Managing Blood Sugar Without Weight Loss

Managing Blood Sugar Without Weight Loss

A Patient Guide

No matter what you’ve been led to believe, raised blood sugar is not your fault. Blood sugar variations are common, and deserve proper investigation, not blame or oversimplified solutions. While you may have been told this is a simple matter of weight or lifestyle, the reality is that blood sugar regulation is complex and influenced by many factors beyond your control.

Understanding Blood Sugar Levels

Blood sugar (glucose) is your body’s main energy source. It needs to be at the right levels to keep everything running smoothly. Raised blood sugar is a real physiological process driven by a number of factors, not a personal failing or lifestyle choice to be judged.

Normal Blood Sugar

  • Fasting blood glucose: Below 100 mg/dL (5.6 mmol/L)
  • After meals: Returns to normal within 2-3 hours
  • A1C: Below 6.0% (42 mmol/mol)

Impaired Glucose Regulation

Sometimes called “prediabetes,” though this term is problematic since it doesn’t necessarily progress to diabetes:

  • Impaired Fasting Glucose: 100-125 mg/dL (5.6-6.9 mmol/L)
  • Impaired Glucose Tolerance: 2-hour glucose 140-199 mg/dL (7.8-11.0 mmol/L) during oral glucose tolerance test
  • A1C: 6.0-6.4% (42-47 mmol/mol)

Diabetes

Diabetes is defined as sustained high blood sugar (hyperglycemia) and should be confirmed with two separate tests, ideally 3 months apart. Diagnostic criteria include:

  • Fasting blood glucose: 126 mg/dL (7.0 mmol/L) or higher
  • 2-hour glucose: 200 mg/dL (11.1 mmol/L) or higher during oral glucose tolerance test
  • A1C: 6.5% (48 mmol/mol) or higher
  • Random blood glucose: 200 mg/dL (11.1 mmol/L) or higher with symptoms

 

In the case of type 2 diabetes, a single test is not enough for diagnosis. Blood sugar can be temporarily elevated due to stress, illness, medications, or other factors. Proper diagnosis requires confirmation with a second test, typically after 3 months.

Symptoms of Raised Blood Sugar

This is often asymptomatic and picked up on a routine blood test, but features include:

  • Changes in thirst or urination patterns
  • Fatigue or energy fluctuations
  • Vision changes
  • Slow healing
  • Unexplained symptoms
  • Changes in hunger levels

Understanding Raised Blood Sugar

There is no evidence that lifestyle changes or medication will significantly reduce your risk of developing diabetes, even when your blood glucose levels are impaired. Long term studies have shown that weight loss does not prevent diabetes. Blood sugar levels often fluctuate because:

  • They are meant to vary throughout the day
  • Many factors affect glucose regulation
  • Hormonal changes impact blood sugar
  • Stress influences glucose levels
  • Medications can affect blood sugar
  • Various health conditions impact glucose regulation

Important Facts About Blood Sugar

While you may have been told that blood sugar is just about diet and exercise, the science shows it’s much more complex. Multiple biological factors often contribute simultaneously:

Physical Factors

  • Genetics (primary influence)
  • Insulin resistance
  • Hormonal changes
  • Inflammatory responses
  • Medication effects
  • Stress levels
  • Sleep patterns

 

Mental Health Factors

  • Chronic stress
  • Trauma and PTSD
  • Depression and anxiety
  • Healthcare anxiety
  • Impact of weight stigma

 

Systemic Factors

Many underlying factors reflect broader systemic issues:

  • Limited access to healthcare
  • Economic barriers to receiving proper care
  • Weight stigma in medical settings
  • Social determinants of health

Challenging Medical Bias

Common problematic medical responses include:

  • Blaming blood sugar issues on weight rather than looking for other underlying causes
  • Prescribing weight loss instead of treating actual symptoms
  • Assuming issues are “lifestyle-related” without evidence
  • Delaying proper testing and treatment due to weight stigma
  • Missing serious conditions due to weight-based assumptions

Managing Blood Sugar Without Weight Loss

Your Rights as a Patient

You deserve healthcare that:

  • Investigates your symptoms without blame
  • Recognizes blood sugar as a biological process
  • Does not recommend weight loss to prevent diabetes
  • Respects your experiences
  • Treats underlying conditions
  • Never requires weight loss as a prerequisite for care
  • Focuses on health outcomes, not weight

Understanding Blood Sugar Tests

  • There are four types of blood sugar measurements:
    • A1C (measures 3 month blood glucose average)
    • Fasting blood glucose (measures blood glucose after 10-12 hr without food or drink)
    • Random blood glucose (measures blood glucose at any time)
    • Oral glucose tolerance test (measures blood glucose 2h after a 75mg glucose load)
  • Targets should be individualized
  • Weight doesn’t determine your target
  • Moderate control is often more appropriate than tight control
  • Quality of life matters

Treatment Options

A riased blood sugar does not indicate a need for treatment. Sometimes, the best course of action is to do nothing.  Several effective medications exist for type 2 diabetes:

  • Metformin (Glucophage, Glumetza)
  • SGLT2 Inhibitors (Invokana, Farxiga, Jardiance)
  • GLP-1 Receptor Agonists (Ozempic, Victoza, Trulicity)
  • DPP-4 Inhibitors (Januvia, Trajenta)
  • Insulin when needed

Advocating for Blood Sugar Management Without Weight Loss

When you hold one or more marginalised identities (such as being Fat or Disabled), finding supportive healthcare can be extremely challenging.

When seeking care:

  • Request focus on symptoms, not size
  • Ask for all available treatment options
  • Discuss medication options thoroughly
  • Bring an advocate to appointments
  • Consider finding weight-inclusive providers
  • Know your right to refuse weight-focused interventions

Creating Your Type 2 Diabetes Management Plan

An effective plan should:

  • Begin with an individual HbA1c target (remember that tight control can be more harmful in the long term and you may be better off working toward moderate control (A1c of 7-8% or 54-64 mmol/mol)
  • Incorporate regular monitoring (every 3-6 months initially, and can extend to 6-12 months when stable)
  • Include appropriate medications if needed
  • Prioritize quality of life
  • Never include weight loss requirements
  • Consider your daily activities and needs

Advocating for Yourself

When seeking care:

  • Request focus on symptoms, not size
  • Ask about evidence-based treatments
  • Discuss medication options thoroughly
  • Consider finding weight-inclusive providers
  • Know your right to refuse weight-focused interventions

 

The stress of repeated stigma may make it difficult to attend follow-up appointments. While this is an understandable response to negative healthcare experiences, maintaining appropriate medical care is important for your long-term wellbeing.

Building Your Support System

Remember

  • Blood sugar varies naturally
  • Tight control isn’t always necessary
  • You deserve care that doesn’t require weight loss
  • Your symptoms are valid regardless of your size
  • Treatment should improve quality of life
  • You are the expert on your own needs

Making Healthcare Decisions

You are the expert on your own life and needs. When evaluating treatment options, consider:

  • Current symptoms and their impact
  • Medication side effects and tolerance
  • Quality of life factors
  • Personal preferences
  • Long-term sustainability
  • Available support systems

Further Resources

This guide was created by Dr. Asher Larmie (The Fat Doctor), a weight-inclusive healthcare provider specializing in helping patients navigate medical bias and advocate for proper care.

For more detailed information about managing your blood sugar, consider joining Dr. Larmie’s comprehensive masterclass.

This information is provided for educational purposes and should not replace professional medical advice. Always consult with healthcare providers for personal medical decisions.