Your fasting glucose is fine. Your two-hour number isn't.

A QUESTION WE HEAR MOST WEEKS

"My fasting glucose always comes back normal. So why does my doctor want to do more testing?"

It's a fair question. Standard blood panels might miss something important.

Fasting glucose is taken after 8-12 hours without food. At that point, your body has had all night to clear whatever was in your bloodstream. For a lot of people, that number looks fine. Even when things are going wrong metabolically, fasting glucose can stay normal for years before it shifts.

The more revealing number is your glucose two hours after eating a real meal. A healthy metabolic response means your body processes that glucose load efficiently and returns to baseline within two hours. If it doesn't, and the number stays elevated, it can be an early sign that something is off, even before fasting glucose or HbA1c changes. In both our Cape Town and Bucharest clinics, we run postprandial glucose as a standard part of our metabolic assessment before any new protocol or molecule gets discussed. This order is important. You need to know what someone's baseline response looks like before you add anything.

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WHAT YOU CAN DO NEXT

• — Ask your GP or clinic for a two-hour postprandial glucose test, not just fasting. If they use an oral glucose tolerance test (OGTT), that works. If you can get a continuous glucose monitor for two to four weeks, even better.
• — When you get your results, look at the two-hour number alongside fasting. A two-hour reading above 7.8 mmol/L (140 mg/dL) is considered impaired glucose tolerance, even if your fasting number is perfectly normal.
• — Act before your fasting glucose changes. Postprandial dysregulation can be present years before the standard markers move.

P.S. Have you ever had a postprandial glucose test, or has your clinic only ever checked fasting? Hit reply and let me know. I'm curious how often this is actually being done.

— Emilian