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E24 Balancing the Confusion: Blood Sugars, Insulin Resistance, and Continuous Glucose Monitors
45 Plays1 year ago
Join me today as I dive into a topic near and dear to my type one diabetic heart: blood sugar foundations! We are discussing what blood sugar is, what regulates it, and what you can do to better manage your own and WHY you may care BEYOND metabolic diseases like diabetes.
We are ALSO taking a look at insulin resistance, the pros/cons of continuous glucose monitors, and how to approach blood sugars mindfully without rigidity and obsession.
Please remember everything you hear on the EBTL podcast should not be taken as medical advice and to always consult your medical provider.
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Transcript
Introduction to 'Eating Between the Lines'
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Hello and welcome to Eating Between the Lines. I am your host, Therese Martinez, and I am so happy to have you here. If you want to untangle yourself from diet culture conditioning and get appropriate, actionable options to nourish your unique life and body, I'm going to dive deep into the nuanced spectrum of health to help you figure out what to prioritize in your journey
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without getting trapped in the extreme ideology of health optimization or total complacency. I am here to help you apply the science effectively, not rigidly, and get you feeling better in your body and mind.
Blood Sugar: A Personal and Broad Health Issue
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Here is how to eat between the lines.
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Hello, hello, welcome back everyone. Today we are diving into the wonderful world of blood sugars. This is a topic near and dear to my type one diabetic heart. And though it is also been highly discussed in so many health and wellness
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realms these days beyond just diabetes.
Understanding Blood Sugar Basics
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I felt very compelled to kind of go over blood sugar basics to help people understand mechanism a little bit more why this is important or not so important to dive into for
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Each person so some of you may have heard of continuous glucose monitors Some of you may not really know much about blood sugars at all
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And some of you may have heard of insulin resistance and, or a one C fasting blood glucose. There might be some familiarity with diabetes, gestational diabetes type two type one. There are a lot of components to blood sugar and manifestations of
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conditions when there is dysregulation. So today we're going over the basics so that you can understand your own body and maybe the body of other loved ones and, or have some compassion for folks that are also dealing with concerns and considerations with their
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blood sugars.
Clearing Up Blood Sugar Misinformation
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I find that there is also just a lot of misinformation out there and so I want to create some clarity for folks that might feel a little distressed and concerned. Maybe they got some lab values back, maybe people are pushing continuous glucose monitors on them and or maybe you have already gotten a continuous glucose monitor
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And you are unsure of the results that you're seeing. I do want to say, I always recommend seeking a professional to kind of help with the evaluation. I don't think that all professionals out there are created equal with how they are kind of educating folks around the appropriateness or inappropriateness of blood sugar trends.
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If you want some recommendations, please reach out to me and I will have some folks to guide you to. In addition to of course, always being able to reach out to me to work with myself. So let's get into this today. So blood sugar in its
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kind of simplest definition, we are considering energy in our bloodstream, right?
Impact of Blood Sugar on Overall Health
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So the sugar in our bloodstream provides energy to our cells. And this is really important because blood sugar can impact a handful of big picture things that impact patterns.
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I've talked about this in previous episodes where patterns are super, super important and helpful to understand. I talked about this when I discussed macronutrients. A large reason why understanding macronutrients is beneficial is because of the impact that it can have on blood sugar regulation. So if we back this up, blood sugar is a huge part of impacting big picture patterns.
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having stable blood sugar. So that concentration of sugar in your bloodstream fluctuates and that is normal. The degree of fluctuation can impact your energy. It can impact cravings and eating tendencies.
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It can impact brain fog, fatigue, mental clarity can impact even hormones. And so it is important to understand how to manipulate intake and lifestyle to best promote blood sugars that help your overall patterns and health. And so that's different for everyone. And I always like to emphasize that we are looking at different
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manipulations of composition of meals, of exercise, of stress management, lifestyle, et cetera. We'll get into all of these variables in a minute, but that will look different for everyone. So let's get into it here.
Factors Affecting Blood Sugar Levels
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We know now that blood sugar is the concentration of sugar in the bloodstream.
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So let's talk about what impacts the concentration of blood sugar and then how this gets regulated. So we have a lot of variables that impact the concentration of blood sugar in the bloodstream. I think that the most tangible and oftentimes just the most impactful, directly impactful variable is food. Though there are a handful of others like stress,
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and sleep and illness. Many times these things that are impacted by cortisol can increase blood sugar and
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I want to kind of back up and say it is again, very normal to have fluctuations in blood sugar. Our curiosity and concern comes when there is dysregulation and an inability for a person to kind of come back to a homeostasis of balanced blood sugar, because we're looking at numbers.
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that occur in the bulk of time, right? And the ability for a person to come back to a stable appropriate number.
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I'm not going to get too caught in the weeds at this moment with numbers, but we will talk a little bit about those later on. So other variables here mentioned stress and cortisol. And also we have alcohol intake. Your hydration status can actually really impact your blood sugars as well. I see this so much, uh, just having type one diabetes. The second I chug a bunch of water.
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sometimes that sticky high blood sugar will come down a lot easier. And so staying hydrated can definitely help regulate your blood sugar, but there are a good handful of considerations that differ between folks with type one and folks that do not have diabetes. And so also your caffeine intake
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can sometimes impact blood sugar spikes, medications, exercise, and the type of exercise we often see, you know, steady state movement like walking, maybe a light jog, cycling, things like that really help bring blood sugar down.
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And sometimes high intensity exercises like weight training or HIIT, CrossFit, things like that can provoke spikes in blood sugar. Now, again, that's fine. Blood sugar fluctuations are normal. And we also know that brief bouts of and stress on the body can help provoke adaptation. And so
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We just want to kind of support recovery and balance. And again, just check in to make sure that our blood sugars are coming back down. Other things like altitude and even cycles for women that have cycles that can also impact blood sugars.
Glycemic Index and Load Explained
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So people will kind of notice different considerations with their blood sugar fluctuations throughout the course of a month, but also with all of these other variables in mind.
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Now, if we come back to food as that is one that is so directly impactful with blood sugars, I want to take a second to discuss it a little bit. So,
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foods that have mostly carbohydrates in them. So we're thinking about breads, pastas, grains, starchy vegetables, fruits, and other things oftentimes like crackers and chips, although there are so many different brands out there now that are like low carb that sometimes I can't just generalize in that sense. I guess that's the same with pastas and breads too, but
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Uh, you know, we were just kind of looking at food labels and seeing carbohydrates as the highest number on that food label. And these are foods that get into our system and get broken down as glucose. Okay. There is something called a glycemic index. A glycemic index is something that rates food as like speed of which it raises the concentration of sugar in your system. So foods that have.
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simpler carbohydrates, like a fruit juice, you know, where it, it doesn't have much protein or fat or fiber. That's going to be a simple carbohydrate. That's going to get into your system pretty quick. More complex carbohydrates are going to be ones with fiber, protein, and fat, particularly more fiber as more complex. And those are going to take a little bit longer to get into the system.
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And so that connects to a glycemic index, the glycemic index. If it is higher, that means that the blood sugar gets raised faster. If it is lower, it gets raised slower. So this is important to know because of how this can impact your blood sugar. Now, sometimes we want fast acting.
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sugar in our system because we're going to go use it. You know, this is utilized a lot with athletics and sports. And sometimes we want it to be a little bit slower because we are needing a little bit more level energy for a longer period of time. That's what kind of balancing blood sugar means. It has a slower absorption into the bloodstream to kind of provide a more level energy distribution.
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So this is kind of where like the more, you know, is helpful, right? You can kind of manipulate the content of the food you consume to provide more or less energy at a faster or slower rate. So if we consider that with carbohydrates, we also consider things like protein to also impact blood sugar.
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A lot of people think it's just carbohydrates. Well, protein actually also influences blood sugar as well. So if we have a big piece of chicken or maybe a steak even too, we can
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see rises in our blood sugar. And this is through a process called gluconeogenesis. A lot of people that have protein shakes might also see a rise in blood sugar and be a little confused, especially if they don't have any carbohydrates. Well, your body does end up breaking down protein into a form of glucose through gluconeogenesis. And this can impact your blood sugar.
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So we have a couple different influences when it comes to food, in addition to those other variables that I talked about. So let's get into.
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the regulation component. This is a complicated system where you're going to simplify this a bit today. So we regulate blood sugar through two main hormones. Again, more complicated system than this, but just for simplicity's sake, let's talk about two main hormones.
Role of Insulin and Glucagon
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One is insulin. Insulin,
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decreases blood sugar in the system by facilitating, taking blood sugar out of the bloodstream and into cells. Okay. So that's what insulin does takes sugar out of the bloodstream, takes it into the cells.
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The other hormone we have is called glucagon. Glucagon stimulates what's called glycogenolysis, which is a breakdown of glycogen. So glycogen is stored glucose. We store glucose in our liver, in our muscles, and this is a way that we can help prevent those big drops in blood sugar. So we need insulin.
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to be working well to keep that blood sugar at an appropriate level in the body right and then we also need glucagon to also bring the blood sugar up so insulin brings it down glucagon can help bring it up especially if we don't have the other
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mechanisms doing that, the other variables doing that. So if we think about areas of dysregulation and let's say diabetes while in folks with type one diabetes, we are not producing insulin. So that's going to make a huge influence on our ability to bring blood sugar down and folks with type two diabetes or folks that might have a progression of this dysregulation
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with something called insulin resistance will also have a hard time bringing that blood sugar down. So in both of these states, we just tend to have higher blood sugar. Insulin resistance refers to an inability to bring blood sugar out of the bloodstream and into the cells more effectively. So if we kind of think about this, I like this visual. If we break this down here,
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Say for example, I consume a piece of white bread and that white bread is getting broken down as I chew it, as I'm swallowing it into my stomach, it gets broken down in there relatively quickly. White bread has a higher glycemic index than let's say whole wheat bread. And so that is going to get into my system pretty quick.
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And so the concentration of my blood sugar is going to rise at a decently quick rate. So that means that insulin is going to be getting produced. My body is going to know that sugar is getting into the system. It's going to trigger that release of insulin. Insulin then goes, chases down that blood sugar, grabs it, knocks on the doors of the cell. The cell says, okay, opens the door.
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blood sugar goes in and now that blood sugar starts to come down.
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So that's kind of how that system works.
Understanding Insulin Resistance
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For folks that have insulin resistance, that blood sugar rises, body says, okay, we need some insulin. Insulin gets released and goes chases after that blood sugar, knocks on the door of the cell and the cell's like, eh, doesn't open. Maybe it opens a little bit. But now we've got all of this circulating blood sugar
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And your body is like, okay, this is not good. Let's go. Let's go. Let's release the troops all all parties out. Lots of insulin getting released. So now we have more insulin to kind of compensate for that rise in blood sugar. And so now we're knocking on all the doors here, trying to get this blood sugar out of the bloodstream into the cells because we don't want to have
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a high blood sugar for very long. And so the cell walls eventually say, okay, you know, eventually there's enough receptors that, that the blood sugar can come down finally. So we can see in folks that have insulin resistance, they might have elevated levels of insulin. Okay. And so that can over time,
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become more and more problematic because blood sugar may stay higher for a longer period of time. For a period of time, maybe higher levels of insulin can work just fine. But over time, the pancreas can sometimes get a little tired and then not produce enough insulin. And then that can also lead to elevated blood sugars for a longer period of time. And, or we can kind of see that
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the insulin levels just are not working. And so the, the insulin resistance is so high that now we still have high insulin and insulin resistance and high blood sugars. So that's a little bit of that in a nutshell, but this is a process of very often times a long disease process too. So what influences insulin resistance?
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Well, it is multifaceted and honestly, there's not a huge level of concrete data, but we have a decent amount of correlation.
Factors Leading to Insulin Resistance
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And what we can see is that.
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Oftentimes associations with a sedentary lifestyle is absolutely connected with insulin resistance. We definitely see increased activity, um, especially in the realm of weight training and maybe higher intensity and just more frequent movement throughout the day, helping with insulin resistance. That means we are increasing insulin sensitivity. That means those.
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cell doors are being a little bit more hospitable, right? And we also know that diet can play a role. So there are, again, associations with kind of working in more anti-inflammatory foods, higher levels of fiber, and definitely balancing blood sugars, right? So working in some of those components of having some protein
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and fat and fiber with the carbohydrates one is consuming to kind of decrease that spike that can happen. So your body isn't in that stress state all the time, but additionally, those other micronutrients that come with the fiber and those other whole foods can
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impact the overall level of inflammation in the body. And then that can sometimes be beneficial. The other one that is often connected and that we see is around genetics and the genetic role that impact one's susceptibility to developing insulin resistance.
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If we're kind of bringing this back into the realm of glycemic index, I want to also take a second to note glycemic load. So the glycemic load of a meal is kind of like adding up the glycemic index of all the different components, right? So I used that example before about that piece of toast. Well,
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how often do we just have a plain piece of white bread? Some people do. I think usually there is some combination of having butter with it and maybe having it with eggs or, you know, a different kind of soup, things like that. So if we're considering a glycemic load of a meal, this is adding up all the components. So this can also
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be helpful when folks are trying to balance blood sugars and understand impact of meals on the system as well. Now, these are not hard and fast rules. I like to always say that with patients, we're really taking into consideration all the variables that can impact blood sugar and health.
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And so sometimes it is important to recognize that we aren't eating and setting up meals to be balanced always and forever. Sometimes meals are designed to be enjoyed because of the design of the meal, right? Like if I'm having potato soup, it's really starchy, but I also want to have it with sourdough bread, which is also starchy and
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having those two together might impact my blood sugar, but I'm going to have an awareness around this so that I understand, okay, this might impact my blood sugar and it might raise it. And ultimately that's probably fine in a well-functioning body. It's okay for blood sugar to go up and down.
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What I'm going to notice is how it impacts me later. Do I feel tired? Do I feel a little lethargic? Am I having any brain fog because of the composition of that meal? And if so, maybe if I know that about myself, I add a little bit of protein and fat.
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Maybe I say that's fine and I look at my diet on a whole. I'm always looking at it on a whole and understanding are all of my meals like that? Am I always not feeling very great after meals? What are the trends there? You know, and, and if the person has an ability to measure blood glucose on a regular basis, they can also see trends and see if those
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trends connect and correlate with the way that they are feeling too, and making manipulations and changes in diet accordingly. But always pulling that lens back, looking at this bird's eye view, not needing to be super duper picky about every single meal. So the glycemic load can play a role though. So if we are having, let's say,
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some rice and I'm also having that rice with beans and I'm having that also I don't know with let's say a tortilla and I'm also having that with soda
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And I'm also having a dessert on the side, right? We're seeing starch on starch on starch mixed with sugar mixed with sugar. That's going to have a pretty decent impact on blood sugar. And so again, considerations, how does this make us feel? How does this also compliment the rest of our diet? I have a lot of meals I love that have tortillas, rice, and beans, a hundred percent.
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I am not going to get caught up in those all having carbohydrates to prevent me from consuming that combination of foods.
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Absolutely delicious. Compliments each other really well. All whole foods all provide great nutrients. I might consider the soda and the dessert in addition to those, because I know I'm already having a decent amount of carbohydrates, right? And so that's where we sort of want to pull the lens back and see how it impacts us on a whole. And how do I feel afterwards? Okay.
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Perhaps sometimes it's helpful to add other sources of fiber and non-starchy options into a meal when I also know that I'm going to be having things like that. Now, fiber is found in rice and beans and sometimes tortillas and so that may not have as high of a glycemic load as say maybe
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when I have barbecued chicken with a lot of barbecue sauce and maybe a piece of bread on the side and also mac and cheese, right? We're considering starch on starch on starch, but also sugar in certain things like sauces that can also impact the whole glycemic load of a meal. So considerations with this.
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Now let's look at continuous glucose monitors.
Continuous Glucose Monitors: Uses and Concerns
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If you do not know what a continuous glucose monitor is, this is a device that people use to see what their blood sugar is on a continual basis. So I wear these all the time and it's been absolutely life changing, game changing for me and management of my blood sugar. There are a lot of people that have found interest in gauging and measuring their blood sugars that do not have diabetes.
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to see their own trends, like I've mentioned before, anything to consider that I've talked about so far. I have mixed feelings on that. Just a lot of times with, with technology, it is really easy to get hyper focused and consumed with metrics that
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You may not need to be super concerned about when you don't have evidence of any metabolic conditions. And if you are prone to getting hyper fixated and preoccupied and obsessed with the numbers, right? So I just always encourage people to kind of check themselves and understand and get the appropriate education around
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what is healthy and, um, and potentially more or less concerning with the nuance around the particular gauge, right? So like I mentioned before, blood sugars have a lot of nuance. We have to consider what we're actually looking at and for when we are measuring blood sugar, you know? So when I'm looking at a,
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a graph, if someone is showing me their blood sugar graph. I am looking at the spikes of blood sugar. I'm looking at how high they go and how quickly they come down. I'm looking at the average number, that balance number, that personal homeostasis. And I'm looking at the person on a whole.
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because blood sugar is just one measurement. So if I'm seeing, let's say a lot of spikes in blood sugar, I'm not seeing spikes in blood sugar and being like, Oh man, this person has all of these spikes. This is so terrible. I look at blood sugar spikes and I'm see, Hmm, I wonder how this person feels. How is that manifesting with other components of their life and their health?
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Right? I'm looking at blood sugar spikes and I know that blood sugar spikes happen more often with simple carbohydrates, not paired with protein, fat and fiber. So my consideration is, is this person getting enough protein, fat and fiber? Would they also feel better if they had more balanced meals? So what are the manifestations of blood sugar fluctuations in this person's health and life?
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What are the interventions we can make in a nutrition and lifestyle realm that help them feel better overall? That's what I'm looking at when I am assessing graphs from continuous glucose monitors.
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Okay. It is a little bit different again, when we are looking at folks with type one diabetes, and then sometimes with folks with type two that may be on insulin and other medications, because there can be considerations with adjustments in medications there too. But this is a little bit more for the folks without diabetes or the folks that have
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concerns and considerations with insulin resistance and blood sugar fluctuations currently and with the progression of metabolic disease. I just want to really emphasize that when it comes to blood sugars, that we are looking at the person on a whole while also understanding how certain trends of blood sugar can impact health down the line.
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foundations stay the same though, right? If a person has insulin resistance, it's going to be really beneficial to move one's body.
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If a person has insulin resistance, it's going to be really helpful to balance meals and to prioritize foods that have anti-inflammatory antioxidant effects that are also high in fiber and also proteins and different micronutrients.
00:30:22
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That's across the board almost all the time though. And there might be specific considerations for folks that might have developments of insulin resistance already. You know, we might want to consider specific manipulations. Some people react to certain foods differently, right? So the glycemic index.
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for example, is not this same thing across the board. So if I have a banana, I might react to a banana differently than another person, but it can help with basics around balancing meals. So again, pretty one-on-one status with blood sugar education. I hope this helps create some clarity around
00:31:14
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what blood sugar is, what regulates it, what impacts it, and what you need to be considering when it comes to helping your health and preventing disease. And if you already have some elements of insulin resistance and or have evidence that your blood sugar may need a little bit of TLC, then we can kind of work on insulin resistance
00:31:43
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insulin sensitivity and blood sugar management with some of these recommendations I talked about.
Blood Sugar Tests and Management
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If you are unsure, you can talk to your practitioner. There are certain tests like your A1C. A1C is a rough three month average around what your blood sugar trends have been. So if we're understanding numbers in the realm of like,
00:32:13
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baseline blood sugar and fluctuations of blood sugar, the A1C takes it all into consideration and kind of averages it out. So it has limitations, right, because it is an average. And that's why sometimes continuous glucose monitors can help because you can just see the trends in real time and you can really take
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certain meals and foods and see how they impact you and other things that you can do like going walking after a high carb meal or something like that can very evidently impact blood sugars. A lot of folks do that when they see that on their continuous glucose monitors, but the A1c can be an average. Fasting blood glucose can also tell you
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what that baseline may be more often. And then there are also things like blood glucose meters where you can test your blood sugar after a meal and see maybe how your blood sugar responds after certain meals for a half an hour, an hour, two hours after, and see trends with that as well. And then lastly,
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Measurements of insulin can show you circulating insulin. There are limitations with labs just because they can be a snapshot for that time. And since we do have many variables that impact blood sugar and insulin as well, then sometimes we might see labs that come back totally normal when it may just happen to be that there was not.
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intake or other variables that impacted it at that time. And you may have considerations of those variables that do impact it on a more regular basis and, or vice versa. So please reach out if you have any additional questions and yeah, again, I hope this
Conclusion and Resources
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helped. If it helped you, it would be really, really, really great if you could share the episode.
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or give a review that was helped me tremendously. It helps the show get seen more by others and help spread the word and understanding of all of the nuance around nutrition and health.
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And then of course for today, blood sugars. So have a great rest of your week and I will talk to you next time. Thank you so much for listening today. If you found this information valuable, please share this episode and give it a review. They truly help a ton. If you want additional support and information, you can head over to my website, teresmartinasrd.com where you can snag my free guide on how to improve your hunger signals. Get on my email list for regular juicy content.
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or apply for the next round of my signature program, restoring nutrition intuition. Otherwise, Instagram at Teresa Martinez RD or my Facebook group Fed Fit and Fad Free Nutrition with Teresa are always places for more content and support. Until next time.