November was Diabetes Awareness Month in Canada. With one in three Canadians already living with diabetes and an estimated 1.5 million living with undiagnosed diabetes, it is important to have an open and honest conversation about high blood sugars.
Chronically elevated blood sugars happen when the body’s pancreas either cannot make insulin (Type I diabetes) or cannot use the insulin it makes properly (Type II diabetes). The job of insulin is to get glucose into cells where it can be used or to store the glucose as fat when it is not being used. In the early stages of blood sugar dysregulation, the cells of the body can become more and more resistant to insulin (known as insulin resistance).
Elevated blood sugars for a prolonged period of time is a risk factor for the development of cardiovascular disease, chronic kidney disease and eye disease. When there is too much glucose in the blood, it makes red blood cells jagged and sharp. When they pass through small blood vessels, they cause inflammation and damage. Other risk factors for the development of these conditions are high blood pressure, smoking, age, gender and high cholesterol. Early signs of blood glucose dysregulation include fatigue, weight gain, extreme thirst, frequent urination, frequent infections and erectile dysfunction. Later signs are numbness and tingling in the hands and feet, poor wound healing and hair loss. Very late stage, uncontrolled or poorly controlled diabetes can involve blindness, heart attack, nerve damage and skin ulcerations/amputations.
The most common type of blood sugar dysregulation we see in practice is type 2 diabetes. This is most often an issue that develops slowly and later in life. A diagnosis of type 2 diabetes can be made when there is a fasting blood glucose reading of 7.0 mmol/L or greater or an A1C of 6.5% or greater. We also test fasting insulin to see if they body’s insulin needs are increasing overtime. In practice however, physicians are careful about assigning a diagnosis of type 2 diabetes as patients can feel that when labelled with “diabetes”, it becomes a part of their identity. It is can be difficult to find hope that things can get better and to break free from the label. It is important to remember that issues with blood sugar regulation is not a disease, it is a risk factor for the development of other diseases. It can take many years for some of these conditions to develop and it can often be controlled by diet, exercise, weight loss and a few select supplements. In some cases, blood sugars cannot be effectively controlled by these measures and blood sugar regulating medications may need to be used.
Here are the top ways to help control blood sugars:
Aerobic exercise (running, biking, swimming, walking) and high intensity interval training (HIIT) is one of the best ways to regulate your blood sugars. Studies show that even 40 min of pedaling on a stationary bike two times a week can significantly lower fasting blood glucose and increase the body’s sensitivity to insulin (Shahgholian et. al., 2015). Exercise plays a major role in the prevention and control of insulin resistance, type 2 diabetes and diabetes-related health complications (Colberg, 2010). When undertaking a new exercise program, it is important to consult a healthcare provider to ensure that it is done safely and effectively.
The type II diabetes diet focuses on increasing fresh leafy green and colourful vegetables, quality lean protein (chicken, cold water fish, beef) and healthy fats (nuts and seeds and cold-pressed oils like olive, avocado and flax). We also focus on greatly reducing processed grains, refined carbohydrates, processed foods and simple sugars (sweets, flours, juice and soda). Dietary habits can be challenging to change. Working with a nutritionist can be a helpful way to stay on track.
Natural supplements can be used to help lower blood sugars. For example, berberine has been shown to be as effective as metformin (an anti-diabetic drug) in lowering blood sugars in a 3 month period of time (Yin, 2008). The herb Gymnemahas also been shown to lower blood sugars and improve cholesterol (Ulbricht et. al., 2011). We use bilberry and ALA to help protect blood vessel walls from glucose.
- Medications (when needed)
If we are unable to lower blood sugars with lifestyle and natural measures, we may need to use anti-diabetic medications to help lower blood sugars and protect blood vessel walls. Naturopathic physicians are trained to prescribe medications and work with you to manage and optimize your medication regimen. The decision to use medications should be based on the severity of blood sugar dysregulation and other risk factors present (i.e. high blood pressure, age, gender, smoking etc.). It is also important to continue to work on lifestyle changes so that the lowest effective dose of the drug may be used to minimize side effects. Once an anti-diabetic medication has been initiated, it does not necessarily have to be taken for the rest of your life. Continuing to work on naturally lowering blood sugars is always the goal and medications can be discontinued when no longer needed.
If you have a family history of diabetes, or you yourself have other cardiovascular risk factors and want to learn more about blood sugar regulation, I encourage you to book an appointment with your naturopathic physician. You can also calculate your cardiovascular risk score on your own or with your physician using this link: http://chd.bestsciencemedicine.com/calc2.html
- Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., Chasan-Taber, L., Albright, A. L., Braun, B., American College of Sports Medicine, American Diabetes Association (2010). Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care, 33(12), e147-67.
- Diabetes Canada. https://www.diabetes.ca/Accessed December 4, 2018.
- Shahgholian, N., KarimiFard, O., & Shahidi, S. (2015). Effects of aerobic exercise on blood glucose in continuous ambulatory peritoneal dialysis patients. Iranian journal of nursing and midwifery research, 20(2), 165-70.
- Ulbricht, Catherine & Rae Abrams, Tracee & Basch, Ethan & Davies-Heerema, Theresa & Foppa, Ivo & Hammerness, Paul & Rusie, Erica & Tanguay-Colucci, Shaina & Taylor, Sarah & Varghese, Minney & Weissner, Wendy & Woods, Jen. (2011). An Evidence-Based Systematic Review of Gymnema(GymnemasylvestreR. Br.) by the Natural Standard Research Collaboration. Journal of dietary supplements. 8. 311-30.
- Yin, J., Xing, H., & Ye, J. (2008). Efficacy of berberine in patients with type 2 diabetes mellitus. Metabolism: clinical and experimental, 57(5), 712-7.