So we’ve discussed how our blood gets overloaded with blood sugar from both our diets and from internal mechanisms that are designed to keep our blood sugar stable but are overactive. This breakdown in blood sugar homeostasis, this balancing act, is actually the most pervasive thing that happens when our blood sugar regulation breaks down, not the fact that we don’t make enough insulin and /or our insulin isn’t effective enough, which is the way that almost everyone puts it.
It’s no secret at all though that glucose dumping so to speak, primarily from the liver but from the kidneys as well and perhaps from other sources as well, does influence type 2 diabetes very significantly. If not for this dysregulation, if not for all this extra glucose in other words, that we don’t need but gets secreted into our blood anyway, there might not even be such a thing as type 2 diabetes.
I remember back when I first started looking into diabetes, they removed the pancreas from a fellow and found that even though he did not secrete any insulin at all, his blood sugar normalized, and this is obviously not a solution because we do need insulin for other things but in the absence of insulin’s counter hormone, glucagon, the body was able to metabolize glucose just fine without insulin.
So we know what glucagon does and it stimulates this additional glucose to be added, and glucagon levels in excess of normal is a big deal indeed, and we can’t just look at insulin while neglecting glucagon and expect to be on the right track or even in the right neighborhood.
So the first practical implication of this is that while this does decrease our tolerance for glucose in our diet, as we already have this background glucose being secreted all the time and what we get from our diet gets piled up on this, if glucagon levels are high enough, in combination with the other hormones that raise blood sugar, that in itself may not be enough.
It is wise to start with managing diabetes though lifestyle changes though, and dietary management is going to form the cornerstone of any sound diabetic management plan, regardless of whatever else we do or need to do in order to achieve adequate control.
It’s important to realize though that, as important as this is, it doesn’t address the underlying problem, or at least doesn’t address it very well. Most of this extra blood sugar secreted by the liver and kidneys comes from non glucose sources actually, so restricting glucose isn’t going to help much if you are prone to excess gluconeogenesis, which is the process of creating glucose from things that aren’t glucose, like protein and even fats, and even more notably, things that are involved in the process of human metabolism like pyruvate and lactate which we have more than an adequate supply of regardless of the diet we eat.
There was this gentleman that I had a lengthy debate with that insisted that you could control this liver dumping by restricting carbohydrates and protein and mostly eating a diet consisting of fats, which he does fine with, but if one has a problem with liver dumping this really isn’t going to help as the liver dumping can go on without any carbohydrates or protein actually. It will even cannibalize your muscles if need be, which is what happened to me actually at one point when I was on a very restrictive dietary kick, but I learned a tough lesson from this and it’s that if you are a big liver dumper, the liver will find a way to dump, regardless, in order to keep your blood sugar high.
Still though, it’s important to control the amount of carbohydrates in our diet, but this isn’t necessarily a matter of how low can you go with some of us at least, and there are consequences involved here as well, which I will speak on more as we go, but we’re basically talking about hormonal imbalances that this can create, although this does seem to differ quite a bit among individual diabetics, but it’s still something we need to be aware of.
So in the end, there are two main things that affect our blood sugar, which are diet which we can call exogenous glucose production, and the internal regulatory stuff, which we can call endogenous glucose production, and we need to pay attention to both, even though it’s the exogenous stuff that we tend to have control over, and it’s a lot more difficult to manage endogenous glucose, but we still need to focus on it.