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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.
