There's a whole lot of focus on hyperglycemia when it comes to looking to treat and prevent diabetic complications, and it's true that high blood sugar is definitely associated with this, and on a dose dependent level as well, but we don't want to get too caught up in this either, as even though we may see some very strong associations with this, this doesn't tell the whole story either.
We actually neglect some other stressors when we do this as well, and we know that lipotoxicity plays a huge role in this as well, meaning our cells being poisoned by fat, as well as glucotoxity, being poisoned by too much sugar. It's not just glucose either, fructose has been shown to be even more toxic, and we measure neither frutcose or free fatty acid levels the way we measure glucose.
So we look at charts which show relative risk of diabetic complications and see the differing levels of A1C where the risk goes up as A1C rises, a very strong positive correlation in fact, and one that goes up geometrically even as A1C rises, meaning that the higher you go the more influence high blood sugar has on this per unit of excess, and then we say, aha, there's your culprit, busted, now all we have to do is worry about A1C.
If blood sugar levels were the only influencer here than that would make perfect sense, however this isn't the case at all. So you see people looking at this data and saying well I don't want any of this risk, or I can handle a little of it, or I'm comfortable with this much, or even I don't care, as if this were the only thing that matters.
Then you hear people saying, well some people get complications even with slightly elevated blood sugar levels, so this can happen anytime, for that matter people get this with normal blood sugar as well although the incidence is a lot lower, and it surely wasn't high blood sugar that did them in here because they didn't have it.
Another thing that tends to happen is that people often will have no idea what the relative risks are here as few people have looked into this, they will instead approach this out of ignorance basically and just believe that any risk involving elevated blood sugar is too much, but given that this isn't just a matter of choosing a certain blood sugar level, this can cause them a great deal of additional stress about their condition.
As well, people may be aware that their blood sugar levels may be associated with twice the risk for complications, and freak out about that, even though twice the risk of someone with normal blood sugar may be still a rather meaningless number, but it sure sounds bad when you put it that way.
People looking to trump up relative risks of something often use that tactic, using relative numbers instead of the actual ones, like for instance if a normal person had a 1% chance of something and this goes to 2%, well good grief you have a 100% more likelihood of the thing now and that does sound a lot worse.
Anyway, as it turns out, diabetic complications are actually a matter of oxidative stress, and high blood sugar does cause this to go up for sure. So I have an abstract for you to look at on this, this can be a very technical subject and this one is technical enough but not overly so, this does explain a bit about what goes wrong here in the end, and it's not glucose per se.
The best way to think of this is to imagine what happens to food as it spoils. So what is behind this is that it reacts with oxygen and this is one of the reasons why you cover things up, to keep it from oxidizing, although over time it will still spoil anyway, but you can reduce the rate that it does by doing this.
Now there are other things involved here like bacteria but oxidation does play a big role and we're just using this as an analogy by the way. So this tends to happen the most with fats by the way, which is worth noting, but all food spoils.
So in terms of cellular metabolism, more sugar and fat means more chance of spoilage, but there are two elements here, the amount and the rate of spoilage, the rate of oxidation in other words. So oxidation plays a big role here and that's actually the part that does the damage to cells, through various means, and we need not worry what they are at this point although I will probably go into this in more detail later on.
The major culprit though has been shown to be something called superoxide, and what happens is that basically when you get more excess nutrients into cells you can have more superoxide in them, you could even think of this as overloading their digestion and they may have poor digestion so there's your two factors right there, although this is a gross oversimplification, but too much oxidation is definitely the culprit here.
We don't really pay much attention at all to oxidation or looking to improve this, and you probably have heard of antioxidants, the body constantly produces these by the way and one of the big ones is superoxide dismutase, which counters superoxide directly, and there are others, glutathione for instance made by the liver.
There are also some things you can take such as certain supplements that also function as antioxidants as well, and some people think that's the only way to improve this, but enhancing the body's natural antioxidants is an even bigger deal actually as the natural ones so to speak are even more potent and this is what tends to break down when you have big issues with this, as diabetics do.
So I wanted to get you to start thinking about this problem, the problem of diabetic complications, as more than just blood sugar, and oxidation is even more central to the problem actually. So we do want to control our blood sugar but it's actually even more important to look to help ourselves in this other way, controlling excess oxidation, which we can do to a significant extent but not if we ignore this.