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In this week’s episode of the Q&A live from the office, Dr. Lucy McBride takes a deep dive into metabolic health. She unpacks the often-misunderstood concept of “prediabetes,” explains how blood sugar regulation works, and offers practical tools for improving insulin sensitivity and overall health—without obsessing over the scale. The conversation also includes a nuanced look at medications like Metformin and GLP-1 agonists (e.g. Ozempic), continuous glucose monitors, and the mental health aspects of our relationship with food.
KEY CONCEPTS:
1. RETHINKING “PREDIABETES”
The term "prediabetes" often implies inevitability, which Dr. McBride challenges.
Hemoglobin A1C levels between 5.7% and 6.4% signal elevated blood sugar but not guaranteed diabetes.
This gray zone presents an opportunity for intervention and agency, not fear.
Metabolic health should be viewed as a continuum—not a binary state.
2. UNDERSTANDING INSULIN AND BLOOD SUGAR REGULATION
Type 1 diabetes = not enough insulin production.
Type 2 diabetes = insulin resistance (insulin is produced but doesn’t work efficiently).
Insulin helps move sugar from the bloodstream into tissues for fuel.
Prolonged high blood sugar can damage organs and lead to serious health issues.
3. LIFESTYLE AS MEDICINE: EXERCISE AND DIET
Cardio and strength training both improve insulin sensitivity.
More muscle mass = more efficient carbohydrate processing.
Diet tips:
Reduce simple sugars and alcohol.
Opt for high-fiber, protein-rich foods.
Don’t skip meals—especially lunch.
Trade-offs matter more than perfection.
4. WHY BMI IS NOT THE WHOLE STORY
Weight and BMI are just one part of a person’s health picture.
Some people with higher BMIs are metabolically healthy; others with “normal” BMI are not.
The goal is not thinness—it’s functional metabolic health and agency.
Personalized care trumps cookie-cutter weight goals.
5. TOOLS IN THE TOOLKIT: METFORMIN, GLP-1s, AND CGMs
Metformin helps insulin work better but isn’t a weight loss drug.
GLP-1 medications like Ozempic improve insulin sensitivity, reduce appetite, and can reset relationships with food.
Continuous Glucose Monitors (CGMs) help clarify real-time blood sugar trends, revealing hidden issues or test inaccuracies.
These tools must be used judiciously and with clear goals.
6. MENTAL HEALTH, STRESS, AND THE METABOLIC CONNECTION
Chronic stress releases cortisol, which raises blood sugar.
Emotional eating is common; food often functions as reward or comfort.
Managing stress, improving sleep, and fostering satiety are essential components of metabolic health.
Agency—not perfection—is the ultimate goal.
NEXT WEEK’S EPISODE PREVIEW:
Dr. McBride will be joined by OBGYN and women’s health advocate Dr. Sharon Malone to discuss menopause, hormone therapy, and how to get what they need out of our medical system.
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