My blood sugar is high: what it means and what to do now

A high glucose reading does not, on its own, mean you have diabetes. Under 100 mg/dl fasting is considered normal; between 100 and 125 there is increased risk, and from 126 upwards we talk about diabetes — but it has to be confirmed with a second test. The first job is to know which of the three you are in.

My blood sugar is high — how do I bring it down?

That is the first thing everybody types, so I will answer it before anything else. What actually lowers glucose, in order of how much it moves the needle:

1. Losing weight, if you have weight to lose. By some distance the biggest lever, and there is a trial that puts numbers on it. It is further down.
2. Moving after you eat. Not training: walking. The glucose peak arrives between 30 and 90 minutes after a meal, and that is where a walk does more than at any other time of day.
3. Changing the order and the company of the plate, rather than removing foods.
4. Sleep. The one nobody mentions, and the one you notice fastest when it goes wrong.

And a warning that will save you time: nothing brings glucose down in two days. Anything that promises it is selling you something. What does exist are changes that move the number within three months — and that period is not arbitrary: it is how long your blood takes to renew itself.

What exactly does my number mean?

It depends what was measured. A routine test usually carries both, and they do not mean the same thing.

The difference matters: fasting glucose is a photograph of this morning; HbA1c is the film of the last two to three months. That is why more weight is put on the second.

Work out the average glucose my HbA1c corresponds to

Does high blood sugar already mean diabetes?

Not necessarily, and this is the part most people are sent home without understanding. A single high value is not a diagnosis: it has to be confirmed, usually with a second measurement on another day. Flu, a bad night, a badly done fast or the stress of the test itself can lift one reading.

Your doctor diagnoses you, and only your doctor. What you can do is arrive at that appointment knowing what to ask — which is exactly what the sheet at the end of this page is for.

My blood sugar is high but I feel fine — is it serious?

Feeling nothing is normal, not the exception. High glucose does not hurt. A great many people live with it for years without a single symptom, and that is precisely why the blood test exists: because the body does not warn you.

So no, you are not imagining it and you are not overreacting by taking it seriously. And no, you do not have to panic either. What you do with a high number that does not hurt is look at it, understand it and decide — which is a different thing from being frightened.

What can I eat if my blood sugar is high?

Here I am going to disappoint you slightly, on purpose. Almost everyone arrives looking for the list: whether they can eat banana, rice, wholemeal bread, cheese or avocado. The list is exactly what does not work.

There are no forbidden foods: there are plates, and there are amounts. The same rice raises glucose far less alongside vegetables and protein, and if you move afterwards. A banana alone at breakfast and a banana after lunch do not do the same thing to your blood.

That said, two things do move the needle for almost everyone: what you drink — soft drinks and juices, even fresh ones, are glucose with nothing to slow it down — and snacking between meals, which does not satisfy and saves you nothing at the next meal.

What to eat and what to avoid, in more detail

What about strength work? Do I need a gym?

For this month's number, a walk after meals gives you the most for the least effort, which is why I put it first. But look a few years ahead and there is a piece almost nobody mentions: muscle.

That is the underlying reason: muscle is lost over the years unless you give it a reason to stay. Walking sorts out today's glucose, but it barely slows that loss; strength work does. Put simply: the walk lowers the number now, and muscle is what keeps it low five years from now.

No gym, no weights and no sports kit needed. Two or three days a week, not back to back — which is what the guidelines recommend: standing up from a chair several times in a row, pushing against a wall, a resistance band, climbing stairs. That is already strength training.

Which exercise, in what order and how much

What if my HbA1c is high but my fasting glucose is normal?

It happens more than you would think, and it is thoroughly confusing. The usual explanation is simple: your fasting glucose is fine, but it climbs sharply after you eat. Because HbA1c sums up the whole two to three months — including every hour after every meal — it picks up peaks the morning test never sees.

If that is you, the good news is that you know exactly where the problem sits: in the hours after eating. And it is the scenario where the post-meal walk pays off most.

There are also laboratory causes that can alter an HbA1c — anaemia, certain haemoglobin variants — which is why the person who should interpret the two figures together is your doctor. If this is your case, take it to them.

How much can it come down, and how fast?

Here there are published numbers, and I would rather give you those than a promise. In the DiRECT trial, published in The Lancet, the proportion of people whose type 2 diabetes went into remission at one year depended almost entirely on the weight they lost:

Two caveats almost nobody adds, because they do not sell: at two years, remission held mainly in those who kept the weight off — among those still 10 kg or more lighter, 64% — and those who regained the weight lost it far more often; and it is considerably more likely when the diagnosis is recent. Remission is not a cure, and nobody can guarantee it to you.

What remission actually means, with the 2021 consensus definition

Can I take metformin or a supplement to bring it down?

Your doctor decides that, and I am not going to give a written opinion on the medication of somebody I have not seen. It is one of the few questions on this page with a short, clear answer: with your doctor.

What I will say is that what you do with food, movement and rest works whether you are medicated or not, and that coordinating with your doctor rather than going it alone always turns out better.

One caveat: if you use insulin or tablets that can push glucose too low (sulfonylureas such as gliclazide), tell your doctor before changing how you eat or starting to walk or do strength work, because the dose may need adjusting.

What does it cost to have someone alongside me?

I do not put the price on the website, and here is why. Not to hide it: the work is not the same for someone whose prediabetes has just been spotted as for someone eight years into medication who has already tried four things. A number on its own, without knowing which of the two you are, tells you nothing useful.

What I can tell you right now, and it holds:

• The first conversation costs nothing and carries no commitment.
• You tell me your situation and I explain how I work, price included, before you decide anything.
• If I think I cannot help you, I will say so and that is the end of it. I am far more interested in not taking you on than in taking you on and having you quit in three weeks.

So the real question is not what it costs: it is whether the plan fits your actual hours, whoever cooks in your house, and what you are willing to sustain for months. You cannot tell that from a website — you can tell it from a conversation.

So where do I start today?

With three things, in this order, and none of them costs money:

1. Write down your two figures and the date. Fasting glucose and HbA1c. Without the date they are useless for comparison.
2. Book an appointment with your doctor to confirm it and to have it read alongside the rest of your results.
3. Start with the walk after lunch. It is the easiest thing to begin and the one whose effect shows up soonest.

And if you have been trying on your own and the number will not move, the problem is usually not your willpower: it is that the plan did not fit your life. That is where I can help.