The three minutes before I opened the envelope
Last week I had my annual physical at the VA hospital. Standard stuff — blood pressure, weight, listen to the heart, order the yearly labs. A few days later, a letter arrived with the results.
I stood at my kitchen counter with the envelope in my hand for about three minutes before I opened it. I was not expecting good news.
Eighteen months ago, my Hemoglobin A1C came back at 7.6. If you are not familiar with A1C, it is a blood test that measures your average blood sugar over the previous 90 days. Under 5.7 is normal. 5.7 to 6.4 is pre-diabetes. Over 6.5 is Type 2 diabetes.
7.6 is not borderline. 7.6 is diabetes.
That was the day my doctor added Empagliflozin — a Type 2 diabetes medication — to my daily routine, and had a hard, honest conversation with me about what needed to change if I did not want to be on more medications, more doses, and eventually insulin.
What I did between then and now
I am not going to pretend this was a straight line. It was not. But roughly, the things I changed over the following eighteen months:
Evening eating protocol. I stopped eating anything after about 6 PM. Cut bread, pasta, sugar, and alcohol from my dinner plate almost entirely. If you have been reading the recent blogs, you know why this matters — late carbs spike blood sugar overnight and trigger a cortisol response at 3 AM. For a diabetic, that spike and crash cycle is even worse than for someone with normal glucose control.
Consistent sleep protocol. Same bedtime, same wake time, cool dark room, no screens after 9 PM. Sleep is not a passive activity for someone managing blood sugar — poor sleep worsens insulin sensitivity the next day. Every hour of quality sleep pays back in blood glucose regulation the following morning.
Walking. Twenty to forty minutes most days. Nothing heroic. But consistent enough that it started to matter.
Medication compliance. This part is embarrassing to admit but worth saying — for years I was a person who forgot half my supplements and skipped doses because I felt fine. I stopped doing that. When my doctor prescribed something, I took it every day at the same time.
What the envelope said
I opened it standing at the counter. Hemoglobin A1C: 6.6.
Down a full point from 7.6. Still technically in the diabetes range (6.5+), but genuinely close to the pre-diabetic threshold. In A1C terms, one full point is a lot. Most people who improve on medication and lifestyle move 0.3 to 0.5 points in that timeframe. One point over eighteen months is substantial.
It is not where I want to end. I want to see 5.7 or lower on a future test — which would put me in remission territory. That is going to take another twelve to eighteen months of the same discipline, probably with a lower medication dose over time as the behavior continues to hold.
But 6.6 was a much better number than the one I was afraid of. And it confirmed something I have been saying on this blog for months — behavior and discipline actually move biology. Not fast. Not without effort. But measurably.
Why I am telling you this
For the same reason I write about sleep. The behavior work is not glamorous, does not fit in a soundbite, and does not sell like a pill or a supplement. But it works.
If you are somewhere in your 40s, 50s, or 60s and you have been sleeping badly, gaining weight without changing what you eat, feeling wired-but-tired in the mornings — I would encourage you to ask your doctor for a full metabolic panel. Specifically ask for the Hemoglobin A1C. It is a cheap test, most standard panels include it, and it will tell you whether you are drifting into pre-diabetic territory without knowing it.
If your A1C is under 5.7, great. Keep doing what you are doing. If it is 5.7 to 6.4, you have a real opportunity to reverse the trend before you cross into diabetes. If it is 6.5 or higher, you and your doctor have a starting point for a conversation.
Sleep, evening eating, walking, and consistency are the things I know actually work — for me, and for the clinical literature I have read. Medication when appropriate is not a moral failure; it is a tool. The two together, done consistently, move numbers.
The sleep connection
This is why I keep coming back to sleep on this blog. Blood sugar and sleep are two sides of the same coin. Poor sleep wrecks blood sugar regulation the following day. Elevated blood sugar overnight triggers cortisol releases that wreck the following night’s sleep. If you are stuck in that loop, you will keep bumping up against the same ceiling no matter how much you diet or how many supplements you try.
The three-pillar Sleep Discipline framework — environment, evening eating, wind-down ritual — is not just about sleeping better. For anyone in the pre-diabetic or diabetic range, it is one of the most measurable behavioral interventions available. And nobody prescribes it because nobody profits from it.
The complete framework
The Sleep Discipline Method walks you through all thirty days of the reset — environment, evening eating, wind-down, morning anchors. Same voice as this blog, same practical tone, same story-based approach.
Get it here for $7: wellnessdiscipline.com
Written from Vermont, on the morning after the letter, feeling better about what the next test might show. — Brian