Normal blood sugar balance
Blood sugar balance, referred to technically as glucose homeostasis, involves a balance between glucose that is entering the bloodstream and glucose that is being removed from the blood and entering the cells. Three things determine the amount of glucose entering the bloodstream: (1) absorption of sugars from the diet; (2) glycogenolysis – the breakdown of stored sugar (glycogen) in the liver to glucose; and (3) gluconeogenesis – the formation of glucose in the liver from amino acids and lactic acid, which usually occurs in response to fasting. If there is no sugar in the diet, then the cells must derive it from somewhere, which initially starts with breakdown of stored sugar. Eventually, in the case of a longer fast, gluconeogenesis breaks down proteins and glucose is formed from the resulting amino acids.
Although blood sugar is regulated by hormones that come from the pancreas, intestines, and adrenals, the two primary hormones involved come from the pancreas. Insulin, produced in the beta-cells of the pancreas, is the best known of these two hormones. Insulin is secreted in response to sugar being in the bloodstream and is responsible for escorting sugar into the cells so it can act as fuel to produce energy. The other primary blood-sugar balancing hormone, glucagon, is secreted from the alpha-cells of the pancreas and has the opposite effect from insulin. Glucagon increases blood sugar in response to low levels by signaling the liver to produce more.
What if blood sugar becomes imbalanced?
When blood sugar is imbalanced, it is typically in the direction of too much sugar in the bloodstream. In type 1 diabetes (once known as juvenile onset diabetes), an autoimmune attack on the pancreatic beta-cells – which can be precipitated by a viral insult coupled with a genetic predisposition, and possibly food allergies and other causes – results in the relatively sudden onset of diabetes. The beta-cells either slow down their insulin production or stop producing it altogether. Insulin replacement in the form of injections or a pump is the treatment for type 1 diabetes.
On the other hand, type 2 diabetes is often a gradual progression from insulin resistance to prediabetes to diabetes. Insulin resistance begins to occur when cells in the body don’t respond to insulin and sugar can’t be removed from the bloodstream. The pancreas responds by making more insulin to lower blood sugar levels, which results in elevated levels of insulin and usually elevated levels of glucose. Although the pancreas continues to make insulin, the insulin does not work as it should, which can lead to prediabetes and, eventually, to diabetes.
Who is at risk to become insulin resistant?
Although obesity is the greatest risk factor for becoming insulin resistant, age can also play a role. Individuals older than 45 are at greater risk because of natural changes in hormone levels, declining muscle mass, and associated changes with body composition.
Genetics can put an individual at greater risk of becoming insulin resistant. If you have a close family relative who is diabetic, or you are of African-American, Alaska-Native, Native-American, Asian-American, Hispanic/Latino, Native-Hawaiian, or Pacific-Islander ethnicity, then you are at greater risk. In the case of women, a history of gestational diabetes or polycystic ovary syndrome are risk factors.
Health history is also important. A history of heart disease or stroke or conditions like elevated blood pressure or abnormal cholesterol levels put you at greater risk. Sleep apnea, or other sleep problems that disrupt normal, restorative sleep, also contribute to risk.
A person who has metabolic syndrome is more likely to develop prediabetes
A diagnosis of metabolic syndrome requires the presence of three or more of the following five criteria: (1) a waist circumference larger than 35 inches for females and 40 inches for males; (2) a triglyceride level greater than 150 mg/dL; (3) an HDL cholesterol level less than 40 mg/dL for men and less than 50 mg/dL for women; (4) blood pressure of 130/85 mmHg or higher; and (5) a fasting blood sugar of 100 mg/dL or higher.
What to look for
It is difficult to know without a blood test if a person is becoming insulin resistant. Although one would not likely have symptoms from elevated insulin, symptoms associated with high blood sugar can be noticeable, particularly if blood sugar is chronically elevated. High blood sugar usually causes increased thirst and urination, with subsequent dehydration.
A chronically elevated blood sugar level often leaves individuals fatigued because sugar in the bloodstream is not getting into the cells to provide energy. For this reason, a person with high blood sugar often feels hungry and tends to eat more to gain quick energy from food. This can start a downward spiral because more dietary calories add to one’s weight, which increases the risk of insulin resistance and prediabetes. High insulin levels also contribute to weight gain. Sometimes the first sign of chronically elevated blood sugar is numbness in the feet – referred to as peripheral neuropathy.
What do you do if you have risk factors for blood sugar imbalance?
Manage your weight
Because obesity is the primary risk factor for poor blood sugar metabolism, weight and body composition play a large role in managing the risk. A modest weight loss of 5-7 percent in someone at high risk can reduce their risk of developing insulin resistance by almost 50 percent.1 For a 220-pound person, losing as little as 11-15 pounds can make all the difference. But to do this, you will need a consistent lifestyle, diet, and exercise routine.
Eat a diet that mitigates metabolic syndrome
The Mediterranean Diet, a low-carbohydrate diet, or the ketogenic diet can all help manage blood sugar, inflammation, and metabolic syndrome risk factors. Each of these diets can lower triglycerides and increase HDL cholesterol (the good cholesterol) levels. These diets are abundant in healthy fats (omega-3’s from fish, oleic acid from olive oil) and lower in carbohydrates (especially simple carbs from desserts, bread, pasta, etc.). The Mediterranean Diet has also been shown to be anti-inflammatory because of its healthy fats and colorful fruits and vegetables. These diets also provide enough protein for satiety and to support weight loss.
A diet with good fats and protein in it can reduce the blood sugar spikes that often come from eating too many carbs. So skip high-glycemic foods and switch to lower-glycemic options that are full of fiber. For example, in the morning choose oatmeal instead of white toast or choose a dietary supplement with vitamins, minerals, and fiber. Use spices like cinnamon, known to help curb blood sugar and lower the risk of insulin resistance. Green tea can enhance thermogenesis (fat burning).
Physical activity helps the cells respond better to insulin, which lowers blood glucose levels. On the flipside, sedentary individuals are at higher risk of becoming insulin resistant. The goal should be to achieve 150 minutes of exercise weekly – and more as tolerated. Moderate intensity cardio exercise and weight training 2-3 times a week makes a huge impact on risk.
Stay hydrated and replace lost magnesium
In the case of elevated blood sugar levels, frequent urination helps clear sugar from the body. However, increased urine output will also cause loss of electrolytes, including magnesium, which can result in dehydration. Lost nutrients such as magnesium should be replaced, which helps maintain healthy blood pressure and blood sugar levels, as well as optimizing hundreds of other reactions in the body.
Get the right bloodwork
The easiest and best way to know if your body is making enough insulin and using it efficiently is with a blood test. A finger prick or venipuncture blood test for glucose and insulin levels, both collected following an 8-hour fast, will tell you your initial fasting levels. You can also invest in an inexpensive glucometer (most pharmacies have them) so you can check your fasting blood sugar frequently to determine trends. You should also test your blood sugar two hours after eating to determine the effect of a meal on your blood sugar.
To determine your long-range blood sugar maintenance, you can test hemoglobin A1c (HbA1c), which is the amount of hemoglobin in your red blood cells that has glucose attached to it. Your HbA1c level will show you a measure of your average blood glucose level during the past 90 days. You can also get a full cholesterol blood panel (LDL, HDL, triglycerides, and VLDL) to monitor these important risk factors associated with insulin resistance.
For more information on metabolic syndrome, you can download our helpful Metabolic Syndrome guide, which provides an overview of metabolic syndrome, dietary and supplement recommendations, recipes, and sample meal plans.
For supplement support for healthy blood sugar levels, check out our Blood Sugar Support Bundle.
- Diabetes Prevention Program Research Group. Long-term effects of lifestyle intervention or metformin on diabetes development and microvascular complications over 15-year follow-up: The Diabetes Prevention Program Outcomes Study. Lancet Diabetes Endocrinol 2015;3(11):866-875.