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.
HORMONES ESSENTIAL FOR THE BLOOD SUGAR CONTROL
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.
DIABETES
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.
DISRUPTION OF THE BLOOD SUGAR BALANCE THREATENS YOUR HEALTH
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.
WAYS TO CONTROL BLOOD SUGAR LEVELS
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.
IN CONCLUSION
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!