Q&A: low blood pressure; high fasting blood sugar; transitioning off GLP1s; & improving sleep
Keep the questions coming!
ICYMI 👉
Today’s LIVE Q&A is about “Addressing Anxiety in Times of Uncertainty.” Join me HERE TODAY at 4/18 at 3 pm ET!
Paid subscribers can submit their questions for me to answer live, right here!
In this week’s reader-submitted Q&A, we’re tackling these questions:
What can I do about low blood pressure?
I had a high fasting blood sugar—should I be worried about diabetes?
How can I safely transition off of a GLP-1?
I’m exhausted—how can I get better sleep?
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The following subscriber questions have been lightly edited for length and clarity.
QUESTION #1: LOW BLOOD PRESSURE
I have low blood pressure … however there isn’t much talk or information about it. I find numbers to be helpful to an extent. It helps me not feel like it’s “all in my head” and I love some data. Are there things I should be aware of/look out for and what to do if you experience those things? Best practices to mitigate symptoms? Thank you for being willing to talk about this!
-Em
Em—I love this question! Low blood pressure tends to fly under the radar in medicine because we’re so busy worrying about high blood pressure that we often forget that too low can feel crummy too.
Low blood pressure—or hypotension—is typically defined as readings below 90/60. But for some people, that’s totally normal and symptom-free. For others, it can cause fatigue, lightheadedness, brain fog, nausea, or that classic “I feel like I might keel over when I stand up too fast” feeling. Sound familiar?
Things that can exacerbate low BP include dehydration, heat, certain medications (such as diuretics or GLP1 medications), long periods of standing, or sudden posture changes. And let’s not forget hormonal shifts (looking at you, perimenopause), stress, or skipped meals that can drop blood pressure even lower.
Best practices to manage it?
Hydrate, hydrate, hydrate—with fluids and electrolytes (not just plain water). Think: broth, coconut water, electrolyte tablets, salted foods.
Eat regularly—low blood sugar and low blood pressure often travel together.
Add a little extra salt to your diet (yes, really—under guidance of your doctor).
Compression socks—glamorous? No. Helpful? Absolutely.
Move slowly from lying to sitting to standing—especially first thing in the morning.
Regular movement—walking, light strength training—helps circulation and can improve symptoms over time.
And if symptoms persist or interfere with daily life, sometimes medications or other interventions (like fludrocortisone or midodrine) are considered, but that’s very case-by-case.
QUESTION #2: HIGH FASTING BLOOD SUGAR
My fasting blood sugar was 103. My doctor said it’s “fine,” but that seems high. Should I be worried about prediabetes?
-Josh
Josh,
Your instinct is right: while your doctor isn’t alarmed, it’s a number worth paying attention to. A normal fasting blood sugar (or glucose) is under 100. A fasting sugar of 126 or above on repeated readings signals diabetes. So a fasting blood sugar of 103 mg/dL falls into a gray zone. It’s not high enough to meet the criteria for diabetes, but it is technically above the ideal range—and what some would call “prediabetes.”
But as I wrote about here, pre-diabetes isn’t as much a diagnosis as it is a description of blood sugars that “live” between normal and the diabetes range. Having blood sugars in the gray zone means your body is starting to have trouble managing blood sugar efficiently. It doesn’t mean you’ll develop diabetes, but it’s a signal to check in on your lifestyle habits and overall metabolic health. Many people with prediabetes can bring their numbers down—or prevent progression to diabetes—through small but meaningful changes. I also did a full podcast on this here.
What helps? Focus on steady blood sugar support: more fiber, protein, and healthy fats; fewer refined carbs and added sugars; regular movement, especially walking after meals; adequate sleep; and managing stress, which can impact insulin sensitivity. Weight management plays a role, too, even small shifts—losing just 5–7% of body weight (if needed) has been shown to significantly reduce diabetes risk.
You also might ask your doctor for a hemoglobin A1C test, which gives a broader picture of your average blood sugar over the past 2–3 months. It can help clarify where you stand and whether follow-up is needed.
So no, a fasting glucose of 103 isn’t something to panic over—but it is an opportunity. It’s your body nudging you to pay attention and maybe make a few changes now, while you have the chance to shift the trajectory in a positive direction.
QUESTION #3: TRANSITIONING OFF GLP-1S
I’ve lost weight on a GLP-1, but now I feel unsure about how to “eat normally” again. How do you help patients transition off these meds while maintaining health and sanity?
-KS
Hi KS,
This is such an honest and important question—and something I hear from a lot of patients.
One of the biggest misconceptions about GLP-1 medications like Ozempic is that they’re either a “forever” drug or a quick fix—when in reality, they’re a tool. A bridge. A way to create space between old patterns and new possibilities.
Coming off these medications doesn’t mean going backward—but it does require intention, curiosity, and often a little re-learning of how to eat in a way that feels both nourishing and sustainable.
Because here’s the thing: Ozempic doesn’t teach you how to eat—it quiets the noise. It helps regulate hunger and satiety in a way that allows people to step out of survival mode, stop obsessing over food, and start paying attention to what their body actually needs. But when the medication goes away, those old thoughts, patterns, or habits may try to creep back in—not because you’ve failed, but because you’re human.
What I often remind patients is that this transition period isn’t about getting it perfect—it’s about getting curious.
Some gentle places to start:
Eating regularly—yes, that might mean actual breakfast and lunch—to keep blood sugar stable and avoid that afternoon crash.
Prioritizing protein—not in a diet-y way, but in a “how do I feel my best and stay full?” kind of way.
Checking in before and after meals—not with judgment, but with awareness. Did I eat enough? Did that meal satisfy me physically and emotionally?
And maybe most importantly—asking why certain habits feel hard or sticky. Is it physical hunger? Stress? Boredom? Emotional discomfort? This is the work. Not glamorous, but real.
I’ve said it before and I’ll say it again: the magic of these medications isn’t just the weight loss. It’s the mental clarity, the reduced shame, the sense of agency people experience when food isn’t running the show.
Coming off a GLP-1 is less about going “back to normal”—and more about defining what your new normal looks like. One that’s built on awareness, nourishment, and self-compassion—not restriction or fear.
And sometimes that takes time, support, and a whole lot of grace.
QUESTION #4: IMPROVING SLEEP
I’ve never been a great sleeper, but I didn’t realize it could be messing with my metabolism. Is it too late to fix my sleep in midlife? And what do you recommend when you’ve tried everything but still can’t get a full night’s rest?
-Steve
Hi Steve,
Such a great—and common—question. First things first: it is absolutely never too late to work on sleep. And while sleep might get more finicky in midlife (thank you, hormones, stress, and the general chaos of modern life), I firmly believe that small changes can have a meaningful impact—even if you never achieve perfect, eight-straight-hours, sleep-like-a-teenager-again rest.
I like to remind patients (and myself!) that sleep is not a luxury or an indulgence—it’s basic human maintenance. It’s the time when your brain literally takes out the trash—clearing metabolic waste, regulating hormones, and resetting your stress response for the next day. And yes—chronic poor sleep can mess with metabolism, blood sugar regulation, hunger cues, and even weight management. But stressing about that just makes sleep harder, so let’s focus on what’s within reach.
When people tell me, “I’ve tried everything,” I like to zoom out and go back to basics—because often what helps most is doing simple things more consistently.
Here’s what I have patients check in on:
Is your sleep environment dark, quiet, and cool? (<65 degrees is best)
Are you eating (or drinking alcohol) too close to bedtime?
Is caffeine sneaking in past noon?
Are you giving your brain any sort of wind-down cue at night (like reading, stretching, or journaling)—or are you scrolling TikTok until your eyelids droop?
Are you stuck in the “lying there for 2 hours in a worry spiral” routine? If so—get up. Change rooms. Reset.
And then there’s the lifestyle stuff we all know but often forget: daily movement, exposure to natural light in the morning, and yes—eating enough during the day (especially protein!) so your blood sugar isn’t crashing overnight.
As for supplements or sleep aids? I think of them as temporary scaffolding—sometimes helpful, but not a long-term strategy on their own. Magnesium glycinate, melatonin (at low doses), or L-theanine can sometimes help. But if the root issue is stress, hormones, or anxiety, pills alone usually don’t cut it.
And remember: “good enough” sleep is still good. We don’t need perfection to see benefits. If you’re improving your routine, getting an extra 30-60 minutes of rest, or waking up feeling even slightly more refreshed—that’s a win.
Sleep isn’t just about discipline or biohacking. It’s about creating an environment—and a life—that allows rest to happen. And in midlife especially, that often starts with giving ourselves permission to care about it.
Disclaimer: The views expressed here are entirely my own. They are not a substitute for advice from your personal physician.
Hello Lucy, thank you for sharing such an important information for those like me, who have sleep problems. I agree that supplements alone will not work as good as they are expected! But still I combine your tips with Nutraharmony magnesium glycinate supplements, and that all together provides me a deep relaxing sleep. I've also tried melatonin, but magnesium has better effect on me. Thanks for your posts!
About a year ago I asked my provider to order a HgbA1c and a fasting insulin, following my routine lab work that resulted in a fasting glucose of 98. My fasting glucoses have been in that area for several years but I had learned that many of us can be pre-diabetic with glucose results not classified as high. My mom was a Type II diabetic and I have lived in fear of it. Sure enough, my HgbA1c was 6.1. With a very low-carb diet, my last A1c was 5.7, about 4 months ago. I'll see my provider again in June and I'm very curious what the next one will be! I think everyone with fasting glucoses over 90, especially combined with diabetic family members, should have HgbA1c testing. I was not overweight, while eating a mostly Mediterranean diet. I also agree that other factors complicate the situation. In the past 10 years I left a job I loved under very bad circumstances, got remarried, moved across the country and didn't handle all of it well! I got therapy, relocated closer to family, changed my diet- all to the good!