Understanding the Consequences of Uncontrolled Blood Sugar and How to Maintain Long-Term Health

According to the CDC, 1 out of 10 adults has diabetes and 1 in 5 is not aware of having diabetes. Also, 1 in 3 adults has prediabetes and 8 out of 10 of those people don't know it. These are surprising stats!

November is Diabetes Awareness Month and it is the perfect time to talk about the consequences of uncontrolled blood sugar and ways you can improve or maintain a normal blood sugar for long-term health.

Did you know it takes 7–8 years for a person to "officially" have type 2 diabetes?

That means, if you are aware of early signs, you can take actions to prevent the progression to type 2 diabetes AND if you are someone who already has adult-onset diabetes, you can take steps to reverse insulin resistance and sometimes, even reduce the need for medications.

Let's first discuss why type 2 (adult-onset) diabetes occurs…

The driver of high blood sugar is something called insulin resistance. A person can have "normal" blood sugars on labs while they are developing insulin resistance.

Essentially, insulin resistance occurs over time (silently) and leads the hormone called insulin to not be able to do its job- which is to lower blood sugar. Deposition of fat in the muscles, liver, and pancreas causes a condition called lipotoxicity in the cell membranes that impairs the uptake of glucose (sugar) into the muscles, which is essential to lowering blood sugar after consuming carbohydrates.

The liver ends up making abnormal amounts of glucose and can get abnormal fat depositions (called fatty liver) causing blood sugar elevations. Also, the cells that make hormones like insulin and glucagon in the pancreas become damaged over time by this process.

Longstanding insulin resistance along with excess visceral fat (the type of fat around the intra-abdominal organs, liver and pancreas) contribute to inflammation and eventually sustained elevated blood sugars that over time, damage small blood vessels throughout the body.

Damaged small blood vessels and inflammation drives plaque formation and blood flow to nerves, the heart, brain, kidneys and other organs becomes impaired. This increases risk for heart disease, strokes, liver disease, peripheral neuropathy, blindness, and kidney damage, to name a few conditions.

Now that you know what contributes to type 2 diabetes and long-term complications that can occur from uncontrolled insulin resistance and elevated blood sugar- let's discuss 7 ways you can improve your blood sugars!

Certain individuals may want to pay closer attention to their risk factors for developing diabetes- those with a family history of type 2 diabetes, premature heart disease, women with polycystic ovarian syndrome, and those with a history of gestational diabetes and people belonging to certain ethnic groups like Asian, South Asian and Hispanic are at an increased risk.

1\. Know your numbers

It is very important to meet with your primary care physician regularly for fasting labs. Some numbers to follow include:

• Fasting blood sugar: Since the risk for damage to small blood vessels occurs even during prediabetes level elevation of blood sugars, it is important to know your blood sugar status. A fasting blood sugar higher than 100 is seen in prediabetes and if over 120, diagnosed as type 2 diabetes if a second test confirms the elevated blood sugar. It is best to not settle in the comfort of a glucose in the prediabetes range as unfortunately, many progress to full-blown diabetes.

• Cholesterol numbers: Increased triglycerides > 150, low HDL and high LDL cholesterol. Triglyceride elevation is part of the metabolic syndrome that includes insulin resistance as one of its signs.

• Elevated hemoglobin A1C- This can increase to abnormal levels later in the disease process. If it is between 5.7%-6.4%, the condition is called prediabetes and diabetes, if > 6.5%

• Note abnormal liver tests- It is always important to discuss elevations in liver enzymes on labs. Often, abnormal fat deposition in the liver can cause elevated liver tests. Having fatty liver is a risk for developing diabetes.

2\. Monitor waist size

For those people at high risk for diabetes as mentioned above and from certain higher risk ethnicities, it is a useful tool to monitor waist circumference. If you already have diabetes, losing visceral fat (often requiring 6–8% of body fat loss) can help reduce the need for diabetes medications.

• Goal waist circumference is under 40 inches for men and under 36 inches in women of Caucasian/European, African & Middle Eastern descent

• Goal waist circumference is under 36 inches for men and under 31.5 inches for women of South Asian, Chinese, Japanese, South & Central American descent

3\. Physical signs of elevated blood sugar

In addition to an expanding waistline, darkening of the skin behind the neck and/or the underarms is called acanthosis nigricans can be a sign of elevated blood sugars and insulin resistance.

4\. Reduce intake of ultra-processed foods and meats

Ultra-processed foods are packaged foods that have been changed quite a bit from their ingredients. For example, a fruit roll-up versus eating real fruit. Cookies, baked goods, chips, and candy are examples of highly processed foods. They not only are high in added sugars and fats, but also do not contain many nutrients. Studies show dietary patterns with high intake of such foods are linked to an increased risk of diabetes, heart disease and increased mortality. Processed meats like bacon are not only high in unhealthy saturated fats but can impair blood sugars by increasing lipotoxicity and have high amounts of sodium, which is not great for blood sugar. Cure meats like cold cuts, hot dogs, sausage and bacon are classified as carcinogenic by the World Health Organization due to multiple studies tying intake with higher risk for certain cancers like colon, stomach and breast cancer.

5\. Don't drink your sugar

Instead of drinking fruit juice, consider eating whole fruit instead. Fiber in whole fruit helps stabilize blood sugar to rise slower rather than a large amount of fruit that is concentrated, typically without fiber, in fruit juices. Sodas and other sugar sweetened beverages contain added sugar, which will cause blood sugar to rise too much in individuals with type 2 diabetes.

6\. Eat more vegetables and fruit

Make dietary changes to follow a PLANT-FORWARD eating pattern like the Mediterranean diet. Eating a diet high in vegetables, fruit, whole grains, plant proteins like beans & lentils, unsaturated fats (nuts, seeds, olive oil) in place of less saturated fat, fish and less meat/red meat can be a healthful pattern when it comes to blood sugar control and is SUSTAINABLE. Separate from weight loss, changing your diet can help improve blood sugar, cholesterol and blood pressure!

7\. Move! 

In addition to 150 mins of cardio/aerobic type exercise weekly, adding in muscle resistance training type exercises can help improve blood sugar. The muscles have improved intake of blood sugar when muscle activity is included in your exercise program. Even walking for 10 minutes 2–3 times a day after meals can help reduce post-meal rises in blood sugar, so even a small amount of exercise can make a difference!

I hope you use this information to empower yourself to identify your own risk factors & make lifestyle changes and a plan of action that help support a healthy blood sugar!

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Dr. Richa Mittal is an Internist and Obesity and Lifestyle Medicine physician in the Dallas Fort Worth area. Her membership-based practice focuses on a patient-centric approach to weight management, cardiometabolic health, and prevention. She offers medical, lifestyle, and culinary medicine tools in her practice to help her patients with sustainable lifestyle changes to optimize long-term health.