A review of 129 studies found that tests for a high rise in blood sugar after meals were better than tests of fasting blood sugar levels as a predictor of coronary heart disease, strokes, or death from any cause (British Medical J, July 17, 2020;370:m2297). Having a blood sugar greater than 155 mg/dL one hour after you eat a meal markedly increases your risk for heart attacks, strokes and premature death, even if your fasting blood sugar is normal (Atherosclerosis, Nov 17, 2016;256:15-20). This test is more dependable than HBA1c, the test used by most doctors to diagnose diabetes today (J Clin Endo & Metab, Nov 15, 2018).

More than 30 percent of type II diabetics don’t know that they have diabetes because their fasting blood sugar is normal at less than 100 mg/dL, so their doctor has told them that they are not diabetic. People who have fasting blood sugar levels between 100 and 125 mg/dL are often told that they have “pre-diabetes,” when they are already at very high risk for heart attacks (BMJ, 2016;355:i5953). More than seventy percent of people with pre-diabetes eventually develop diabetes (Diabetes Care, 2020;43(Suppl 1):S32-6).

In my opinion, use of the term “pre-diabetes” is going to kill a lot of people because extensive damage is done to every cell in your body when your blood sugar rises too high after meals, even if your fasting blood sugar level is normal. I believe that you should be told that you are already diabetic and at high risk for all the side effects of diabetes if your blood sugar rises above 155 mg/dl one hour after you eat a meal. Most cases of type II diabetes are caused by inability to respond adequately to insulin, which can be cured with lifestyle changes but not with drugs.

Who Needs to Be Checked for One-Hour-After-Eating Blood Sugar?
People who have any of the following factors should get a blood test for blood sugar one hour after they eat a full meal:
• excess fat (body mass index greater than 25)
• increased belly fat (pinch more than 2 inches of fat underneath your skin near your belly button
• waist circumference in men > 37 inches (94 cm), in women >31 inches (80 cm)
• proportionately small buttocks (an independent risk factor for diabetes)
• smokes or lives with a smoker
• systolic blood pressure >120 at bedtime
• diastolic blood pressure > 90 at bedtime
• high bad cholesterol: LDL >100
• low good cholesterol: HDL <40
• Lp(a), a clotting factor, >30 mg/dL
• C-reactive protein >3 mg/L
• high sensitivity CRP >10 mg/L
• HBA1c >5.6

My Recommendations
Type II diabetes puts you at increased risk for heart attacks, strokes and premature death. Many people do not realize that they are diabetic because their doctors have told them incorrectly that a fasting blood sugar below 100 mg/dL rules out diabetes. Check the risk factors listed above. As part of your yearly check-up, I believe that everyone should get a blood sugar level drawn one hour after they eat a full meal. If it is greater than 155 mg/dL, make immediate lifestyle changes to reverse the damage that has already occurred from high blood sugar and to prevent further damage. We have no drugs that cure diabetes, but most type II diabetes can be prevented or cured with lifestyle changes:
• lose excess weight if overweight
• exercise
• avoid smoking
• avoid or severely restrict alcohol
• eat a healthful diet with plenty of vegetables, fruits, whole grains, beans, nuts and other seeds
• avoid sugared drinks including fruit juices, sugar-added foods and other refined carbohydrates, red meat, processed meats, and fried foods
• keep hydroxy vitamin D levels above 30 ng/mL
See Most Type II Diabetics Could Be Cured with Lifestyle Changes
How Exercise Helps to Prevent Diabetes and Heart Attacks