Managing blood sugar: Insulin resistance and hypoglycemia in fitness. | Precision Nutrition

Managing blood sugar:
Insulin resistance and hypoglycemia in fitness.

By Bryan Walsh


How is it that people who are doing what they are “supposed” to be doing –- eating healthy, exercising, maintaining a normal body composition -– still have blood sugar issues?

We’ll explore that, and more, in today’s article. If you’ve ever been interested in blood sugar management, insulin resistance, and hypoglycemia, this is one article you’ll want to check out.


In a previous article (Trouble losing body fat? Are anemia and low oxygen delivery to blame?) I focused on oxygen, one of the two fuel sources for what is arguably one of the most important components of your cell, the mitochondria. Without oxygen, it is impossible for your cells to work at their full capacity or for you to be healthy.

The second source of fuel for the mitochondria -– glucose –- has an equally important role in the function of cells. In this article, I’ll look at glucose and its role in blood sugar.

The blood sugar bandwagon

With the epidemic of diabetes and metabolic syndrome plaguing the industrial world in recent years, blood sugar and insulin have gotten their fair share of media attention.

In fact, blood sugar balance is a major tenet of virtually every diet book from The Zone to The Atkins Diet. And with good reason: imbalanced blood sugar levels are at the crux of many health issues, including being overweight.

But there is much more to know about the blood sugar picture.

Real people, real issues

In our practice, we constantly see people with blood sugar imbalances. But these people are not run-of-the-mill Americans. Not by a long shot.

These are health-conscious, educated individuals who do not spend their time eating Twinkies, bingeing at McDonalds and competing in the World’s Laziest Couch Potato competition.

Rather, we see people who eat well, exercise regularly, have normal body composition and take supplements, but still don’t feel well. They, too, are coming in with blood sugar issues of which they weren’t even aware.

How is it that people who are doing what they are “supposed” to be doing –- eating healthy, exercising, maintaining a normal body composition -– still have blood sugar issues?

Two paths

When talking about blood sugar balance, for simplicity’s sake, there are two possibilities:

  1. Insulin resistance, which is characterized by two things: chronically elevated blood sugar levels, and subsequent elevated insulin levels to help deal with the blood sugar.
  2. Hypoglycemia, which refers generally to low (“hypo”) blood sugar (“glycemia”), but is really characterized by blood sugar fluctuations –- sometimes it’s high and sometimes it’s low.

Both, however, have insulin surges.

And while each of these have their separate issues metabolically, both will cause issues with the function of mitochondria because there is not a steady stream of blood sugar available for ATP (energy) production.

Insulin resistance

When someone is insulin resistant, glucose cannot effectively enter into the cell –- chronically elevated insulin levels create dysfunctional insulin receptor sites on the cell.

Because blood sugar is not adequately entering the cells, it stays in general circulation rather than being stored. As a result, the body must produce higher levels of insulin to remove glucose from the blood stream, which causes even greater metabolic dysfunction.

Characteristic symptoms of insulin resistance include: fatigue after meals, craving for sweets that doesn’t go away when sweets are eaten, increased thirst, and frequent urination.


Clinically, hypoglycemia can be viewed as fluctuations in blood sugar. People with hypoglycemia can experience symptoms such as lightheadedness, irritability, shakiness and fatigue between meals, which is often relieved after eating.

Individuals with this pattern and periods of low blood sugar will have surges of insulin, rather than chronically elevated levels.

Normally, the body should respond to low blood sugar by producing cortisol to increase blood sugar levels. However, in this case, periodically hypoglycemic people usually have low adrenal function and rely on adrenaline to elevate blood sugar between meals, which causes the shakiness and and lightheadedness between meals.

Symptoms are usually relieved after eating because meals provide a source of glucose that their body could not create itself.

Because their bodies rely on adrenaline to elevate blood sugar, people with some degree of hypoglycemia can have insulin surges between meals, rather than following meals, or chronically, as in insulin resistance.

Hypoglycemic tendencies Insulin resistant tendencies
Feels better after meals Feels tired after meals
Sugar cravings before meals Sugar cravings after meals
May have difficulty staying asleep at night May have difficulty getting to sleep at night

A nasty, vicious cycle

But here is one of the biggest points: looking healthy, having a muscular body, and exercising regularly does not mean that you have normal blood sugar management.

In today’s modern world, all bets are off with regard to physiology. In fact, researchers have started using new terms like “non-obese insulin resistance” and “atypical metabolic syndrome” because normal-looking people are having blood sugar management issues.

Below is a vicious cycle that is common in people today.

Though there are a number of mechanisms involved in this cycle, here is a basic explanation. Elevated blood sugar increases insulin. Insulin causes an increase cortisol and cortisol increases blood sugar. And round and round it goes.

People can enter into this cycle in one of two ways. The first is through improper eating. Excess sugar or carbohydrates, excessively large meals or glycemically imbalanced meals can excessively elevate blood sugar levels, causing this cycle to begin.

The second way the cycle can be started is via cortisol. Anything that elevates cortisol (i.e. stress, parasitic infection, food allergies, inflammation, etc.) will also elevate blood sugar and therefore insulin levels.

In other words, you could have a perfect diet and exercise program, but if you have elevated cortisol levels, you may also be increasing your blood sugar from the inside.

Too much of a good thing

Insulin is necessary for life. Without it, you’d be dead. But as with most hormones, insulin should be balanced. In excess, elevated insulin levels have a host of negative consequences on the body. Here are some reasons you want to take insulin seriously.

What to do

The best way to determine whether you have blood sugar issues is to get blood work done. A good blood chemistry screen will contain enough markers to adequately identify patterns of blood sugar mismanagement.

Here is a very general guideline of patterns to look for in blood work.

Hypoglycemic patterns Insulin resistant patterns
Fasting blood sugar below 85 mg/dL
LDH (lactate dehydrogenase) below 140 U/L
Fasting blood sugar above 100 md/dL
Triglycerides above 100 mg/dL*
HDL cholesterol below 55 mg/dL
Cholesterol above 200 mg/dL
LDL cholesterol above 120 mg/dL

*The closer the triglycerides are to the cholesterol, the worse the problem. Ideally they will be a 2:1 ratio or more (i.e. Total cholesterol=180, triglycerides=90).

Understand that these are merely patterns and there are many more issues to consider. These are very general guidelines to help you get started. Please see a qualified medical professional for an accurate diagnosis.

Do it yourself

A quick and easy way you can check this yourself is by purchasing a glucometer. They usually cost around $50 and give you the ability to look at your blood sugar throughout the day. Here are some ways how you can use it:

  1. First thing in the morning. Blood sugar should be between 85 and 100.
  2. Two hours after a meal, it will ideally be between 85 and 100 depending on the size and quality of the meal.
  3. You could eat a meal, and then track your blood sugar at 30 minute intervals for 2 hours following a meal. Some people believe a glycemically balanced meal will not raise it much above 120. For example, if you eat celery and almond butter, or a salad with grilled chicken, your blood sugar should not go above 120 at any point after the meal.

A good protein-based meal with adequate levels of healthy fat and fibre should not raise your blood sugar levels too high. If it does, either the macronutrient ratio was off, the meal was too large, or in some cases, you might have a sensitivity to the food that causes a stress response and elevates blood sugar.

For most of you, the first step toward eating properly for blood sugar management is starting with the Precision Nutrition System.   Indeed, over 85% of our clients see the types of results they’re looking for by following this program.

However, for the other 15% that use the program and still need to go a bit deeper, working with a coach through Precision Nutrition Coaching is the next step.


Blood sugar dysregulation and elevated insulin levels have negative impacts on numerous physiological systems in the body.

But on a fundamental level if adequate glucose cannot enter a cell, the mitochondria will not be able to produce optimal amounts of ATP to run the cells, organs and systems of the body, and we will not be optimally healthy, much less have the body we desire.

The mitochondria use two primary sources of fuel to produce the energy required to run your body effectively: oxygen and glucose. Clinically, these are “high priority” situations because if either one of these processes are not working correctly, nothing will.

It doesn’t matter if it is a hormonal issue, thyroid issue, cardiovascular issue, neurological issue, or weight loss issue — if you cannot get oxygen and/or glucose into the cell for energy, nothing will work as well as it should.

These are basic fundamentals to health and fitness that must be addressed before deciding which supplement works better or whose workout program is the best for fat loss.

Passionate about nutrition and health?

If so, and you’d like to learn more about it, consider the Precision Nutrition Level 1 Certification. Our next group kicks off shortly.

What’s it all about?

The Precision Nutrition Level 1 Certification is the world’s most respected nutrition education program. It gives you the knowledge, systems, and tools to really understand how food influences a person’s health and fitness. Plus the ability to turn that knowledge into a thriving coaching practice.

Developed over 15 years, and proven with over 100,000 clients, the Level 1 curriculum stands alone as the authority on the science of nutrition and the art of coaching.

Whether you’re already mid-career, or just starting out, the Level 1 Certification is your springboard to a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results.

[Of course, if you’re already a student or graduate of the Level 1 Certification, check out our Level 2 Certification Master Class. It’s an exclusive, year-long mentorship designed for elite professionals looking to master the art of coaching and be part of the top 1% of health and fitness coaches in the world.]

Interested? Add your name to the presale list. You’ll save up to 44% and secure your spot 24 hours before everyone else.

We’ll be opening up spots in our next Precision Nutrition Level 1 Certification on Wednesday, October 2nd, 2019.

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  • Pay less than everyone else. We like to reward people who are eager to boost their credentials and are ready to commit to getting the education they need. So we’re offering a discount of up to 44% off the general price when you sign up for the presale list.
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If you’re ready for a deeper understanding of nutrition, the authority to coach it, and the ability to turn what you know into results… this is your chance to see what the world’s top professional nutrition coaching system can do for you.

Spots open October 2nd — don't miss out! Get on the Precision Nutrition Level 1 Certification presale list today.

If you're interested in the Level 1 Certification, we strongly recommend you join the presale list below. Spots are limited and open just twice per year.

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