Blood Sugar

  If you have someone in your life who is diabetic, or if you are yourself, you are well familiar with the subject of blood sugar.  Even those who are not diabetic experience its effects when they become sleepy after eating a big meal high in carbohydrates:  “I need a siesta!”   Blood sugar interests me because I have someone very dear to me whose life has been devastated by adult onset diabetes (Type 2 diabetes).  Factoring in my family history and body type, I too am at significant risk for developing the disease.  The subject of adult onset diabetes and how we manage our blood sugars through diet and exercise is fairly complex.  From a nutritional standpoint, it’s an important idea to wrap our brains around because diabetes will impact so many of us.  If you are a person in your 50’s who just had a normal fasting glucose test at your last check up, you still have a 1 in 8 chance of developing diabetes in the next decade. 

  When we eat food, it is broken down into smaller packets by the digestive system.  The energy that your body needs to run properly is sent out into the blood stream in the form of sugar (glucose).  Your blood sugar level (blood glucose) is the amount of sugar in your blood at any given time.  The muscles, the brain and all the organs of the body depend on receiving the right amount of glucose to function.  After you eat a meal, blood sugar levels rise.  Your body responds by sending out insulin to move some of the sugars into the muscles and other organs (like sending out the police force to move the thugs off the street).  There is a very narrow range of blood sugar level that the body aims to achieve when it is working properly – not too much and not too little.  For example, normal levels might mean fasting blood sugars in the 70s to mid-80s, a mild spike up to around 120 mg/dl after eating a significant amount of carbohydrates, and then a return to under 100 mg/dl by two hours after the meal.  By comparison, diabetics are advised to keep their blood sugars under 140 mg/dl two hours after eating.

  The beta-cells in the pancreas are responsible for producing insulin at the right time and in the right amounts.  The problem that occurs in diabetes is that the body’s sugar regulation mechanism fails and the blood sugar levels remain too high for too long.  When there are perpetually too many sugars circulating in the blood, they harm the body.  They can damage the retina of the eye and scratch the inner lining of the arteries.  The body patches these arterial scratches with LDL cholesterol.  The cholesterol hardens like cement, ultimately narrowing the artery wall (called hardening of the arteries).  This of course can lead to heart attacks and strokes.  It’s a big part of why we visit the cardiologist.

  Two different malfunctions can cause the body to fail at regulating your blood sugar:   your body’s muscle and liver cells may have become resistant to insulin (the normal amount of policemen aren’t able to make the thugs get off the street), or the beta-cells in the pancreas are failing – perhaps dying – and there are not enough of them to do the job of producing adequate insulin (there aren’t enough policemen to get the thugs off the street).  The first condition is insulin resistance.  The pancreas must respond to this situation by producing even more insulin than normal to keep blood sugars down.  People with insulin resistance often have no symptoms and do not have abnormal scores on the traditional fasting blood glucose test that is given to detect diabetes.  The average screening done in an annual physical will not identify a problem.  If you have concerns because of your family history, you will have to press your physician for other tests that may give soft indicators that this is a problem for you. 
  The second scenario is characterized by the pancreas not being able to produce enough insulin to keep blood sugars down.   This is what occurs in juvenile diabetes (Type 1), but there are some indicators that adults may also have genetic predispositions that lead the beta-cells to die off or fail at their insulin production duties later in life.  Another condition that can lead to the death of beta cells occurs when the body's own immune system, for reasons still not well understood, begins to attack and destroy its own beta-cells (an autoimmune response).  This phenomena may have both genetic and environmental origins.
  Both of these malfunctions in the body's ability to regulate blood sugar can lead to impaired glucose intolerance (pre-diabetes).  There is no test to determine which one of these processes may be happening inside of you, and as you continue down the road to diabetes, you may actually have BOTH occuring.  If either malfunction progresses to a serious enough level, you will eventually register as "diabetic":  in both scenarios more insulin is needed to clear the blood of excess sugars.  If you don’t respond to medications that encourages the pancreas to release more insulin, you likely have lost a lot of your insulin producing beta-cells. 
  Insulin resistance sometimes leads to the death of beta-cells.  The pancreas has to work so hard to make so much extra insulin for so long, the beta-cells eventually wear down and can’t keep up.  Also playing into this dynamic is the fact that high levels of glucose in the blood stream are toxic to the beta-cells in the pancreas (called “glucose toxicity”).  Having chronically high glucose in the blood damages and kills the beta-cells, contributing to the development of impaired glucose tolerance. 

  Another term frequently used in talking about the diabetes pathway is “metabolic syndrome”.   You are labeled as having metabolic syndrome if you have excess weight around your middle, are insulin resistant (mildly elevated fasting glucose), have low levels of good cholesterol (HDL), high blood pressure, and/or have high triglycerides (which indicate excess sugars are being stored in the liver, making it fatty).

The road to diabetes looks something like this:

Insulin resistance (your body doesn’t drop glucose levels as quickly as it should after eating;  you have intermittent high blood sugars, but this doesn’t show up on a fasting glucose test)

       ↓

Metabolic syndrome (not all individuals will be identified with this profile on their path to diabetes)

       ↓

Impaired fasting glucose (you score high on a fasting glucose test)
(pre-diabetes)

      and
Impaired glucose tolerance (not enough insulin is being produced and/or being used)

(pre-diabetes)

       ↓

Early diabetes, non-insulin dependent

       ↓

Late diabetes, insulin dependent

    The best place to work on prevention of diabetes is at the stages of insulin resistance and impaired glucose tolerance, when there are still healthy beta-cells available to do at least some of the job.  Unfortunately, since many people are not even aware that they may be insulin resistant, they don't perceive that diabetes is an issue for them.  

Factors that put you in a higher risk group for pre-diabetes and diabetes:

• being overweight
• carries any excess weight around the mid-section (an "apple" body type)
• being over age 45
• being physically inactive
• giving birth to a baby over 9 lbs. or having gestational diabetes
• having polycystic ovarian syndrome (PCOS)
• having a history of cardiovascular disease
• having a family background of African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander
• having a parent or sibling with diabetes
• having high blood pressure
• having low HDL (good) cholesterol or high LDL (bad) cholesterol
• insulin resistance which can go undetected for years -- more severe cases may have presence of dark patches on the skin called acanthosis nigricans 
• having high fasting triglycerides

We cannot control the genetics we inherit, but we CAN control our diet, weight and level of exercise.  There ARE steps you can take to lessen the odds that you will head further down the road to diabetes.

  Steps you can take to avoid diabetes:

·    Eat a diet that is not always challenging the system to produce high levels of insulin to clear sugars out of the blood.  Sorry, that does mean that sugary snacks and desserts should not be a commonplace event in your diet, but "special."  Reduce carbohydrates to levels where blood sugars aren’t constantly spiking.  Strive for a high protein/low-fat diet, with non-starchy vegetables and complex carbohydrates (as found in whole grains), rather than foods high in the simple carbohydrates found in refined sugar, starchy vegetables and white rice. 

·    Try eating 5-6 times a day (3 smaller meals and 2-3 snacks) instead of depending on two large meals – much like what is recommended for diabetics. 

·     Exercise, of course, causes the body to burn sugars and maintains the health of all body systems.  Research indicates exercise can help make the insulin more effective.  It kick starts the metabolism to help in weight management.

·    Maintain a healthy weight and body mass index.  Individuals who carry their excess weight around their middle are particularly vulnerable to developing diabetes.

  There is some current debate whether being overweight causes diabetes OR whether the impaired ability of the body to regulate insulin and blood sugar causes people to be overweight.  It’s probably a little of both.  Even individuals with no weight problem can develop adult onset diabetes.  The best approach is to not be defeated by guilt that you may have brought this condition upon yourself.   Kick into gear with a commitment to do all you can to improve your health.  Many people headed down the pathway to diabetes are able to reverse course when they eat better, exercise, and get down to a healthy weight.  
  I know some of you reading this have already walked this road and now are living with diabetes.  I encourage you:  continue to be diligent with your diet and exercise regimen to keep those blood sugars well managed.  All the organs of your body receive the benefits of "keeping the thugs off the street".  You can meet the challenges that diabetes has brought to your life by fighting back with all the weapons in your arsenal:  good diet, consistent exercise, and close monitoring by your health professional.  Let diabetes be the adversity that motivates and pushes you into a more healthy lifestyle.  You can do it!
   For more information go to:  http://diabetes.niddk.nih.gov/index.aspx