Blood Sugar Control - Why so important?

Hi, it's Dr. Andersen, and today I'm answering a question that I get asked an awful lot, have over the years. It's about blood sugar and blood sugar control. Now, why is this so important that we control our blood sugar? What does that mean? What does it mean when we don't? And what are the implications around that? Now, if you look, one of the most common types of disorders— it's chronic— is insulin sensitivity problems and the spectrum of type 2 diabetes. So most of what we're going to talk about today is for type 2 diabetes, and that is an insulin sensitivity disease. We're not going to talk too much about type 1 diabetes. We'll do that separately. It's really 2 different kind of diseases in that, even though they both have diabetes in the name. So why is it so important to control your blood sugar, and, and what does that really mean? Well, you want to start with what is blood sugar, what does it do, and how does it do it? So here's the idea. Blood sugar is the part in the plasma or serum, the more clear part of your blood where the cells aren't, that is dissolved, and it's glucose and a few other Simple sugars, but mostly glucose, which is what we measure. What happens is that, of course, we eat— we eat carbohydrates, and that goes and gets turned into glucose and a few other sugars and put into the blood. Now, under extreme conditions, you can also remove some stored glucose from your liver and a few other spots, and if you really are low on glucose, you can actually make your own glucose. But most of what we get is from our food unless we're fasting or something of that nature. So that's what your blood sugar is. Now, normally no lab in your body is the same all day long. So we get a blood draw, you know, in the morning or whenever you get it, and that's a number. Well, that's a number at that point in time. But there's an average. And so your blood sugar goes from its lowest point during the day to whatever its highest point, and that can be like a sine wave going up and down, like a flat roller coaster almost. And you want it to be within a particular range. You don't want it to go too low. If it goes very low, you can lose consciousness or even die. And you don't want it to be high, but you often don't feel high blood sugar. Some people get used to it and they can, but you feel low blood sugar. Again, topic for another day. So it's really this between the low and the high end that we care about. And so what happens if you go from the blood, in order for the blood to drop the sugar off and get inside your cells, it's really important that insulin gets involved and that sort of opens the gate, sits at a receptor, it helps the sugar get into the cells. There's a few places in your body that don't need that receptor completely, like your brain and your liver usually don't need those receptors, but everywhere else pretty much does. Okay. Now, what happens once it's in the cell is why we have blood sugar, which is we burn it for energy. And so inside of your cell, there's the mitochondria we've talked about, and they use— they have a number of energy sources they can use, but they really prefer carbohydrate or sugars. So your blood sugar is really important. Now, if insulin is the key to get it in, And blood sugar is kind of the normal thing that we measure. Blood sugar fluctuation can be a marker that insulin is doing a really good job or maybe not doing a really good job. Now, again, as we said, I'm going to talk about hypoglycemia elsewhere, and that's where you can get a little too much insulin activity and your blood sugar drops too, too low. What we're talking about today with the type 2 diabetes spectrum and insulin resistance is literally it goes to the cell, sits there, and it doesn't really do its job very well. Or the receptor gets resistant. So why is that a problem? Well, one problem is your cell needs the sugar so that it could create energy. So what will happen under normal circumstances is your body will have a feedback mechanism saying, we're not getting the energy burning that we need out of the sugar, the blood is full of sugar, so we know it's there, and so the insulin— the pancreas releases more insulin. Okay. This is what drives a lot of insulin resistance because you keep beating on the receptors. They open up and do their job eventually, but it dulls the receptor. Okay, it's sort of like if you go up to your door and instead of just turning the knob and opening the door, you beat on the knob of the door 3 or 4 times and then you turn it and open it. What's going to happen is the mechanism that closes your door, the lock and the key, is going to get loose. And that's not because you're opening your door all the time, it's because you're beating on the door. Well, your pancreas releasing extra insulin just to get your blood sugar down is doing the same kind of thing, only it's on a very tiny level biochemically. Now, that's resistance, and that starts to build up. Now, people will say, well, what's the big deal with that, right? It's okay, so my blood sugar eventually will come down, you know, I'll make enough insulin. No harm, no foul. The reason blood sugar control is so important and that we want the low and the high to, you know, have a range, but we don't want them to be too far apart and out of whack, and we have resistance, what happens is the highs get higher and then you have kind of a crash down when you finally get the insulin released. That's a marker, that range being in a nice tighter group is a marker for appropriate insulin function. But people will say, well, all right, uh, why is there a problem with the insulin? Maybe, you know, my pancreas is doing a good job, it's creating more, right? Yes, you have a champion pancreas, it's doing a great job. The problem that happens is twofold. One is you're beating on the lock instead of opening it, and so you make, uh, the receptor sites duller and duller and duller. You get more insulin resistance, and eventually become a type 2 diabetic. That's part of the problem. But the other part of the problem is that insulin is one of those chemicals in your body, so it's a hormone, and it binds to a receptor, and it does particular things with blood sugar. But what we found out in the last number of decades is insulin that doesn't have anything else to do is sort of like a child left alone with tools or fire or something, something not good is going to happen because it turns out that insulin is not only there to open up and help blood sugar get into your cells. That's one thing it does. Insulin in excess triggers a lot of biochemistry that is very pro-inflammatory. And so, for instance, fats that you might eat that would otherwise not be bad for you can be shunted biochemically to very inflammatory versions of the fat. And so this is one of the many reasons why people with uncontrolled blood sugar, type 2 diabetes, have more vascular inflammation, cardiovascular disease, etc., etc. That's a real, real common part of the type 2 diabetes spectrum. So, and insulin does a lot of other pro-inflammatory things. So you want to have enough insulin to take care of the sugar you have. You want to be balanced. You don't want to have to have your pancreas releasing all this extra insulin to take care of your blood sugar. Now you say, well, without me getting my blood drawn like all day long, you know, how does the doctor know that my blood sugar fluctuations, the highs are getting higher and the lows are getting lower, right? When you get your blood tested for this, normally in addition to your blood sugar, They also do a test called a hemoglobin A1C. Hemoglobin A1C is related to compounds inside your hemoglobin, that's where it got its name, but it's a marker that shows how far apart or what the average blood sugar is getting to be. So your hemoglobin A1C is a backwards look of between 3 and 4 months depending on how stable your hemoglobin is. So that way your doctor can look at the A1C, and the higher the number goes, the higher your average blood sugar is. And there's charts that show you, you can look them up online. But for example, they're looking for, you know, an ideal hemoglobin A1C of 5 to 5.5, 5.6. When you start getting in the 6 range and up, depending on your lab and how they report it, they'll start to report things like insulin insensitivity, prediabetes, whatever way they say it. Now, if that's happening and you're above, you know, 6, 6.5 or higher, your doctor might actually check your morning insulin, they may check some other factors, or they may have you start monitoring your blood sugar at home. So what's the important take-home from controlling your blood sugar? Well, the better you control the blood sugar, the more you bring the average down, so the more you bring the hemoglobin A1c down, the less downstream inflammatory and other disease-causing effects your insulin excess will cause you. That's where it's really, really important. The insulin's not doing a bad thing with respect to the sugar. Remember, you beat up the door, you beat up the receptor, and some of that is genetic that you turn on later in life. That's just what happens. But you got this receptor problem, and so now your pancreas has to put out extra insulin to take care of the sugar. It's the extra insulin that then runs around after it hits and runs off of your receptors. Some of it sticks and works, some of it doesn't. It's that extra insulin that creates all the trouble. So we want to lower the average blood sugar fluctuation, lower the extra insulin, and that is associated with less disease, longer life, all sorts of good things, plus you usually lose weight, etc. So what do you do about that? Well, these could be hours and hours of talk, but We're just going to spend just a few seconds. The first level is diet and exercise, no matter what guideline you read, and that is because I have had patients with very bad A1Cs and very high triglycerides and other stuff that go along with this completely change their diet to a low glycemic diet. If you don't know what that is, you can look it up. There's a billion sites online about low glycemic foods and low glycemic eating, etc. Have them do that, and they started to just work their skeletal muscle, move out, work out a little bit more, and had their A1Cs, you know, over the course of 6 months to 12 months come way, way down. Their average blood sugar goes down, triglycerides look better. Well, it's because they're eating in a way where they get enough carbohydrate in, but not too much. And so there's no need for the pancreas to do this extra insulin release. Now, if that's not working enough, and you should do as much as you can with diet and exercise, if that's not working enough, There are drugs that are insulin sensitizing, and then there's a next level that are insulin secreting. They help your body make insulin. Then there's insulin if it gets, you know, high enough, and now there's even biological drugs that manipulate other parts of the insulin blood sugar system. So there are many levels that your doctor has, but the first thing they're going to tell you to do is diet and exercise, eating a low glycemic diet, increasing your fiber, making sure you get good level protein and good quality fat, etc. And that, in many cases, especially if they tell you you're pre-diabetic, that is enough to bring you back down to normal values, but you do have to work at it with your diet. Well, this is the end of this one for Dr. A, why blood sugar control is important and what it means and what it does, and I'll see you all back here again very, very soon.