Katy Harvey: Kristie, thank you so much for being here. We’re going to start with a quick lightning round.

Kristie Messerli: I’m excited too.

Katy Harvey: One food that people are unnecessarily afraid of.

Kristie Messerli: Bananas.

Katy Harvey: One habit that’s wildly underrated?

Kristie Messerli: Walking.

Katy Harvey: Best breakfast for balancing blood sugar.

Kristie Messerli: This one’s nuanced — it depends. But eggs with toast, avocado, and fruit is a good one. Or, if you need something on the go, a protein drink with fruit and half a bagel.

Katy Harvey: Biggest blood sugar mistake.

Kristie Messerli: Not checking your numbers at all.

Katy Harvey: Coffee before breakfast — yes, no, or depends?

Kristie Messerli: Generally no. Coffee with breakfast, yes.

Katy Harvey: Favorite way to move your body after meals?

Kristie Messerli: Going on walks, taking my dogs out.

Katy Harvey: One thing social media gets horribly wrong about diabetes.

Kristie Messerli: That diabetes is a reversible condition. It’s not.

Getting Into Diabetes Education

Katy Harvey: Give us more context on who you are and how you became a diabetes specialist.

Kristie Messerli: A lot of dietitians get into this field because they themselves struggle with their relationship with food and their body. I spent my life dieting, watched my mom and grandma diet my whole life, and it got worse in college — classes were tailored toward weight management, and we did skinfold tests on each other and calculated BMI in front of the class. I went into the profession thinking it would heal something in me, and it kind of exacerbated it instead.

After becoming a dietitian, I started working at a tribal health center serving the Native American population in my hometown. My aunt, who’s a dietitian running an eating disorder clinic in Seattle, encouraged me to start logging hours toward becoming a certified diabetes educator, since I’d be seeing a lot of diabetes there. She was right — I saw patients from age 11 to their 90s.

I developed a huge passion for diabetes even though it doesn’t run in my family. But people were getting bad advice from doctors — just lose weight, cut carbs, cut traditional foods — advice that felt like a risk to their identity. Even when people had wonderful A1Cs, I’d get referrals for weight management with nothing else wrong in their chart. That’s why I eventually started my private practice.

Katy Harvey: What made you shift away from the “lose weight to control blood sugar” narrative?

Kristie Messerli: It never worked for me, or my mom, or my sister. There was always an icky feeling about weight loss. What really turned the tables was seeing people drop their A1C three points, with beautiful labs, and still get referred to me for weight management. They’d tell me they couldn’t even feel happy about their blood sugar because their doctor was still upset about their weight. People were losing the motivation to care for their health because they realized they’d be treated the same regardless of their numbers.

Her Philosophy on Diabetes Care

Katy Harvey: What’s your approach when working with someone who has diabetes?

Kristie Messerli: I look at people from a bird’s-eye view. We’re told blood sugar depends on how much we eat and exercise, and while true, that misses the whole picture — stress, sleep, how long someone’s been diagnosed, medications, family history, even socioeconomic factors like access to medication. I dig into nutrition and lab work, but also really try to understand someone’s life.

I also want to help people manage blood sugar with as little disruption to their life as possible. Most of us don’t want to be told we have to overhaul everything. People feel relief realizing it’s not just about food — food matters, but it’s not the only piece.

Top Diabetes Myths

Katy Harvey: What are the top diabetes myths you hear all the time?

Kristie Messerli: First: that diabetes is reversible. This sets people up with a false sense of what the future looks like. Diabetes tends to be progressive, and age alone increases risk. Second: fear of carbohydrates. Carbs are our body’s preferred energy source, and cutting them out entirely isn’t sustainable for most people — it can actually worsen carb tolerance and insulin resistance over time. Third: that you have to lose weight to lower blood sugar. Weight loss and lower blood sugar don’t have a causal relationship.

Katy Harvey: Walk us through the reversible-vs-remission distinction.

Kristie Messerli: The American Diabetes Association’s standards of care state diabetes is not reversible — the more accurate term is remission, meaning an A1C under 5.7 for three or more months without medication. By the time someone is diagnosed, their pancreas is functioning about 60% less efficiently than before. Since we can’t reverse that damage, it makes sense that diabetes isn’t truly reversible, even though we can absolutely protect the pancreas and improve insulin sensitivity.

People who cling to the idea that it’s reversible often go to extremes trying to “fix” it and feel like failures when their numbers don’t drop below 5.7 — even when they’re doing everything right. Framing it as manageable rather than reversible keeps people empowered rather than stuck.

What She Actually Guides Clients to Do

Katy Harvey: If you’re not focused on weight loss or restrictive diets, what are you guiding people toward?

Kristie Messerli: First, understanding what’s actually happening in their body — I use visuals to show how all carbs, whether from a donut or a banana, break down into sugar. That understanding eases a lot of anxiety. I dig into medical history, medications, and what a typical day looks like for them.

We look at pairing carbs with protein, fat, and fiber — “eat what you want, then add what you need.” I also dig into stress, sleep, and something a lot of diabetes educators skip: the shame and guilt around diagnosis, which can hold people back from actually making change.

Katy Harvey: Do you see a lot of shame around diagnosis?

Kristie Messerli: All the time. I had a client in my group coaching program who attended calls from her car because she was so anxious about anyone knowing she had diabetes — her husband didn’t even know. By the end of the program she’d had some open conversations with her family, but that shame keeps people from getting labs done or checking their numbers at home. It touches every part of someone’s life.

Katy Harvey: Where do you think that shame comes from, compared to other conditions?

Kristie Messerli: Diabetes is treated as something you could have prevented, so people feel judged for “failing.” I’ve worked with clients across every body size and background, including a woman with a “normal” BMI whose doctor had no real advice for her once weight loss wasn’t the answer. We blame people’s choices for a condition that’s far more nuanced than that.

GLP-1 Medications

Katy Harvey: What’s your take on GLP-1 medications?

Kristie Messerli: I love them for a lot of reasons, and have reservations too. Most are a once-weekly injection, which helps people who struggle with daily pills. They work by responding to rising blood sugar after carbs are eaten, so they don’t cause lows the way insulin can. I’ve seen clients get a much better handle on their blood sugar.

But the medication is FDA-approved for diabetes management — weight loss is a side effect, not a guarantee. I’ve had clients not lose weight on it and feel like they failed, when really their blood sugar was doing great. I’ve also seen clients go from three oral medications down to one GLP-1 injection, which lifts a real mental burden.

Medication Shame

Katy Harvey: Do you see shame around needing medication in general?

Kristie Messerli: Constantly. I made a video about how you don’t get an award for not being on medication. Working in clinical settings, I saw the complications of poorly managed diabetes firsthand — kidney disease, heart disease, stroke, and foot issues like neuropathy that can lead to ulcers and amputations. Any A1C above seven for an extended time raises the risk of these complications.

I’ve had clients avoid medication that could clearly help just to say they weren’t on it, which is playing with fire. Often people are handed a prescription with no other education, which fuels anxiety — most people want to know they’re doing something themselves too, not just taking a pill.

I also had a client who managed near-remission numbers only by being rigidly disciplined about food and exercise, to the point that any small deviation sent her spiraling. Eventually we talked about whether a low dose of medication might make things easier for her — and it was clearly indicated regardless of how disciplined she was.

Prediabetes vs. Diabetes

Katy Harvey: Can you break down the difference between prediabetes and diabetes? A lot of people panic over the prediabetes label.

Kristie Messerli: The real difference is where the A1C falls — 5.7 to 6.4 is prediabetes, above 6.4 is diabetes. Prediabetes is worth taking seriously, but I recommend eating and living the same way I’d recommend to anyone: caring about blood sugar, stress, sleep, and mental health. Genetics play a role too — family history raises the odds significantly.

I don’t think prediabetes should send anyone back into dieting. Yo-yo dieting, weight cycling, and cutting out whole food groups repeatedly seem to contribute to blood sugar instability, and I think that’s a real driver behind the rising rates of diabetes.

Handling an Unexpected Lab Result

Katy Harvey: How do you talk a client through a panicked message about a rising A1C?

Kristie Messerli: I start by validating the fear rather than rushing to find a silver lining. Then I ask what their expectation was going in — what number did they think they’d get? That helps me understand if the shock is really about the number, or about something else. I also ask them why they think it went up, since I’m not in their home seeing their day-to-day. Having them self-assess first builds a skill they can keep using without needing me every time.

Cravings

Katy Harvey: How do you guide people on honoring cravings alongside blood sugar management?

Kristie Messerli: I don’t think cravings are inherently bad — I have them too. First I assess blood sugar stability, because unstable blood sugar or under-eating during the day can intensify cravings into something more urgent, versus a simple “this sounds good.” A lot of women I work with go all day eating very little and then wonder why they’re craving everything by evening.

If blood sugar is stable and someone’s eating enough, cravings are part of intuitive eating and worth honoring. The nuance with diabetes is pairing frequent cravings — like a nightly sweet treat — with some protein or fiber so blood sugar stays steadier. But if it’s a one-off, like ice cream with the kids, there’s no need to overthink it. Context and frequency matter.

What People Obsess Over vs. What They Overlook

Katy Harvey: What do people obsess over that doesn’t matter much, and what do they overlook that actually does?

Kristie Messerli: People put nearly all their focus on carbohydrates and treat everything else as secondary. I think of a woman I saw regularly in a clinical setting who was extremely consistent with her health, but after her husband passed away suddenly, her numbers shot up even though nothing about her diet or exercise had changed. Her whole life had changed. Food can heal, but we forget we’re a whole person, not just our food choices.

What Clients Have Taught Her

Katy Harvey: What have you learned from working with so many people with diabetes?

Kristie Messerli: I thought I already understood blood sugar management from a book-knowledge standpoint, but working directly with people taught me so much more nuance. Since I don’t personally have diabetes, the biggest thing I’ve learned is how much shame and guilt shapes how people live with the diagnosis — enough that I built an entire section on shame and self-compassion into my group coaching program.

Three Things to Focus On

Katy Harvey: If you could leave people with three things to focus on for healthier blood sugar, what would they be?

Kristie Messerli: First, start looking at your numbers with regular lab work — fasting blood sugar between 80 and 130, and under 180 two hours after a meal, plus a regular A1C test.

Second, find a way to move your body that feels good — walking, playing with your kids, cleaning the house. Activity helps the body use sugar more efficiently.

Third, eat more fiber. People focus heavily on carbs and protein, but fiber is the real MVP — it can help with cholesterol, blood sugar, and blood pressure all at once. Ideally from food (berries, nuts, seeds, avocados) rather than supplements.

Katy Harvey: What about CGMs — should people without diabetes use them?

Kristie Messerli: Not necessary, and not indicated — not even for prediabetes. CGMs are usually only covered by insurance for people on insulin, so most of my clients either pay out of pocket or use a finger-stick glucometer. I wore one myself for two weeks just to understand the experience before teaching it to patients, and even I found it wasn’t necessary — it caused a lot of hyper-focus on numbers.

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