in this episode: before someone becomes insulin dependent, and we will explain what that means in a moment, it is not a difficult condition to address if the patient is willing to do the work and is working with a provider who understands the root cause.

The problem is that millions of people are either undiagnosed or partially diagnosed, managing a number on a lab report while the underlying picture continues to develop. This is what Part 1 of the blood sugar series is about: understanding what is happening in your body, which tests can actually reveal it, and why the conventional approach so often stops at the prescription pad.

Early Symptoms of Type 2 Diabetes

If you have Type 2 diabetes and no one has told you yet, your body is likely already sending signals. The most common early symptoms include increased urination, increased thirst, increased appetite, and persistent sugar cravings.

That last symptom is worth pausing on. Dr. Katz explained this clearly: when blood sugar drops, the body sends a very real signal demanding more sugar to maintain function. That is not a character flaw or a lack of willpower. It is a physiological response. Your body is genuinely demanding sugar because it has lost the ability to regulate blood glucose effectively. And unfortunately, giving your body what it is demanding in that moment is exactly the wrong response if you are trying to address the condition.

Other early symptoms can include fatigue, weakness, and a persistent sense of feeling run down. Over time, recurring infections, slow-healing wounds, and numbness or tingling in the hands and feet can also develop. These are signals that the body is already under real metabolic stress.

The Long-Term Picture: What Happens When Diabetes Goes Unmanaged

The longer blood sugar goes uncontrolled, the more serious and widespread the damage becomes. Dr. Katz and Dr. Ryder walked through the long-term complications in this episode, and it is worth understanding them clearly, not to alarm you, but because the earlier you act, the more of this becomes avoidable.

The two areas where unmanaged diabetes causes the most consistent long-term damage are the kidneys and the eyes. Kidney disease is a well-established consequence of Type 2 diabetes, and getting onto a transplant list when your own condition caused the damage is, as Dr. Katz described, a very difficult road. Retinopathy, which is damage to the blood vessels in the retina, can lead to blurry vision, floaters, and in severe cases, permanent blindness.

Diabetic neuropathy, the numbness, tingling, and pins-and-needles sensations many people recognize, typically starts in the legs and feet. It is caused by a combination of poor circulation and chronic inflammation in the blood vessels. Left unaddressed, neuropathy can become permanent. In the most serious cases, poor circulation combined with infection can result in tissue death and, in some situations, limb amputation.

There is also a neurological connection that does not get nearly enough attention. Uncontrolled blood sugar has been linked to an increased risk of Alzheimer's disease and cognitive decline. Some researchers have used the term Type 3 diabetes to describe how glucose dysregulation in the brain may contribute to memory loss and dementia. Dr. Katz noted that patients often recognize this connection immediately: "Oh yeah, my parent had diabetes, and yes, they ended up getting Alzheimer's." It is a real and documented correlation.

This content is for educational purposes only and does not constitute medical advice. If you are experiencing symptoms of diabetes or cognitive changes, please speak with a qualified healthcare provider.

What Causes Type 2 Diabetes?

Being overweight or obese is the primary lifestyle driver of Type 2 diabetes. Dr. Ryder explained that metabolic syndrome, a cluster of risk factors that together increase the likelihood of developing diabetes, heart disease, and stroke, is often the intermediary step between lifestyle habits and a full diabetes diagnosis.

The pancreas is at the center of the process. Every time you eat, especially foods high in sugar or refined carbohydrates, your pancreas is stimulated to produce insulin. Insulin helps your cells absorb glucose from the blood. But insulin also signals the body to store fat. When you consistently eat too much, the pancreas has to produce increasing amounts of insulin just to keep blood sugar at a manageable level. Over time, this wears down the pancreatic beta cells, the cells responsible for making insulin, and the system begins to fail.

Lack of physical activity accelerates the problem. Movement helps the body use glucose more efficiently. Without regular activity, the cycle of high intake and poor regulation compounds quickly.

Metabolic Syndrome: The Warning Stage Before Diabetes

Metabolic syndrome is not a single condition. It is a cluster of five measurable risk factors. A diagnosis requires that at least three of the five be present:

Waist circumference: greater than 40 inches in men, greater than 35 inches in women.
Triglycerides: above 150.
HDL (good) cholesterol: below 40 in men, below 50 in women.
Fasting blood sugar: above 100.
Blood pressure: 130 over 85 or higher.

If any three of those five apply to you, metabolic syndrome is the clinical diagnosis. Dr. Katz described high blood pressure, high cholesterol, and high blood sugar as "the trio," and when that trio is present together and left unaddressed, diabetes becomes a very real next step.

He also made an important practical point: all of these markers need to be measured fasting. Eating before a lipid panel or blood sugar test will skew the results significantly. Always fast before these tests and drink plenty of water beforehand to support a clean blood draw.

What Your Doctor Isn't Telling You: Sugar Is Genuinely Addictive

Every week, Dr. Katz runs a segment on the show called "What Isn't Your Doctor Telling You," and in this episode, the topic was sugar addiction. This one matters more than most people realize.

When you eat sugar, whether it is table sugar, corn syrup, or something processed and packaged, it activates the same dopamine and adrenaline pathways in the brain that cocaine uses. Dr. Katz was direct: this is not a metaphor or a loose comparison. It is a physiological pathway. Sugar triggers dopamine, which is the brain's pleasure and reward response, and adrenaline, which produces that brief energy spike. Then the sugar metabolizes quickly, blood glucose drops, and the body is tired and demanding more.

This is why stopping sugar is so genuinely difficult for so many people. It is not about discipline. It is a biochemical cycle that keeps pulling the body back into the loop.

Now, what about artificial sweeteners? Dr. Katz addressed this directly. Artificial sweeteners do not offer the escape route most people are hoping for. Check the labels on diet products and you will find phenylalanine, an amino acid that also stimulates dopamine. These products are designed to activate the same craving and reward cycle as regular sugar. Switching to diet versions rarely breaks the addiction because the neurological hook is still there.

This content is for educational purposes only and does not constitute medical advice. If you are managing sugar cravings as part of a diabetes or metabolic health treatment plan, please work with a qualified healthcare provider before making changes to your diet or supplement routine.

The Blood Sugar Tests That Actually Matter, and the One Most Doctors Skip

This section can genuinely change how you advocate for your own care. Dr. Katz and Dr. Ryder walked through the full range of conventional blood sugar testing, including one test that is rarely ordered but arguably one of the most informative markers available.

Hemoglobin A1C

The A1C test is considered the gold standard for diagnosing and monitoring Type 2 diabetes. It measures your average blood glucose level over the past two to three months, which gives a far more reliable picture than any single glucose reading taken at one moment in time.

The reference ranges are:
Below 5.6: normal.
5.7 to 6.4: pre-diabetes.
6.5 and above: diagnostic for diabetes.

If you are in the pre-diabetes range, Dr. Katz was emphatic: that is your window. That is the moment to make meaningful lifestyle changes before the pancreas becomes more compromised and insulin dependence becomes a real possibility.

Fasting Glucose

The fasting glucose test is typically included in a comprehensive metabolic panel. You fast overnight, come in for a blood draw, and the lab measures the glucose level in your blood at that baseline state with no food, no stimulation.

The reference ranges are:
Normal: 99 or below.
Pre-diabetes: 100 to 130.
Diabetes: 130 and above.

The comprehensive metabolic panel also includes kidney and liver function markers, which is important because both systems are at risk when blood sugar is chronically elevated.

Fasting Insulin: The Test You Are Probably Not Getting

Here is where the conventional and naturopathic approaches diverge in a meaningful way. Dr. Ryder pointed out that most conventional doctors do not run a fasting insulin test. Dr. Katz said he could do an entire episode on this one test alone, and he is not wrong.

Fasting insulin measures how much insulin is circulating in your blood in the absence of food. The standard lab reference range typically runs up to approximately 24 to 25. However, many metabolic health clinicians consider fasting insulin under 10 to be a healthier functional target, with an optimal range often cited between 3 and 10. Someone with a fasting insulin of 14 or 18 may still appear normal on a standard lab report while already showing early signs of insulin resistance in a naturopathic or functional medicine framework.

Here is why this matters. If your fasting insulin is creeping upward while your blood glucose stays the same or also rises, that tells you something critical: your pancreas is working harder and harder just to maintain normal blood sugar levels. The system is straining. You are heading toward a problem. You cannot see that trend from an A1C or a fasting glucose alone. Fasting insulin is what reveals it years before a formal diagnosis.

This is the test to ask your provider about. And if they are not running it, that conversation is worth having.

Glucose Tolerance Test

The glucose tolerance test measures how your body responds to a direct sugar load. You fast overnight, get a baseline blood draw, then drink a glucose solution and have your blood drawn again one to two hours later. The resulting glucose level indicates whether your body's insulin response is functioning within a healthy range, and flags whether the result falls into a pre-diabetic or diabetic marker territory.

Fructosamine

The fructosamine test is less commonly ordered but useful in specific circumstances. Like the A1C, it measures average blood glucose over a window of time. The difference is that its window is only two to three weeks rather than two to three months. When a patient has recently made dietary changes, and the doctors want to see whether those changes are producing measurable results before the next A1C cycle, fructosamine provides that shorter-window view. The gold standard for ongoing monitoring remains the A1C.

Dr. Ryder's Tip of the Week: The Snacking Habit That Is Quietly Wrecking Your Blood Sugar

Here is one of the most practical takeaways from this episode, and it is something you can change starting today.

If you find yourself snacking constantly or feeling like you have to eat between meals, your body may be struggling to regulate blood sugar. Dr. Ryder introduced a concept called the migrating motor complex, or MMC. This is an electrical current that moves through the stomach and intestines, but only when the digestive system is not actively processing food. It acts as an internal cleaning mechanism, clearing out undigested food residue, intestinal debris, and other matter from the gut. It begins roughly an hour after the last meal.

Every time you eat or drink something other than water, you interrupt the MMC. The body pauses the process and returns to digestion. Constant snacking means the MMC rarely gets to finish its work. Over time, this affects the body's ability to regulate blood sugar and insulin effectively.

Dr. Ryder's recommendation is to aim for at least four hours between meals, with no snacking and no sugary drinks, including fruit juice, in between. She made a simple but accurate observation: this is essentially how most people's grandparents ate. Breakfast, lunch, and dinner. No grazing, no constant snacking. That rhythm gave the body time to regulate, digest, and run its internal cleaning process between meals.

Dr. Katz added an important counterpoint. The six-small-meals-a-day approach that became popular in fitness culture completely disrupts this process. So does eating only one meal a day. The body needs a consistent rhythm to regulate blood sugar effectively. Disrupting that rhythm continuously, even with small or healthy foods, is one of the quieter contributors to the blood sugar dysregulation that eventually leads to metabolic syndrome and Type 2 diabetes.

Conventional Treatments for Type 2 Diabetes

When a patient receives a Type 2 diabetes diagnosis through conventional medicine, the response typically involves monitoring tools, medications, and in some cases, surgery. Here is what Dr. Katz and Dr. Ryder covered.

Glucose Monitoring

Standard care begins with a glucose monitoring kit. Traditional kits use a finger prick to check blood glucose at various points throughout the day. Technology has advanced significantly. Continuous glucose monitors now track blood sugar in real time and can send alerts directly to a smartphone when levels drop too low or spike too high.

Dr. Katz noted that while these tools provide patients with more information, they can sometimes be used to manage the number rather than address what is driving it. Using a pump to compensate for a cookie and then simply push more insulin is controlling the blood sugar, not treating the diabetes.

Medications

Several classes of medications are used to manage blood sugar in Type 2 diabetes.

Biguanides (Metformin): Metformin is the most widely used first-line medication for Type 2 diabetes. It reduces the amount of sugar the liver produces, improves the body's sensitivity to insulin, and helps the muscles absorb glucose. Dr. Ryder noted that Metformin has a reasonably strong track record, including studies suggesting support for longevity and cardiovascular protection. Side effects include folic acid depletion, and the primary risk, like most blood-sugar-lowering medications, is dropping blood sugar too low. Monitoring blood work while on Metformin is important.

Sulfonylureas (glimepiride, glipizide, glyburide): These medications stimulate the pancreatic beta cells to produce more insulin. They are older medications, still in use, and carry the same primary risk as most diabetes drugs: the possibility of blood sugar dropping too low.

DPP-4 Inhibitors: A newer category of drugs that help the body produce more insulin by a different mechanism than Metformin. The goal is the same: lower blood glucose, and the risks follow a similar pattern.

GLP-1 Receptor Agonists (Ozempic, Wegovy, Mounjaro, Semaglutide): These are among the most talked-about medications in both the diabetes and weight loss space right now. GLP-1 drugs mimic a natural hormone called incretin. They increase beta cell function, reduce appetite, slow stomach emptying, and help the body use insulin more effectively. They were originally developed and FDA-approved specifically for Type 2 diabetes. Dr. Ryder's position was clear: for patients who have genuinely worked through other options, these medications can be appropriate. For patients who want to lose a small amount of weight and do not have a diabetes diagnosis, the doctors were equally direct that these medications are not the right tool for that purpose.

SGLT-2 Inhibitors: These drugs work by preventing the kidneys from reabsorbing glucose, allowing more sugar to be excreted through urine. The result is lower blood sugar.

This content is for educational purposes only and does not constitute medical advice. Do not start, stop, or change any medication without speaking with a qualified healthcare provider who understands your full history. The team at Naturopathic Physicians Group is available for consultations to discuss both conventional and naturopathic approaches to blood sugar management.

Insulin Therapy

When blood sugar can no longer be controlled with oral or injectable medications, insulin becomes necessary. Dr. Katz was direct: reaching this point is something worth avoiding if possible, because it reflects significant pancreatic compromise, not just elevated numbers.

Rapid-acting insulin: Starts working within 20 minutes and lasts up to five hours. Must be taken just before or immediately after eating.

Short-acting insulin (Humulin R): Takes about 30 minutes to kick in and lasts approximately eight hours. Used when a quicker drop is not needed but a sustained effect is helpful.

Intermediate-acting insulin (Humulin NPH): Takes up to 90 minutes to become active and lasts up to 24 hours.

Long-acting insulin (Lantus): A slow, steady release used once daily. The longer the insulin acts, the more vigilance is required to avoid blood sugar dropping too low, which is the primary risk across all insulin types.

Dr. Katz also noted that ongoing insulin use can make weight loss more difficult because insulin signals the body to store fat, which compounds the original problem.

What the Naturopathic Approach Does Differently

Naturopathic medicine runs many of the same blood sugar tests that conventional medicine uses. But it does not stop there.

If you want to see how this same root-cause, trend-based approach applies to hormones specifically, take a look at our recent hormone series. The philosophy is identical: track trends, identify the upstream driver, and act while the changes are still manageable.

With blood sugar and metabolic health, the naturopathic goal is not just to read a number on a lab report. It is to understand what that number is doing over time, what is driving it, and what else in the body is being affected by the underlying dysfunction. Dr. Katz explained it clearly in this episode: metabolic syndrome does not develop overnight. It builds over the years and leaves a trail of inflammation and risk across multiple systems. A naturopathic evaluation means tracking trends in kidney function, liver function, insulin levels, and cholesterol ratios together. It means looking at where inflammation is coming from, not just what the numbers say at this one visit.

Dr. Ryder added that catching those early trends is one of the things naturopathic physicians do best. A fasting glucose that is technically in the normal range but edging slightly upward each year is a signal. A fasting insulin that is creeping toward the top of the healthy range is a signal. Seeing those patterns and responding to them early, with targeted and proportionate interventions, is the difference between catching something in time and managing a diagnosis indefinitely.

For patients who are already on medications, the naturopathic goal remains the same: address the root cause so that reducing or eventually eliminating those medications becomes a real possibility. As Dr. Katz said in this episode, if all your doctor is doing is giving you drugs, you can assume you will be on those drugs for life. If that is not the outcome you want, the conversation about root cause is worth having.

Ready to Take a Closer Look at Your Blood Sugar?

If any of this hits close to home, the next step is simple: work with someone who will run all five of these tests, not just the basic A1C.

Dr. Katz and Dr. Ryder at Naturopathic Physicians Group in Scottsdale, Arizona, work with patients who are pre-diabetic, newly diagnosed, already managing a diagnosis on medications, or simply concerned about their metabolic health and want a full picture. Both in-office and virtual consultations are available.

Schedule here: https://naturopathicgroup.com/contact
Call: (480) 451-6161
Email: [email protected]

Part 2 of this series, "How to Reverse Insulin Resistance Naturally: Tests, Treatments, and What Actually Works", covers the natural and naturopathic approaches to blood sugar and insulin resistance: the dietary changes, specific supplements, and lifestyle shifts that can move your numbers in the right direction.

This content is for educational purposes only and does not constitute medical advice. Nothing here replaces the care of a qualified healthcare professional. Please speak with a provider before making changes to your medications, diet, or supplement routine.