New Blood Sugar Testing Beyond A1C: A Practical Guide

You do the “right” thing, you get bloodwork, you see an A1C that looks acceptable, and you still do not feel like you got a straight answer about your blood sugar health.

This video’s perspective is practical and a little impatient with that situation. The core idea is that hemoglobin A1C is often treated like the final word, but it has blind spots, and those blind spots matter if you are trying to catch problems early.

Instead of arguing about one number, the discussion pushes you toward a small set of tests that cover different time windows and different biology, especially fructosamine and 1,5-anhydroglucitol (1,5-AG) (commonly ordered as the GlycoMark test).

Pro Tip: If you are only allowed to add one “extra” test beyond A1C, ask your clinician whether 1,5-AG (GlycoMark) or fructosamine makes the most sense for your situation, especially if you suspect spikes after meals.

Why “normal A1C” can still feel confusing

A1C is marketed as a long-term average, and that sounds comforting. You want a simple dashboard light.

But averages can hide extremes.

This framing emphasizes a common real-world problem: you can have an A1C that looks “not alarming” while still having frequent postmeal spikes, big swings, or periods of prolonged elevation that never show up clearly in the average.

A1C is also not just about glucose. It is about glucose interacting with hemoglobin inside red blood cells, and that detail becomes important when red blood cells do not behave the same way in every person.

The result is that two people can have similar A1C values while experiencing very different day-to-day glucose patterns. If your goal is early detection and tighter feedback, the video argues you need more than one lens.

A1C pitfalls the video wants you to remember

The video repeatedly comes back to one major pitfall: there is wide variability in red blood cell breakdown and lifespan.

That matters because A1C is essentially measuring how much glucose has attached to hemoglobin over the lifespan of those cells. If your red blood cells turn over faster or slower than average, the A1C can be misleading for you.

This is not a fringe complaint. Major diabetes organizations note that A1C has limitations and can be affected by conditions that change red blood cell turnover (for example, certain anemias or hemoglobin variants). The American Diabetes Association (ADA) discusses these limitations in its Standards of Care, including situations where A1C may be less reliable and glucose-based criteria are preferred ADA Standards of CareTrusted Source.

Here is the practical takeaway: A1C is useful, but it is not a perfect truth serum.

What can distort A1C (high level)

You do not need to memorize a medical textbook, but it helps to know the categories that can throw A1C off. Discuss these with a clinician if they apply to you.

Important: If you have known anemia, kidney disease, a hemoglobin variant, or you recently had major blood loss or transfusion, ask your clinician whether A1C is the best monitoring tool for you. ADA guidance notes that A1C can be less reliable in several of these contexts ADA Standards of CareTrusted Source.

The video’s upgrade: fructosamine and 1,5-AG (GlycoMark)

The central “new testing” message is not that A1C is useless. It is that you should pair it with tests that capture shorter-term control and variability.

Two tests are emphasized:

The video’s practical point is simple: use multiple markers across time windows.

A1C gives you a longer view. Fructosamine and 1,5-AG give you a more responsive, shorter-term view that may better reflect postmeal spikes.

What the research shows: 1,5-AG has been studied as a marker of short-term hyperglycemia and postprandial excursions, because higher glucose can increase urinary loss of 1,5-AG. Reviews describe it as potentially useful for detecting glycemic variability that A1C can miss NIH overview of glycated proteins and markersTrusted Source.

1,5-AG in plain language

1,5-AG is a naturally occurring dietary polyol that is normally reabsorbed by the kidneys. When blood glucose rises high enough to spill into urine, glucose competes with 1,5-AG reabsorption, and 1,5-AG levels can fall.

That is why this test is framed as a better “spike detector” than A1C.

The speaker mentions using a commercially available option called GlycoMark and suggests running it alongside fructosamine and A1C for a more complete picture.

Fructosamine in plain language

Fructosamine reflects glucose attaching to circulating proteins, mainly albumin. Because albumin turns over faster than red blood cells, fructosamine generally reflects a shorter period.

This can be helpful if:

It is still not perfect. Protein levels and albumin turnover can affect it, so interpretation should be individualized.

A practical lab checklist for metabolic health (fasted)

The video’s “next time you get your labs” advice is direct. Bring a list.

You are encouraged to ask for a combined picture of glucose and insulin, plus the extra glycemic markers.

Here is the stack as described in the discussion.

A helpful nuance in the video: fasting insulin is acknowledged as variable based on short-term conditions, such as when you last ate, exercise, and carbohydrate intake. That variability is presented as one reason to value fructosamine and 1,5-AG as “stability” checks over a couple of weeks.

Did you know? Diagnostic thresholds for diabetes and prediabetes are often based on A1C and fasting glucose, but even the U.S. National Institute of Diabetes and Digestive and Kidney Diseases notes that A1C can be inaccurate in some people, and results should be interpreted in context NIDDK A1C TestTrusted Source.

Stop obsessing over one glucose spike, focus on patterns

A single reading can scare people.

This video pushes back on that fear.

The discussion highlights that acute, transient bumps in glucose can happen for reasons that are not inherently dangerous, and may even occur with healthy behaviors. Two examples are called out:

The key insight here is the difference between a brief rise and a harmful pattern.

What you are trying to avoid is not “any bump.” The goal is to avoid massive peaks and troughs or prolonged elevations.

This is exactly where shorter-term markers can help. If you are seeing an A1C you do not trust, or you are wondering whether your day-to-day swings are larger than you think, fructosamine and 1,5-AG can add context.

Q: My glucose went up after a sauna or workout. Is that bad?

A: A temporary rise can happen with heat exposure or exercise, and it does not automatically mean your metabolic health is worsening. The more useful question is whether you are having repeated high spikes after meals, large swings, or sustained elevations over hours.

If you are unsure, ask your clinician about pairing fingerstick or CGM data with labs like A1C, fructosamine, or 1,5-AG to understand your overall pattern.

Video host, metabolic health educator

Fasted vs postmeal testing: the “lipid load” idea

Most people only see their labs in a fasted state.

The video argues that this is incomplete, especially for cardiometabolic risk.

The discussion introduces a practical concept: once you have established your baseline fasted panel, consider checking how your body handles a normal meal. This is referred to as a lipid load test.

The suggested approach is intentionally simple and “real life.” Eat a standard meal you would habitually eat, then test about 90 minutes after completing the meal.

One example meal given in the video is:

The point is not that everyone must eat that meal. The point is standardization, pick a meal you can repeat so the comparison is meaningful.

Why the postmeal window matters

This framing emphasizes that a lot of vascular biology happens when you are not fasted. Triglycerides rise after eating, glucose and insulin change, and inflammatory and oxidative processes can shift.

The video makes a strong claim in plain language: cardiovascular disease processes are not only a “fasting problem,” so you should at least know what your body does after meals.

Research supports the broader concept that nonfasting lipids can be clinically informative, and many guidelines now accept nonfasting lipid testing in appropriate contexts. For example, statements from major cardiovascular groups discuss the practicality and value of nonfasting lipids for routine assessment in many patients European Atherosclerosis Society consensusTrusted Source.

How to do a simple postmeal check (step-by-step)

This is not medical advice or a diagnosis tool, it is a practical discussion to bring to your clinician.

Short version: you are stress-testing your metabolism with your own food.

Important: If you have diabetes, are pregnant, have a history of eating disorders, or take glucose-lowering medications, do not experiment on your own. Talk with your clinician about whether postmeal testing is appropriate and how to do it safely.

Beyond LDL: ApoB, ApoA1, and the ratio focus

The video is not only about glucose. It is also about common bloodwork pitfalls in cardiometabolic health.

A major theme is that LDL cholesterol alone is not the best summary of atherogenic particles.

Instead, the discussion emphasizes:

The speaker notes a practical problem: many people never get ApoB measured at all.

The video’s target ratio is clear: as close to 0.5 as possible.

This ratio framing has support in cardiovascular literature. ApoB and ApoB:ApoA1 are discussed as useful risk markers in large studies and clinical guidance, although which marker is “best” can depend on population and clinical context. Many lipid guidelines recognize ApoB as a reasonable alternative or add-on to LDL-C, particularly when triglycerides are elevated or risk is uncertain 2019 ESC/EAS Dyslipidaemia GuidelinesTrusted Source.

A practical add-on list the video mentions

If you are already ordering advanced lipids, the video suggests considering additional markers often missed in routine panels.

This is a “build a better dashboard” approach. Not everyone needs every test, but the video’s stance is that if you are trying to understand cardiometabolic risk, you should measure the markers that actually map to the biology you care about.

Nuances and edge cases the video touches on

The most useful parts of the conversation are often the side comments, because they reveal how the speaker thinks about edge cases.

Fasting insulin: “normal range” vs “optimal”

A viewer asks about an A1C of 5.6 and fasting insulin of 7.

The response is nuanced. An insulin of 7 is described as not alarming, especially given that lab reference ranges can go up to about 20. But the speaker’s personal “metabolically healthy” target is closer to 4 or 5.

This highlights a common misconception: reference ranges are not the same as personalized targets. Reference ranges are often statistical, not necessarily optimal for long-term risk reduction.

At the same time, the video also warns you not to over-interpret insulin in isolation because it varies with recent meals, exercise, and carbohydrate intake.

Aging and rising glucose

Another viewer (age 66, very active) asks if rising fasting glucose and an A1C of 5.6 means they are “destined” for worse outcomes.

The answer acknowledges that glucose can rise with age, but pushes back on the idea that an A1C of 5.6 is automatically a disaster. The practical suggestion is to look at the whole pattern using additional markers like 1,5-AG and fructosamine.

This is a “do not catastrophize one number” message, paired with “do not be complacent either.”

ApoB rising on low-carb or keto diets

A viewer asks how to lower ApoB.

The video’s response includes a notable nuance: ApoB can increase on a low-carb or keto diet, and the speaker presents this as something that can happen naturally and may not be “a big deal” in isolation. They also encourage looking at ApoB in context, especially with ApoA1 and the ratio.

This is a good example of the video’s broader philosophy: context beats single markers.

B12 labs in pregnancy and “functional” testing

A viewer asks about high B12 while pregnant and taking liver supplements.

The video points out that serum B12 can “bounce around” and suggests looking at methylmalonic acid (MMA) as a more functional marker, along with red blood cell indices like MCV and MCH.

This aligns with a common clinical approach: MMA can help evaluate functional B12 status in some contexts, because it tends to rise when B12-dependent metabolism is impaired NIH Office of Dietary Supplements, Vitamin B12Trusted Source.

It also includes a practical food-supplement note: the speaker does not think humans are intended to eat liver every day, and suggests backing off daily liver supplementation, especially in pregnancy, and discussing supplementation choices with a prenatal clinician.

»MORE: Consider creating a one-page “lab ask” list for your next appointment: fasting glucose, fasting insulin, A1C, fructosamine, 1,5-AG (GlycoMark), ApoB, ApoA1, Lp(a), and a note about whether you want a postmeal check.

Key Takeaways