Note: This is a case study from a real-life example in my practice. This is meant to be educational only; not medical advice. All names have been changed to protect the client’s privacy.

 

When Jen first came to see me, she was fed-up.

Diagnosed with prediabetes and Hashimoto’s thyroiditis, Jen had followed every conventional recommendation without much guidance. She adjusted her diet, added exercise, and even tried Ozempic (a GLP-1 agonist).

Yet, her A1C remained stubbornly elevated, weight wouldn’t budge, and all her symptoms persisted, despite all her best efforts.

Her symptoms painted a broader picture: persistent fatigue, joint stiffness, restless sleep, and exercise intolerance (She lacked stamina and showed little progress in building muscle strength).

In addition to an elevated fasting blood sugar (>95 mg/dL) and hemoglobin A1C ( >6.1%), her lab work also revealed elevated hs-CRP, a marker of systemic inflammation.

We started with foundational dietary changes and targeted nutrients and herbs to support her thyroid and reduce her most disruptive symptoms.

Jen experienced small (but impactful) wins: slightly better sleep, reduced joint pain, and more energy. But her weight still barely budged, and her A1C hadn’t improved by more than a point or two.

What was missing? A deeper look into the interconnected systems driving her symptoms: blood sugar regulation, inflammation, and gut health.

 

Blood Sugar—More Than Just Willpower

When we think about balancing blood sugar, the conversation often revolves around diet – as it should. Macronutrient balance—pairing carbohydrates with protein and anti-inflammatory fat—is a great starting point. Studies show that patterns like the Mediterranean diet exert a benefit because they balance macronutrients and emphasize anti-inflammatory polyunsaturated and monounsaturated fats. But that’s just the tip of the iceberg.

Blood sugar spikes and dips are not just dietary challenges; they’re systemic issues. Every time your blood sugar spikes, your body releases insulin to bring it back down. Over time, frequent spikes can create insulin resistance, a condition where your cells become less responsive to insulin.

 

Insulin resistance: The Lock and Key

Think of insulin as the key and the receptors on cells as the locks. Normally, when food is consumed, the body releases insulin, which acts as the key to unlock the receptors and allow glucose to enter cells for energy.

However, frequent blood sugar spikes flood the system with insulin, causing the locks (cell receptors) to become worn out or jammed. The keys (insulin) no longer fit as effectively, making it harder for glucose to enter the cells.

The result? Glucose stays in the bloodstream, causing elevated blood sugar levels and symptoms such as fatigue and cravings, despite plenty of energy being available but inaccessible.

What does this mean for Jen? These spikes were likely fueling her inflammation, poor sleep, and fatigue. Functional medicine looks beyond diet to address the deeper drivers of blood sugar dysregulation, like inflammation and gut health.

 

The Blood Sugar x Inflammation Connection

Blood sugar imbalances and inflammation are deeply intertwined. When blood sugar spikes, it triggers inflammatory pathways, releasing cytokines that increase oxidative stress. This chronic inflammation further worsens insulin resistance, creating a vicious cycle.

For Jen, her elevated hs-CRP—a marker of inflammation—was a key clue. Chronic inflammation doesn’t just cause symptoms like joint pain, fatigue, and exercise intolerance; it also perpetuates insulin resistance, creating a cycle that’s hard to break. In Jen’s case, this cycle was particularly damaging because insulin resistance was fueling her autoimmune condition, keeping Hashimoto’s symptoms flared.

When cells are resistant to insulin, glucose builds up in the bloodstream, triggering more inflammation and oxidative stress. This inflammatory environment can exacerbate autoimmunity by overstimulating the immune system and promoting tissue damage.

For Jen, this meant her thyroid function couldn’t stabilize, leaving her stuck in a pattern of persistent fatigue, poor sleep, and joint stiffness. Addressing blood sugar without targeting inflammation—and vice versa—would only offer temporary relief.

Research shows that nutraceuticals like omega-3s, curcumin, and berberine can help reduce inflammation while improving insulin sensitivity. But there’s another piece of the puzzle: gut health.

 

The Role of the Microbiome in Metabolic Health

Your gut isn’t just key to digestion—it’s also home to trillions of bacteria that make up your microbiome. These bacteria play a crucial role in regulating blood sugar levels.

On busy days, Jen’s diet often lacked the variety of plants needed to support a healthy microbiome. Research shows that eating a diverse range of fibers and colorful foods enriches the microbiome and boosts the production of short-chain fatty acids (SCFAs), such as butyrate. These compounds play a vital role in maintaining gut barrier integrity and promoting better metabolic outcomes.

The more phytonutrients and polyphenols we consume—compounds found in colorful foods like vegetables, fruits, nuts, seeds, legumes, coffee, green tea, and herbs like turmeric—the greater the positive shift in the microbiome toward improved metabolic health.

For example, Akkermansia muciniphila, a beneficial gut bacterium, has been linked to better insulin sensitivity and reduced inflammation. Studies indicate that low levels of Akkermansia can negatively impact insulin sensitivity and body composition. By targeting this species through dietary strategies, we can enhance the microbiome’s ability to regulate blood sugar and reduce inflammation.

 

The Blood Sugar x Cortisol Connection

Blood sugar regulation doesn’t just impact inflammation and insulin sensitivity—it also plays a significant role in hormonal balance and sleep quality. One key player in this dynamic is cortisol, the body’s stress hormone, which has a profound impact on blood sugar levels.

Under normal conditions, cortisol levels follow a predictable daily rhythm, peaking in the morning to help the body wake up and tapering off throughout the day. However, blood sugar imbalances can disrupt this rhythm, creating a cascade of issues, including disrupted sleep and fatigue.

 

The Dawn Phenomenon

For individuals with insulin resistance or blood sugar dysregulation, the “dawn phenomenon” is a common occurrence. Overnight, the liver releases glucose into the bloodstream to provide energy for the waking hours—a natural process that helps maintain steady blood sugar levels. Cortisol plays a role in this process by signaling the liver to release glucose.

In a healthy individual, insulin regulates this rise in blood sugar. But in cases of insulin resistance, the body struggles to respond effectively. This causes blood sugar levels to spike in the early morning and may lead to waking up during the night, particularly between 2–4 a.m., as cortisol levels begin to increase.

 

Sleep Disruption and Fatigue

Blood sugar swings can trigger cortisol production at inappropriate times. When blood sugar drops too low overnight, the body perceives it as a stressor, prompting cortisol to spike to restore glucose levels. This cortisol surge can wake the body from sleep, leaving individuals feeling restless or fatigued in the morning.

For Jen, this cycle of dysregulated blood sugar and cortisol spikes helps explain her restless sleep and persistent fatigue. Despite her efforts, her body was stuck in a loop of poor sleep and metabolic stress, further exacerbating her symptoms.

 

Tools in the Functional Medicine Toolkit for Blood Sugar Balance

For Jen, balancing her blood sugar required a multi-faceted approach. Here’s some of what we focused on when we tailored her personalized plan:

 

Dietary Changes

  • Add more fiber and colorful, phytonutrient-rich foods to enrich the microbiome.
  • Pair carbohydrates with protein and healthy fats to stabilize blood sugar.
  • Focus on PUFA/MUFA fats, including sources like fish, olive oil, avocados, nuts, and seeds.

 

Nutraceutical Support

Berberine: Lowers A1C by ~1%, comparable to metformin, by improving insulin sensitivity and reducing glucose production.

Omega-3s: Provides anti-inflammatory effects that support insulin function.

Curcumin: Reduces inflammation and improves glucose regulation.

Magnesium: Essential for insulin sensitivity and overall metabolic health.

Vitamin D: Supports glucose metabolism and insulin sensitivity.

Alpha-Lipoic Acid (ALA): Improves glucose regulation and reduces oxidative stress.

 

Movement

  • Focus on low-impact exercises like walking to reduce stiffness and enhance mitochondrial function.
  • Research highlights evening walks, HIIT, and resistance training as the most effective activities for improving blood sugar sensitivity.

 

Gut Health

  • Support GI mucosa and digestion to promote a healthy microbiome.
  • Incorporate polyphenols and prebiotic-rich foods to target beneficial bacteria like Bacteroides and Akkermansia muciniphila and enhance gut health.

 

What Happened Next?

After incorporating these changes, Jen started to see progression in her blood sugar. We started using a continuous glucose monitor (CGM) to keep tabs on her progress. At her 6 month follow-up, we had re-assessed her A1C and hs-CRP which had begun to drop.

Most exciting was that her energy stabilized, her joint pain improved significantly, and her brain fog lifted for the first time in years! She also reported that her body composition started to improve (we started to monitor her weight mass instead of just body weight).

By addressing the root causes of her symptoms—blood sugar dysregulation, inflammation, and gut health—Jen finally felt like her efforts were paying off.

 

Conclusion: What Jen can teach us about balancing blood sugar

Jen’s journey is a powerful reminder that blood sugar management is about more than oversimplified recommendations about low-carb or over restrictive diets. Understanding how the body’s systems — blood sugar, inflammation/immune system, and gut — work together is the key to optimizing metabolic health.

Functional medicine offers a toolkit that addresses the root causes of imbalances and builds on the foundations of diet and lifestyle to achieve lasting health.

 

Are you curious about how plant diversity impacts your microbiome, inflammation, and metabolic health? Download the free Rainbow Evaluation to see where you stand—and start your journey to vibrant health today!

 

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