Blood Sugar Balance

Human body requires energy, which comes from food. Sugars and starches, known as carbohydrates, are the most efficient energy sources. In the gut, they are broken down to glucose, which gets into the blood stream and is delivered to various organs and muscle. Blood glucose is often called blood sugar. The blood sugar concentration in healthy individuals varies from 60 – 90 mg/dL after fasting to not more than 140 – 150 mg/dL one hour after a meal. This is called a healthy blood sugar balance. It goes back to the baseline level 2 – 3 hours after a meal.

The blood sugar concentration is controlled by two hormones, glucagon and insulin. Both hormones are produced in the pancreas in response to changes in the blood sugar levels. During fasting, the decreasing blood sugar levels trigger secretion of glucagon by the pancreatic alpha cells and inhibit insulin production by the pancreatic beta cells. The increase of the blood sugar level after a meal stops glucagon production and promotes insulin secretion by the pancreatic beta cells. Therefore, glucagon and insulin are antagonists.
Glucagon stimulates breakdown of glycogen, a starch-like compound produced and stored in the liver, to glucose. If glycogen is depleted, glucagon triggers gluconeogenesis in liver cells. Gluconeogenesis is a process of glucose synthesis from the products of protein and fat digestion. Glucagon also stimulates fat breakdown in the adipose (fat) tissue. Insulin stimulates glucose uptake by all cells in the body, especially by muscle, liver, and adipose tissue. In the liver, insulin promotes synthesis of glycogen from glucose. Insulin also stimulates fat production and storage in the adipose tissue.
In summary, the blood glucose concentration is self-regulated. When it is too high, insulin is produced, and the excess of glucose is quickly absorbed and stored for later. When it is too low, glucagon is secreted, and the glucose is released to the blood stream.

The delicate and precise mechanism of the blood sugar maintenance is impaired in diabetes mellitus, a chronic metabolic disorder. Type 1 diabetes is a condition when the pancreatic beta cells stop producing insulin. Most type 2 diabetes patients produce at least some insulin, but their bodies have a reduced capacity to absorb glucose even in the presence of insulin. Diabetes of both types results in a significant (2 – 5-fold) in the bloodstream for hours and days. Disruption of the blood sugar regulation has multiple serious health consequences.

A very high (>400 mg/dL) blood sugar level might cause potentially fatal conditions, such as a coma and diabetic ketoacidosis. These conditions occur predominantly in patients with type 1 diabetes, when it is left untreated. However, even a moderate increase of the blood sugar levels, above 120 mg/dL after fasting and above 240 mg/dL after eating, which is typical for the early stages of type 2 diabetes, should not be left unchecked.
The most serious and consequential effect of a sustained increase of blood sugar is blood vessel damage. The latter can cause blindness because of retinal vessel destruction, heart attack and stroke due to atherosclerotic changes of the main arteries and brain blood vessels, and nephropathy because of the vessel damage in the kidneys.
Furthermore, high blood sugar triggers a vicious cycle of metabolic disruptions. Beta cells constantly exposed to the glucose levels similar or higher than those normally occurring for a short period of time after eating, are forced to produce more and more insulin. In a long term, insulin overproduction might lead to the beta cell damage. Muscle, liver, and adipose cells, exposed to elevated levels of insulin for the extended time periods deplete their capacity to respond to this hormone, insulin resistance worsens, and diabetes progresses.

The only way to avoid the long-term complications and life-threatening consequences of diabetes is to restore the blood sugar balance. For type 1 diabetes, insulin injected several times a day or delivered with an insulin pump, is the only therapeutic way to maintain the blood glucose reasonably close to its normal levels. The proper dose of insulin is calculated based on the amount of carbohydrates consumed with each meal to avoid a dangerously low blood sugar. For the patients with type 2 diabetes, manifested by the insulin resistance, rather by the lack of insulin production, there is a variety of approaches to control the blood glucose levels.
Exercise. This is the first line of defense against the damages caused by high blood sugar, or hyperglycemia. If you have too much “fuel” (sugar) in your blood, then aim to “burn” the excess.
Start with adding 15 minutes of any physical activity. Gardening, mopping the kitchen floor, going to a store two blocks away and back, or walking your dog will do. Just do something that makes you breathe a bit faster for a few minutes every day. Enjoy. Make it a part of your routine. Consider those minutes as a “me” time. Be consistent, and you will find yourself signing up for hikes and races in a few months.
Eating healthy without dieting. This is the second line of defense. There is not any specific diet or meal plan currently recommended for the patients with type 2 diabetes by medical professionals. Any culture- or religion-based restrictions, including vegan or vegetarian, can be accommodated for a person with diabetes. The common strategy for meal planning includes avoiding processed foods, including the nutrient-rich vegetables, seeds and nuts, and keeping in mind that some foods, consumed in large amounts, might cause a blood sugar spike even in a healthy individual, let alone the person with diabetes. They contain relatively high amounts of glucose or starches that are easily broken down to produce glucose. The examples of these foods are grapes, watermelon, bananas, white bread, corn, pasta, potatoes, and other sweet and starchy products. Soda, chips and candy are not mentioned here, because these are the processed foods that the medical professionals recommend limiting anyway.
Medications. For most people diagnosed with diabetes the diet and exercise regimen are not enough to maintain the blood sugar levels in a healthy range. There are several pills and shots that help to restore the broken mechanism of the blood sugar balance.
• Glucose suppressors are represented by biguanides, better known as metformin, a pill prescribed to most of the patients newly diagnosed with type 2 diabetes. It decreases glucose production in the liver and promotes glucose delivery from blood stream. Consider Metformin-like medications as insulin helpers and glucagon adversaries.
• DPP-4 inhibitors promote synthesis of insulin and decrease synthesis of glucagon by sustaining the increased levels of yet another group of hormones, incretins. These medications are often combined with metformin in one pill.
• GLP-1 receptor agonists also increase the level of incretins. These are injectable medications.
• Insulin secretagogues include sulfonylureas, meglitinides, and D-phenylalanine derivatives. They stimulate insulin production by pancreatic beta cells. Sulfonylureas can be used in combination with any other class of oral diabetic medications besides meglitinides.
• Insulin sensitizers, thiazolidinediones, improve glucose transport and decrease glucose production by liver.
• SGLT-2 inhibitors, gliflozins, prevent glucose re-absorption by kidneys, so the excess glucose is removed from the body with urine.
This list includes only the most commonly prescribed medications. You should discuss these and other options with a medical professional.

Diabetes does not have a cure yet. However, it is not a reason to give up. Medical professionals are working on an “artificial pancreas”, which is a combination of a continuous blood sugar monitor and an insulin pump, which will inject the right amount of insulin at a right time. There are more non-insulin medications for the type 2 diabetes patients in the pipeline. In the meantime, make sure to share this article on social media with your friends, post a link to it on your web site, and let’s get up and moving, keep in touch with the medical care provider, and make the healthy food choices!