Glucose High

If you scored high in the ‘Glucose High’ section of the Health Score Quiz, please read this article as it contains some useful information and resources to help you.

The questions or statements posed in this section help to determine if you might be at risk of acute or chronically elevated blood glucose.

Please note this is not a diagnosis. On this page we discuss considerations for someone that might have symptoms relating to elevated glucose, how to assess if you think you have issues with glucose as well as offering some insight into what you can do about it.

On this page we are going to look at:

1. What is blood glucose and why do we need it?
2. The 3 main causes of elevated glucose
3. Risks, symptom and conditions associated with chronically elevated insulin
4. How to test if you have elevated blood glucose
5. How the gut can influence glucose regulation
6. What can you do to help reduce or stabilise your blood glucose?
• Foundations – Nutrition, sleep, movement, stress management
• Advanced strategies to assist with chronically elevated glucose

What is blood glucose and why do we need it?

Blood glucose is essentially the main sugar that the body utilises to help make energy. Our brain needs a constant supply of glucose and uses various hormones to try and keep your blood glucose within a fairly tight range. If the glucose levels go too high or too low this can cause a number of symptoms, some of which can cause significant acute issues whilst other issues can arise over time from poor management of glucose or chronically elevated levels of glucose, as seen with type 2 diabetics.

The body has the ability to make glucose from the foods that you eat and also from it’s own stores. Because of the importance of blood glucose, we can actually make it from carbohydrates, proteins and fats.

Our body also creates a storage form of glucose known as glycogen. This can be found in the liver and in muscle tissue. In muscle tissue we store it there, so the muscles have immediate access for it if we need to move. The liver provides a storage point so that glucose can be released as required by the rest of the body, especially in times of stress/demand.

The 3 causes of elevated glucose

There are three main reasons you might have issues with elevated blood glucose:

1. Production
2. Consumption
3. Clearance

Production

This relates to the body continually producing glucose, often related to certain hormones in the body that stimulate the release of glucose into the blood stream or a lack of certain hormones that suppress the release of glucose into the blood stream.

Examples of this include the balance between the hormone’s insulin and glucagon (both made in the pancreas) as well as the hormones we typically associated to stress, cortisol and adrenaline.

In the case of insulin and glucagon, insulin is seen as the hormone that helps to move glucose from the blood into cells where it can be used to make energy. However, it also has or should have an opposing relationship to glucagon. Glucagon is the hormone secreted when we need to release glucose from the liver to provide more available glucose for our cells to make energy.

As with the case of type 1 diabetes where the pancreas no longer makes insulin, this can have a negative effect on both the clearance of blood glucose as well as not being able to offer an opposing hormone to glucagon, therefore we can be both poor at clearance and be producing more. This results in acute a very dangerous elevations in blood glucose. When glucose goes very high this can result in significant toxicity in the body. This is not just for type 1 diabetics, this can also be seen in type 2 diabetic, particularly those that have had type 2 diabetes for a significant period of time and due to fatty build up in the pancreas the pancreas starts to lose its ability to produce insulin effectively.

In the case of adrenaline and cortisol, these two hormones also help to increase the production of glucose from other substrates like fatty acids & proteins as well as the release of glucose from the liver.

This is to assist in a fight or flight response state and is a perfectly normal response to stress. The challenge that we have now is our relationships with stress, that have become more chronic and generally poorly managed. In some instances, stress is the main driving force behind someone having excessive production of glucose.

Consumption

I look at this in two ways. What are we actually consuming, so that’s the food that you are eating, looking at the quantity and the quality of ingredients as well. I also consider consumption as how much energy are our cells consuming, so in simple terms what are we burning off.

A lot of glucose control relates to the management of the calories that we consume. If we chronically over consume what our body requires, this will result in the gaining of body fat, period! The gaining of body fat can result in us becoming more insulin resistant (worse at clearance of glucose from the blood), which over time can result in elevated blood glucose and eventually type 2 diabetes.

Having said that, it is not just about how much we eat, the choices we make in terms of the quality of food and its macronutrient, micronutrient, phytonutrient and fibre profile can also influence how our blood glucose responds. Some individuals have acute periods of high blood glucose, but also experience symptoms relating to low blood glucose as well.

The quality of the food that we eat not only helps us to manage the total calorie intake, it can also influence how our sugars react to that meal. More stable glucose levels will typically result in more stable physical and mental energy. This is why regulating blood glucose is one of the most important interventions within nutrition.

Clearance

Clearance relates to how well we are able to clear glucose from the blood stream into tissues so it can be used to make energy. When someone is poor at clearing glucose from the blood into cells for energy production, this is often termed as insulin resistance. The reason for this is that the hormone insulin is the hormone that helps to initiate the process whereby our cells draw glucose in. Insulin is like the postman that knocks on the door to help deliver a parcel.

If the body is having a hard time getting glucose into the cell a few things can start to happen. More insulin can be produced to force the issue or excess glucose can build up in the blood stream, resulting in chronically elevated glucose.

Issues obviously arise when there is not enough insulin being produced, for example with type 1 diabetes or long-term type 2 diabetes. Before one is diabetic however, we can compensate by producing higher levels of insulin. In the short term this is not an issue, however if the body either over-responds with excessive insulin after eating or is in a state where the insulin is now chronically elevated, this can cause a number of issues.

A variety of things can contribute to poor clearance and thus elevated insulin and/or glucose, these include:

• Quantity and quality of foods
• Inflammation & oxidative stress, especially within our cells
• Over production of stress hormones like adrenaline and cortisol

Risks, conditions and symptoms associated to chronically elevated insulin levels

1. Increased fat storage
2. Increased fatty liver
3. Increases in inflammation
4. Increased cardiovascular risk
5. Increased cancer risk
6. Imbalances in sex hormones that in women could lead to increased levels of “male” hormones and result in PCOS or infertility issues. In men it can negatively impact levels of testosterone and the increased fat can promote elevated levels of estrogen.
7. Increase production of cholesterol
8. Elevated blood pressure
9. Poor appetite control
10. Increased risk of mood disorders

As you can see, poor management or glucose resulting in poor management of insulin can result in far reaching affects through the body. It is not just about your risk of diabetes, it is about all areas of cardiovascular health, cognitive function, hormone balance and more. Again, this is why blood glucose regulation through appropriate quantity and quality of food is important.

How to test if you have elevated blood glucose

If you are concerned that you may have issues with elevated glucose and generally poor glucose control, then there are a few really beneficial tests that you can consider.

Fasting Glucose

This is the level of glucose in the blood typically following an overnight fast and before eating or drinking anything other than water. Whilst this can be useful, it is only a small part of understanding how you manage your glucose, so as a standalone test it has many flaws. The flaws include:

1. Glucose can be easily affected by stress levels
2. You don’t know how hard your body is working to maintain normal glucose levels
3. You don’t know from this how your body responds following meals

Fasting insulin or Fasting C-Peptide

Running either of these markers in conjunction with the fasting glucose gives an idea on how hard the body is working to maintain the levels of glucose noted in the test. For example, if someone has optimal fasting glucose and insulin levels then the body is doing a good job, alternatively glucose could be fine, but the body is producing 6 x more insulin than you would expect, this is a sign of insulin resistance. Alternatively, you may have low or normal insulin levels but elevated glucose, indicating the body is now making adequate insulin.

For me, insulin/C-peptide are some of the most underutilised but clinically relevant markers for so many people, and is a reason we like to assess fasting glucose and fasting insulin with almost all our clients.

HbA1c

HbA1c, simply put is a marker that indicates your average blood glucose levels over around a 3month period. Because HbA1c looks at your Haemoglobin (Hb) and the amount it has been glycated which basically means the amount of glucose attached to it.

It is a really useful marker for tracking diabetes and diagnosing diabetes, but it has one major flaw. Because it uses haemoglobin (found in your red blood cells) as the main protein, if one has anaemia or any other condition or imbalance effecting the levels or life cycle of your red blood cells or levels of haemoglobin, this will instantly skew your test results. For this reason, it is important that any baseline HbA1c is taken with a haematology at the same time, and any sudden changes in HbA1c levels should be followed up with a haematology assessment. Overall though, this is a very useful marker.

Triglycerides

This is another important marker to look at. Any slight increases out of the optimal reference range of 0.6 to 1.0 mmol/l can be a sign of insulin resistance. Our body can start to make excessive levels of triglycerides from the glucose in the blood in an attempt to reduce the levels of glucose. This not only increases cardiovascular risk, but also contributes to increased fat gain and insulin resistance and becomes a vicious cycle.

Other markers and tests that can be useful include:

• Glucose challenge test – Assesses how you respond to a fixed amount of glucose over a 2hour period
• Continuous glucose monitoring – Freestyle Libre is a very useful tool and best used in conjunction with a food, sleep, symptoms and emotions diary
• Body Composition Analysis with visceral fat levels – DEXA or a good quality BIA machine – We offer this in clinic
• Liver enzymes – Assessing for fatty liver, e.g. AST, ALT, GGT
• Thyroid function – TSH, Free T4 and Free T3
• Inflammatory markers – C-reactive protein
• Cortisol rhythm (salvia/urine) or metabolised cortisol (urine)

How the gut can influence glucose regulation

In the gut there are specific cells that produce certain hormones. Interestingly these cells can sense the ingestion of carbohydrates. One of the hormones produced by these gut cells is called glucagon like peptide 1 (GLP-1). GLP-1 then triggers of an immediate release of pre-made insulin from the pancreas. This process has been termed the first phase insulin response. Amazingly this response can take as little as 2mins from the moment you eat carbohydrates, not from the point you absorb carbohydrates.

The point at which we absorb foods and the subsequent production and release of insulin based upon the demand required is known as the second phase insulin response.

Ultimately the first phase insulin response allows for a spiked release of insulin, so that when glucose is absorbed in from the gut into the blood stream, insulin is already present helping to deliver glucose to cells. The result of this is a lower spike in blood glucose and less insulin being release over a sustain period after the meal. Another role of insulin is to shut down the release of glucagon. If you remember, this is another hormone released by the pancreas involved in the breakdown of glycogen into glucose and release from the liver into systemic circulation. If an insulin surge occurs this means that glucagon can be shut down.

A blunted first phase insulin response is something that is being associated with one of the very earliest stages of type 2 diabetes development. We should also consider how it is impacting conditions like Polycystic Ovarian Syndrome which can be strongly impacted by sustained elevations in insulin.

With all this in mind, in some cases you have to consider the influence of digestive health on glucose control, although it is certainly not my starting point!

What can you do to help reduce or stabilise your blood glucose?

Foundational Interventions

At this point it is worth reviewing your foundation nutrition and lifestyle sections to see what might be influencing the regulation of glucose, and contributing to high blood glucose symptoms.

Nutrition

• Be aware of the total calories consumed and its relation to energy output. Are you just eating too much, doing too little or a bit from column A and a bit from column B. it’s not a sexy answer, but it’s fundamental!
• Eat less refined sugar and flour-based foods
• Eat more fibrous foods, especially fibrous veggies
• Get sufficient protein in each main meal to help balance glucose
• Eat healthier fats from things like olives, avocado, some nuts, seeds etc and for those that choose too, oily fish, grass fed/wild meats etc.
• Eat lower sugar fruits
• Eat a diet rich in phytonutrients – a high plant-based diet
• Eat within a restricted window each day, allow for a minimum of a 12hour fast, but more likely a 16-18 hour fast daily.

Sleep

A lack of sleep has been linked with increased insulin resistance. Not only that, poor sleep impacts appetite hormones, and we tend to eat more food in general and reach for more “pick me up” foods like sugar foods or more refined ingredients.

Movement

Exercise helps us clear glucose stored in the muscle tissue and in the liver. Whilst glucose can increase acutely while exercising, this is a normal response. The benefit with exercise is the cascade of events post exercise, that means we are more insulin sensitive, better able to dispose of glucose into the cell and more efficient at utilising energy in the cell.

Also, if we can maintain good levels of muscle this helps because it creates more mitochondria, this is where we make energy in our cells. More mitochondria means we use more energy at rest.

Stress

This is probably the most overlooked area when it comes to glucose management. I see so many people now where stress is the main factor behind their health issues. Elevated blood glucose is no different. High stress = more cortisol and adrenaline = more glucose production.

Review your foundational areas and see if there is something that can be worked on to help improve glucose management for you.

Advanced Interventions

Below you will find some example areas and possible interventions. We advise that any advanced interventions be done under the supervision of a professional, who can take your unique case into consideration and be guided by appropriate lab tests.

Increasing GLP-1

For those with a blunted first phase insulin response, and excessive post meal elevation in glucose and possibly a subsequent dramatic drop in blood glucose (too much variability).

• Pea protein
• Fish Oil
• Berberine
• Resistance starch
• Mindful eating

Mitochondrial Function

For those with high insulin and glucose. Improving the health of the cell from the inside by reducing oxidative stress, so that the cell is able to accept glucose and more efficient at making energy.

Low carb, low-moderate protein, high plant based and moderate fat diet, with an emphasis on monounsaturated fats and some oily fish.

Compounds

• COQ10
• Alpha Lipoic Acid
• Carnitine
• Vitamin E
• N-Acetyl-cysteine
• Phospholipid replacement therapy

Increasing insulin sensitivity or stimulating insulin secretion

Increasing sensitivity

• Exercise
• Paleo / Mediterranean diet
• Calorie restriction & fasting
• Fish Oil
• Ginseng
• Chromium
• Cinnamon
• Bilberry

Increasing secretion of insulin

• Fenugreek
• Gymnnema
• Vanadium

Reducing Glucagon

One of insulin’s main jobs is to suppress the production of glucagon. Without this it can cause glucagon to be released unimpeded causing a continuous release of glucose into the blood stream, resulting in chronically elevated glucose.

Therapeutic Approaches to helping lower glucose production:

• GABA – supplements to support GABA production or potentially GABA supplements themselves
• Berberine – Helps to reduce the livers production of glucose

Optimising Bile

Bile acids act on signalling molecules. In doing this it helps regulate both glucose and lipids.

Bile can help to decrease liver production/release of glucose, reduces the absorption of glucose from the intestines into the blood stream, increases GLP-1, increases pancreatic insulin production.

Stimulating bile acid production or bile flow:

• Swedish Bitters
• Dandelion root
• Milk Thistle
• Ginger
• Curcumin
• Beetroot
• Glycine
• Taurine