Type 2 diabetes presents itself various ways, and it isn’t enough just to say that someone has high blood sugar, the type and manifestation of high blood sugar matters as well. This isn’t something we normally even look at that closely, but we really need to, as this can provide some real insight into what is going wrong.
We do tend to view high blood sugar in two categories, post meal readings, generally taken a couple of hours after we eat, and what we call fasting readings, which are at least supposed to be baseline readings not under the influence of digested food.
This is not always so cut and dried and if someone has slow digestion for instance, then their fasting readings aren’t going to be true fasting, and we may need to look beyond the normal amount of time that most people require to get to a fasting state.
We can say though that there are two issues that are going on here, an exaggerated response to eating, and excessive levels of baseline blood sugar. The baseline blood sugar influences our readings all of the time though, for instance if it is elevated, then we are starting out higher and also under a greater glucose load without the food, so the food we eat only adds to that.
There are some people though whose blood sugar returns to normal between meals, in the fasting state, and then they may go up way too high after meals. What we’re looking to measure after meals though isn’t the blood sugar readings, it’s the difference between the two readings, before and after the meal.
Most people just look at the post meal reading though but given that the idea is to see how the food influenced our blood sugar, that’s not the way to do it. So you get these simple minded recommendations like don’t go over 140 or 180 or whatever 2 hours after a meal but someone might be higher than that to start with, so that’s not going to be helpful in choosing what food to eat, as even eating nothing may not be able to satisfy these requirements.
How much a meal puts you up though does matter, and this is one of the things that we need to use to decide what to eat, but it’s certainly not the only thing, and for some diabetics, this will end up providing too short sighted of a view.
The reason is that after meal, or post prandial (PP) rises in blood sugar is just one part of things, and depending on the individual, this might not even be that significant in the overall scheme of things.
The second part, and the one we tend not to pay anywhere near enough attention to, is our baseline blood sugar levels, the background glucose that is secreted into our blood independent of food. This blood sugar is not driven by diet, it’s driven by hormones, and type 2 diabetes is essentially a hormone disorder.
In simple terms, our bodies think our blood sugar isn’t high enough even though it may already be way too high, and it seeks to raise it further, and it can be very successful in doing so. Depending on the situation, it will perceive a certain level as desirable and work hard to keep us at that, at a minimum.
So instead of keeping us from going below 80 for instance, which happens in a non diabetic, it can work just as hard and just as effectively to not see us go below a higher number, which may be 120, 150, 180, 200, or even higher depending on the degree of the hormonal dysregulation present.
Sometimes people refer to this as broken signaling, and it’s true that there are some signaling issues, but it’s better to understand this as signaling working very well indeed, although the goal of this signaling can be set too high for various reasons.
So our blood sugar can be persistently high, and we can call this our set point, the lowest we tend to go, with a normal set point generally being in the 80’s, with diabetic set points being higher to various degrees.
Some people, those tending to have lower set points, will often advise diabetics to manage their diabetes through dietary restriction, and that might work well for them, with their lower set points, whereby they really have one major problem, and that’s going up too much after meals.
What you eat though really doesn’t affect your set point that much though, it can over time by way of excessive insulin secretion, and eating a diet that secretes too much insulin can worsen this, but this process occurs over a long period of time and also resolves over a long period of time as well.
There are other things going on here though and if your set point is too high, your diet isn’t really going to help this very much at all. This is because your blood sugar is being put up by other factors besides diet, because a fasting state is independent of diet really.
We then tend to say that if diet doesn’t work, then we need medication, and then go off on a pin the tail on the donkey approach, without testing anything or really thinking about the situation too much. Here, try this, and if it doesn’t work, we’ll try something else.
We do need to think of these matters independent of diet, and think about them in terms of the hormones involved, but that’s not even deep enough. We need to really look at what is behind these hormonal imbalances, for instance insulin resistance, and then look to what may be behind that, inflammation for instance, and then look to get as close to the root cause as we can.
Although type 2 diabetes is brutally complex, it really all boils down to cellular toxicities, and we can simplify that by saying that there’s too much inflammation going on. So we need to view our approaches in terms of how well they manage these toxicities and inflammation in turn.
It is likely that our higher blood sugar is actually a positive adaptive mechanism, where our bodies actually may require higher blood sugar to function better, much like we require higher blood pressure to function. Getting rid of the symptom, the high blood sugar or blood pressure, without addressing the cause, the need for it, will just make things worse. The body is still just as sick but now it can’t compensate as effectively.
The takeaway here is that we really need to pay attention to inflammation if we’re looking to manage type 2 diabetes, and the degree that we need to pay attention to this is manifest in the degree of persistently high blood sugar we have, levels that the body has picked for us as normal. To change this normal, we need to look to address the underlying conditions causing this abnormal perception of normal.