7 Things You May Not Know About Your Blood Sugar
Did you know that so much of our vitality as we age is dictated by our metabolic health? Metabolic health involves how our body responds to the food we take in: how efficiently it uses the food as energy, how much insulin is released when we take in food, and how that insulin affects the cells in our body. Metabolically healthy folks are less likely to develop type 2 diabetes, cancer, and heart disease later in life. It could even affect our cognitive health as we age. As a physician, I am always curious about the various tools we have at our disposal in order to build health habits that will ensure our longevity and vitality. One such tool is a continuous glucose monitor, or CGM.
In a more conventional medical setting, CGMs are used by patients who already have diabetes to optimize their control over their blood sugar with or without the use of medication. I have found it to be enormously helpful in my diabetic patients, allowing them to gain insight into which foods and behaviors cause their blood sugar curves to flatten out instead of spiking. We want to avoid glucose spikes generally because when blood sugar spikes, it induces a response in our body to release a large amount of insulin. While normal insulin release is a good thing - we want the excess glucose we get from food intake to be funneled into our cells instead of hanging out in our blood stream- years of large insulin surges can lead to something called “insulin resistance,” which causes metabolic diseases like diabetes and heart disease. Over time, more and more insulin exposure (via glucose surges) causes our cells to become more resistant to insulin’s effects. As this happens, more glucose remains in our blood stream, which leads to various disease states. As I mentioned before, heart disease and diabetes are two common disease states that most Americans suffer from later in life that are linked to insulin resistance. Less commonly considered diseases that are affected by insulin resistance are PCOS, stroke, and frailty later in life. It is critical that we consider the effects of insulin resistance before these diseases manifest in order to ensure our longevity and vitality as we age.
CGMs are devices that use a subcutaneous (just under the skin) needle to continuously monitor our glucose levels for a set period of time. Technological advancements have enabled these numbers to be nearly instantaneously delivered to our phones via bluetooth devices, so that we can see the effects of the foods that we eat minute-by-minute. While fasting blood glucose measurements are also important and should be performed at your yearly physical exam, the CGM gives a more comprehensive picture of your glucose response throughout the day. This can help us to see if we are particularly sensitive to certain foods and behaviors in order to adjust our lifestyles to optimize our blood sugar control, in hopes of preventing insulin resistance and metabolic disease.
Through an app called Levels, I was able to access CGMs without a diabetes diagnosis to measure my own blood sugar for 30 days. What I discovered was illuminating, and I wanted to share it with you. I have a family history of a few incidences of heart disease and diabetes on both sides. I also like to practice food freedom, not considering any food as particularly “bad” in moderation and eating intuitively by listening to my body and its cravings. Therefore I entered this experiment deciding that I would not be changing any of my eating habits for most of the CGM use in order to see what my typical eating and exercise patterns produced in terms of a glucose response. I also know that where we are in our cycle can influence insulin sensitivity, and I was curious to see how that manifested in my body.
Levels sends you three CGMs, each to be deployed just under the skin on the back of your upper arm for 10 days, so 30 days total of glucose monitoring. Here are a few things I learned in my 30 days of CGM use, but please keep in mind that individual results will vary - those who have more of a family history of diabetes, folks who have had gestational diabetes or PCOS, and folks of different ethnic backgrounds (mine being primarily mediterranean/southern european where whole grains are a dietary staple) may notice far more glucose spikes than I did and have more of a call to limit carbohydrates in their diet than I have. Please also note that cost can be a barrier to entry here - it was about $240 total for a 30 day subscription to the app and for the three CGMs. I hope that by spreading awareness of this tool, it will eventually become more accessible at a lower price point. This will come with more commercial demand for CGMs from diabetic and nondiabetic patients alike. Unfortunately, even yearly fasting glucose levels are becoming less accessible, as more and more commercial insurance companies are refusing to cover preventative health testing. Please let your doctor know if this is the case for you, so that they can work with you to order testing that will be covered by your insurance whenever possible. But I digress! Here is what I learned:
1. The order in which we eat our food matters.
I have been talking about this with my patients for the past few years, but it was powerful to see how this personally affected my blood sugar. Various health and wellness figures, most notably Glucose Goddess, have been using CGMs to come up with dietary “hacks” that can help us to balance our blood sugar. One of which I consistently saw was to eat veggies first, then protein and fat, then carbs last whenever it is easy. After seeing my blood sugar surge with a piece of toast in the morning (balanced with turkey sausage, eggs, and fruit), I decided to try to play around with this a bit and discovered that when I eat protein first, my blood sugar spikes are far less dramatic. Eating vegetables first was helpful too, but the most prominent effect on my blood sugar came from starting my meal with whatever protein was in front of me when possible. If the meal contained a starchy carbohydrate and I ate that last, I noticed far less of a glucose spike as well. This is a relatively easy habit to adopt that I will carry with me from now on. Note that I did not have to necessarily restrict myself from eating, for example, a piece of sourdough bread that has fiber and makes me feel full and content. I simply had to switch the order in which I consumed my food to balance my blood sugar.
2. Exercise influences glucose release and control.
It was not uncommon for exercise to cause a brief spike in my blood sugar, which is a normal physiologic response that is beneficial for endurance and stamina. However, on days that I exercised, I noticed a lasting beneficial effect on my blood sugar stability even through the following day. Movement in any form was helpful, and it’s a call for us to move in the ways that bring us joy and make us feel strong to build our healthiest lives.
3. Not all alcohol is created equally.
I am not a huge drinker, but I will have a cocktail or glass of wine a couple of times a week pretty consistently. Not only did ANY alcohol cause my blood sugar to spike, certain types of alcohol (beer & wine for me) also caused my blood sugar to dip and surge while I was sleeping, which likely contributes to the poor sleep I notice even when I just have one alcoholic drink. Alcohol consumed earlier in the evening had less of an overnight effect than alcohol just before bed. This allows me to modify my alcohol intake in many ways: having a drink before or with dinner with friends earlier in the night rather than later, having a sugar- and sweetener-free cocktail when possible rather than beer or wine, and avoiding alcohol altogether more often are all habits I’ll be carrying with me long after this experiment ends.
4. Sleep affects our metabolic health more than we may think.
Some nights I sleep so deeply and soundly, and some nights I have work on my mind or I’m reading a good book and I stay up later than I intended due to an overstimulated mind. On the days following nights of good sleep, my blood sugar did not fluctuate nearly as much as on days that I had slept poorly the night before. Moving forward, when I wake up feeling like I’ve slept poorly, I’ll strive to have a lower carbohydrate intake than the days where I slept well. This is a particularly helpful finding, because we often crave carbohydrates when we haven’t slept well, and those blood sugar spikes are likely simulating wakefulness at the cost of metabolic stability.
5. Stress affects our metabolic health more than we may think.
Unsurprisingly to me, days where I felt more stressed or busier at work yielded more chaotic glucose curves. Things that did not spike my blood sugar on less stressful days caused my blood sugar to surge on days where I felt more stressed. I also had more blood glucose dips on those days, which made me crave carbohydrates more. It is impossible to avoid stress in our lives. It is not impossible, however, to make eating choices on particularly stressful days to keep our glucose more stable. Focusing on lean, healthy protein and lots of vegetable intake on days where we are feeling more stressed will lead to more glucose control and likely will help with both stress and our long-term health outcomes. A double benefit!
6. Not all carbs are created equally.
My body loves quinoa, it turns out. I can eat a pretty big serving of it without even eating protein or vegetables beforehand and not have a blood sugar spike. Homemade sourdough bread makes me spike less than store bought bread of any kind (interestingly including store bought sourdough!) and popcorn also causes a modest spike for me on an empty stomach. However, the number one culprit of the most prolific spikes consistently over the few weeks of this experiment was…drumroll please…pretzels! I don’t eat pretzels super frequently in my day to day life, as I think there are other salty snacks that are more delicious and interesting (sorry pretzels), however we have recently had them around more and WOW do they really not agree with my blood sugar. I honestly will probably generally avoid them from now on unless I have a really intense craving for them. And quinoa is a whole grain packed with fiber and lots of micronutrients that I will definitely be consuming more! While I won’t cut any food out completely (pretzels dipped in nutella are still going to be in my treat rotation, just less often), it was helpful to see how the things I am commonly consuming affect my blood sugar.
7. All bodies are different.
I really thought that eating vegetables first was going to have a profound effect on my blood sugar stability, as I’ve seen other folks’ glucose curves who practiced this dietary change and it was remarkable. However, my body really likes protein first at meals more than I anticipated. Some people with absolutely no family history of metabolic disease may not notice such large spikes in their blood sugar with simple carbohydrates. Some folks who have more of a genetic tendency toward insulin resistance and metabolic disease may notice far more dramatic spikes and higher fasting glucose levels on days following more carbohydrate intake. My hope is that CGMs will become less expensive for everyone to use as they become more of a mainstay in diabetic care and more widely available, so that we all can have a better idea of our bodies’ metabolic dispositions.
That concludes our grand glucose experiment! I hope you found this information useful. If you’re interested in optimizing your health to ensure longevity and vitality later in life, please meet with an Integrative or Functional Medicine physician. We specialize in creating a comprehensive and individualized plan to promote your overall health and wellbeing and love to partner with our patients to empower them to live their healthiest lives.
Stephanie Karozos, MD
