Could Poor Glucose Management be behind your Hormonal Symptoms?
Blood sugar instability underpins hormonal problems, low energy, weight gain, thyroid problems and paves the way for metabolic diseases.
Here's what happened when I monitored my body's glucose management system using a Continuous Glucose Monitor (CGM)...
Why is optimal glucose management important?
Controlling blood sugar is something that I speak to most clients about since fluctuating blood sugar lies behind many modern health issues because of the complex relationship between sugar (glucose) and our hormonal system. When we eat carbohydrates of any kind our digestive system converts the carbohydrate to glucose. Simple carbohydrates convert quickly and create dramatic blood sugar spikes, complex carbohydrates convert more slowly and cause a more steady rise in glucose. Glucose shows up quickly in the blood after it has passed through the gut wall and takes around 10 minutes to be detectable in the interstitial fluid (measured by CGMs) that surrounds the cells within the body.
The body keeps a close eye on the glucose levels in the blood and maintains a very narrow range of tolerance. Once the tolerance has been breached, the pancreas releases insulin which acts as a key that opens a door on the cell membrane allowing the glucose to move out of the blood and into the cells where it is used by the citric acid cycle to make energy. This is what should happen. Certain food and drinks, lifestyle choices, stress levels, sleep deprivation, illness, and even travelling on long journey cause blood sugar to spike and in healthy people the body will clear the glucose spikes quickly and efficiently.
It's the (frequency and) dose that makes the poison
Prolonged or chronic exposure to blood sugar spiking foods and lifestyle choices begin to exhaust this inner balancing system and over time two things tend to happen. Constant high levels of glucose in the blood require ever increasing amounts of insulin to clear it. Over time the cells stop responding to insulin and no longer open their doors to the glucose. The glucose then remains stuck in the blood which the body treats as life threatening so it triggers the pancreas to make more insulin. This is called insulin resistance.
Over time the pancreas also gets exhausted and unable to meet the constant demand for insulin and so blood sugar remains elevated causing Type-2 Diabetes symptoms such as frequent urination and constant thirst. Insulin resistance and Type-2 Diabetes are conditions that fall under the umbrella of metabolic syndrome. There are many other health issues that are caused or exacerbated by unstable blood sugar yet this connection is often overlooked by mainstream medicine in favour of prescription medication or invasive procedures.
Insulin, the disrupter or the saviour?
There's a complex relationship between insulin, the stress hormones cortisol and adrenaline, the reproductive hormone estrogen, the thyroid hormone thyroxine, and general liver health. When insulin rises, so does estrogen – hence the connection with menstrual and reproductive challenges. When estrogen rises, thyroxine decreases – hence the connection with hypothyroidism. When cortisol rises due to stress (anxiety, dehydration, poor sleep, long journeys) or the use of stimulants such as caffeine, smoking and vaping, the liver releases glycogen which is converted to glucose as part of the fight or flight response increasing insulin and estrogen and decreasing thyroxine. So you can see why persistently elevated blood sugar sits behind many common health complaints including:
Hormonal conditions including heavy periods, PCOS, acne, migraines, hirsutism, fertility difficulties.
Worse than normal peri-menopause or menopause symptoms.
Low energy or energy highs and slumps.
Weight gain or difficulty losing weight.
Cravings or needing to eat every couple of hours.
My HbA1c (blood test) results indicate I’m not diabetic so why would I need a CGM?
GP’s routinely test HbA1c levels in blood tests and to formally diagnose Type-2 Diabetes. If you have had a recent blood test, have a look and see if this was tested. Levels <42 mmol/mol are considered non-diabetic, 42-47 mmol/mol are pre-diabetic, and >47 mmol/mol is considered diabetic. You may have seen people wearing a little disc on the back of their arm and up until a year or so ago, these little gadgets called Continuous Glucose Monitors were only available on the NHS to people with a formal diagnosis of Type-2 Diabetes to help them monitor glucose levels in their interstitial fluid, either as an alternative to frequent finger prick testing or as well as. Continuous Glucose Monitors (CGM’s) are now widely used by non-symptomatic or otherwise healthy people to optimise their health because knowing how your body is handling dietary glucose and understanding the effect diet, lifestyle, stress, and sleep have on glucose levels in the body provides a valuable insight into your current metabolic health giving you the chance to make diet and lifestyle changes before they cause metabolic diseases such as type-2 diabetes. Good news if you don't like blood tests and want to find out how well your glucose management system is working.
A blood test measures the glucose in your blood at a point in time i.e. when the blood was taken and whilst this is used by your GP to determine your type-2 diabetes status, it won’t tell you the effect those every day decisions or events are having on glucose levels, how quickly your body is clearing glucose from your blood, and your risk of developing metabolic syndrome in the future. The rate at which glucose is being cleared from your blood and into your cells tells you how sensitive your cells are to insulin. Greater insulin sensitivity or a speedy transfer of glucose from blood to cells indicates better metabolic health. Remember it is easier (and easy) to prevent metabolic diseases than it is to reverse them.
Here's what happened when I wore a CGM...
Earlier this summer I wore a CGM for 15 days (they stop working at around 15 days) to see how my diet and lifestyle were impacting my glucose levels and blood sugar stability. For a non-diabetic wearer the glucose level should be between is 3.8 -7.8 mmo/L before and outside of meals, should return to within this range within 2 hours of eating, and average around 5.6 mmol/L over the course of the day. Each time I ate something I made a note in the app of what it was, any exercise I did, and any stressful or unusual events such as commuting, hot weather, poor sleep, and illness. Overall my results were positive but there were some anomalies which were interesting, take a look...
The impact of a long car journey
See how my blood sugar dropped below normal during the night indicating my adrenal glands struggled to keep my blood sugar stable whilst asleep due to very early dinner, long journey, and late night.
Drinking a vegetable juice
See the spike after I drank a fresh home-made vegetable juice made from celery, cucumber, courgette, green apple, carrot, small piece of ginger after stir-fry dinner of brown rice, chicken and vegetables.
The effect of a meal high in simple carbohydrate
2 spikes are shown, the first one from eating dried fruit and nuts as a snack on a training course in the afternoon and from eating risotto with fish for dinner.
The effect of disrupted sleep
An overnight stay on the top floor of a hot guesthouse during the recent heatwave prevented adequate sleep created a stress response which caused a prolonged spike in blood sugar for several hours in the early hours of the morning.
The effect of illness
A sudden onset of nausea and loss of appetite (suspected tummy bug) created a stress response and a spike in blood sugar despite not eating.
The effect of having zero protein at breakfast
My blood sugar was stable before and after an exercise class and a 1.5hr commute but spiked significantly after eating overnight oats made from oats, plenish almond milk, soaked seeds, nuts, and a few blueberries. Not my normal breakfast of eggs with vegetables. The lack of protein before eating the carbs caused the high spike.
What will a CGM reveal about your glucose management system?
Interested in knowing how your body is handling dietary glucose and understanding the effect your diet, lifestyle, stress, and sleep are having on glucose levels in your body? Finding out provides you with a valuable insight into your current metabolic health giving you the chance to make diet and lifestyle changes before they cause metabolic diseases such as type-2 diabetes. See my '14-day Glucose Assessment' mini-package that includes a monitor, results interpretation, and tailored diet and lifestyle advice.