Controlling your blood sugar level is vital to your metabolic health, helping you avoid type 2 diabetes, hypertension, stroke, and heart problems, as well as delivering positive effects, such as weight loss and cholesterol reduction

Controlling your blood sugar is, in many ways, the key to metabolic health.  Such control not only reduces your risk of health problems such as diabetes and heart disease but also helps with weight loss, blood pressure and cholesterol level reduction.  However, blood sugar control is not a quick fix but a lifelong process, requiring monitoring, support, and guidance.

Metabolism is the bodily process meant to convert food into energy, which our cells use to run their vital activities.  The process involves the digestion, absorption, and assimilation of food.  The best metabolic scenario is to produce enough energy to give you high vitality without storing much as fat.  We generally describe a person like that as “looking good and feeling great.”

Our basic metabolic rate (the amount of energy we spend when resting) accounts for 60% of our daily energy consumption.

You will be classified as in good metabolic health if your blood pressure is below 120/82, blood sugar level is under 5 mmol/L (90 mg/dL), waist conference is less than 37 inches for men or 32 inches for women, and your HDL (the good guy cholesterol) is above 1.0 mmol/L (50 mg/dL) for men and women, Triglyceride less than 1.7 mmol/L (150 mg/dL).  Anything outside any of these ranges is a risk factor.  Having three or more risk factors is enough for a diagnosis of metabolic syndrome.

However, such a diagnosis is not made if blood glucose dysregulation is missing because people who have a healthy blood glucose level are at a lower risk of cardiovascular disease, diabetes, and dementia.

In a review of 44 high-quality studies on type 2 diabetes published between 2016 and 2017, the authors concluded that regulating blood sugar should be a key treatment goal for patients with diabetes.  This is because such treatments have been linked to many health benefits, such as weight loss, reductions in blood pressure and cholesterol levels, and reduced risk of heart attack, stroke and heart-related death.

“But I don’t eat sugar………….”

Studies confirm that 90-92% of diabetics suffer from type 2 diabetes.  This is mainly due to insulin resistance, complicated at a later stage by the failure of the pancreas to produce adequate amounts of insulin, resulting in high blood glucose.  “Pre-diabetes” is inadequate control of blood sugar before it reaches the level of having type 2 diabetes.

I have met many patients who say that they do not eat sugar but who, when you dig a little deeper, admit that they eat cereal for breakfast, have bread or potatoes for lunch, and pasta, pizza or rice for dinner.  All of these carbohydrates are full of sugar.  Digesting a potato is comparable to opening a bag of sugar in the stomach.

Food’s glycaemic index and glycaemic load are important.

The glycaemic index tells you how fast after they are ingested, carbohydrates are going to cause a glucose and insulin spike.  White bread and rice have a glycaemic index close to sugar.  Glycaemic load indicates the sugar content of the food.  So, for example, watermelon has a high glycaemic index but low glycaemic load; hence its ingestion could be okay in moderation.

Nutraceutical agents to control blood sugar include Berberine, which also improves your lipid profile, decreasing triglycerides, total cholesterol, and LDL cholesterol.  They also include mixed strain probiotics, chromium, cinnamon, and psyllium husk, which also helps weight loss and improves constipation.

Technology – a source of comfort or anxiety?

Technology has invaded conventional medicine to the extent that it greatly improves diagnostic accuracy but negatively impacts medical training because doctors have become totally reliant on it.

Technology has a great impact on acute medicine.  In coronary care and intensive care units, heart and lung monitoring are of great value, guiding therapy and providing early warnings.

The same technology can also monitor your personal health, with Oura Rings tracking the quality and quantity of your sleep and Apple Watches logging your physical activity.

The Financial Times recently reviewed a continuous glucose monitor (CGM), which helps people see the effect of the food they eat and thus identify undiagnosed prediabetics (13% in the UK and 37% of the US population).  Again, the CGM also helps people find out where they stand in the metabolic health spectrum.  (One study showed that only 12% of the US population enjoy optimal metabolic health.)

The gadget aims to prevent metabolic conditions such as obesity, prediabetes, and type 2 diabetes.  It could also help to optimise our physical activity and even banish the dreaded 4pm slump.  Critics think it’s not going to work because we have not yet defined what is normal for people of all ages and ethnicities.  And, let’s face it, the data on that little screen may also cause worry and confusion since blood sugar levels are influenced by many factors, not just food and physical activity.

Not all sugar is equal

There are different types of sugar.  Glucose, fructose (fruit sugar) and lactose (milk sugar) contain just one type; hence they are called monosaccharides.  On the other hand, sucrose (table sugar) is a disaccharide made up of equal amounts of glucose and fructose.

Glucose is the body’s preferred form of sugar because it stimulates the pancreas to produce insulin, allowing glucose to enter every cell to give you energy.  Food high in glucose includes table sugar and processed carbohydrates (starches), such as bread, rice, pasta and pizza.  Consumption of these foods causes a spike in insulin, and over time may result in insulin resistance, the underlying cause of metabolic syndrome and diabetes.

On the other hand, fructose is fruit sugar, seven times sweeter than glucose.  Fructose is also available in honey, but the real health problem is related to high fructose corn syrup (HFCS), the sugar in fruit juice, fizzy drinks, and sports drinks, and in many ways, the cause of our obesity pandemic.

Fructose is different from glucose because it does not circulate in the blood but is taken up directly by the liver to be processed mainly into fat.  This can result in fatty liver, which progresses to non-alcoholic fatty liver disease (NAFLD), highly associated with metabolic syndrome.

This dangerous type of sugar does not show up on a blood sugar meter or monitor and is not detectable by any other means, such as checking insulin levels.

What’s lurking in your ketchup or bread?

Glucose absorption is well regulated in the gut, while fructose is not, meaning that fructose causes more damage unchecked.  Fructose was beneficial to ensure the survival of our ancestors in the famines of the past, but it is detrimental to our bodies while we are dealing with a huge amount of HFCS.  This factory-made substance is a tenth of the cost of sugar cane, so it is added to so many foods and drinks, from the obvious – soda, candy, snack bars – to the less so – salad dressings, ketchup and even bread.

Fructose in fruit is different from HFCS – it’s loaded with nutrients and contains a good amount of fibre, which slows down the absorption of sugar.  A glass of apple juice may contain the same amount of fructose as four whole apples.  You can easily drink two glasses of apple juice but obviously cannot eat eight apples in one go.

Fructose also lowers leptin (the “stop eating” hormone), so increasing your appetite and making it hard not to overeat, with a long-lasting negative impact on health.

There is strong evidence in medical literature to indicate that HFCS in fizzy drinks and fruit juice is associated with a high incidence of hypertension, adiposity, and gout (high uric acid level.)

I have met many diabetics who are frustrated because their blood sugar fluctuates while their food intake and physical activity do not change.  But blood sugar levels are affected by other factors: heavy or unusual exercise can obviously lower it due to increased consumption.  Lack of sleep raises blood sugar, as does stress because high cortisol antagonises insulin.

Many diabetics get admitted to the hospital with worsening diabetes due to infection, which increases the demand for insulin.  A high intake of alcohol raises blood sugar, as does hot weather.  Dehydration, menstruation, severe pain and medication can also cause fluctuation.

How to track your blood glucose

You can take blood sugar meter readings at different times of the day and night.  Haemoglobin A1c (HbA1c) reflects your glycaemic control over the last 3 months.

Low blood sugar and anxiety are linked, but the relationship is complicated.  Symptoms of low blood sugar can mirror those of anxiety or worsen existing anxiety.  Shakiness, fast heart rate, irritability, nausea, difficulty concentrating, and panic are all shared symptoms.

Some people, especially those who have diabetes, may also experience anxiety around regulating their blood sugar levels.  This may manifest as an overwhelming fear that you will become hypoglycaemic or not adequately manage your condition.

Low blood sugar occurs when a person’s blood glucose falls below normal levels.  This state is also called hypoglycaemia, insulin shock and insulin reaction.  For a person with diabetes, the level is below 5 mmol/L (70 mg/dL.)  For a person without diabetes, low blood sugar is considered to be below 3.5 mmol/L (55 mg/dL).

In addition to the symptoms above, low blood sugar can cause panic attacks, confusion, blurred vision and even loss of consciousness.  In the face of these, diabetic people often find it hard to monitor their blood sugar accurately.

The diabetic’s craving for sweetness is a survival mechanism, but if you are merely anxious, this inborn preference can work against you.

Sugar causes a serotonin crush, which gives you a short-lived boost for an hour or two before your serotonin level crashes and you feel even worse.  Sugar also suppresses a brain hormone known as BDNF, a natural anti-depressant.

How can you positively impact your blood sugar levels?

Exercise is great, especially strength training.  This is because a larger muscle mass raises your basic metabolic rate and energy consumption.  Eating protein at every meal stabilises your appetite and reduces your food intake.  Intermittent fasting trains the body to burn fat.  You also need to reduce your intake of sugar and processed carbohydrates, substitute slow carbohydrates for fast, and avoid vegetable oils, which can result in high inflammation, insulin resistance and metabolic syndrome.

Even simple steps, such as getting adequate sleep, reducing stress levels and gentle exercise, have a positive impact on glycaemic control.

So, my friends, don’t get anxious about your blood sugar level, which is in any case difficult to monitor, but which is straightforward to enhance – exercise, sleep, less stress, and a good diet can work wonders, giving our remarkable human bodies the tools by which to survive and thrive.  Please share your thoughts and ask any questions on this subject, and please do subscribe to the newsletter so that you don’t miss further vital information.  Thank you!



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