It is often said – we fear what we do not understand.
This is especially true when it comes to our health. We often stumble upon questions that require expert advice, but we usually resort to Google for answers and find ourselves satisfied with what it provides.
One such question that people with diabetes frequently ask is, “Why is my blood sugar level fluctuating?” While you may already understand the importance of maintaining a stable blood sugar level, the reasons behind these fluctuations might still be unclear.
If you want to know why is your blood sugar going up and down rapidly, fret not! The aim of this content is to answer specific questions like what causes blood sugar to rise without eating, whether sugar fluctuations can be controlled with a proper diet, and other pressing questions that might be keeping you awake at night.
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Why is it important to maintain blood sugar levels?
Our body normally maintains a blood sugar level ranging between 80 and 120 mg%. This is made possible by the synergy of two hormones – insulin and glucagon. However, if there is an increase in blood sugar level beyond the normal range, it becomes toxic for our body due to:
- Glycation: when sugar molecule attaches itself to lipid, protein or nucleic acid molecule.
- Osmotic stress: This is when a quick change in the elements around a cell causes water to move differently across the cell’s outer layer.
- Oxidative stress: A condition when there are too many unstable molecules (free radicals) in the body and not enough antioxidants to get rid of them.
Constant glycation over time can lead to complications that impact and potentially debilitate other organs and tissues. Therefore, it’s crucial to keep blood sugar levels under control.
How does insulin and glucagon work in tandem to regulate blood sugar?
Diabetes is not a disease of inappropriate or insufficient insulin secretion alone. It is a bi-hormonal disorder. Both these hormones – Insulin and glucagon are produced by the pancreas. While the alpha cells in the pancreas make and release glucagon, beta cells make and release insulin. Glucagon increases the blood sugar level, while insulin reduces it. Together they keep our blood sugar within normal range.
When we eat, and during the post-meal (postprandial) period, our blood sugar level increases. In response, the pancreas secretes insulin. Insulin sends a signal to the liver, muscles and other cells to store the excess glucose. This results in excess glucose being store as body fat and the rest is stored as glycogen in the liver and muscles.
When we are fasting or sleeping, our blood sugar level decreases. In response, the pancreas releases glucagon. This glucagon travels through the blood to the liver, where it breaks down glycogen into glucose. This glucose then enters the bloodstream, thereby increasing the blood sugar level.
Thus, insulin and glucagon work together to keep our blood sugar level in the normal range.
Why sugar level fluctuate?
Fluctuating blood sugar is called Glycaemic variability. This can occur due to several reasons. One such common reason is the consumption of ultra-processed foods (refined carbs) which causes a sudden spike in blood sugar.
Approximately 1.5 to 2 hours after consuming ultra-processed foods, there is a subsequent spike in insulin levels, leading to a significant drop in blood sugar levels. This causes reactive hypoglycaemia or deficiency of glucose in the bloodstream.
To counter the effect of hypoglycaemia, the glucose level has to be increased. So the body secretes regulatory hormones such as glucagon, adrenalin and growth hormone. However, this process often leads to symptoms commonly experienced by individuals with diabetes, such as jitteriness, palpitations, and anxiety.
In addition to consuming ultra-processed foods, there are several other factors that can contribute to fluctuations in blood sugar levels. These include:
- Dehydration: Insufficient hydration can affect blood sugar regulation, as it can lead to a decrease in blood volume and concentration of glucose.
- Artificial sweeteners: Some artificial sweeteners, despite being low in calories, can still trigger a release of insulin, causing blood sugar levels to fluctuate.
- Alcohol: Drinking alcoholic beverages can disrupt glucose production and regulation in the liver, leading to fluctuations in blood sugar levels.
- Hormonal imbalance: Hormonal imbalances, such as those seen in conditions like polycystic ovary syndrome (PCOS) or thyroid disorders, can impact insulin sensitivity and contribute to blood sugar fluctuations.
- Insufficient quality sleep: Lack of adequate and restful sleep can affect insulin sensitivity and glucose metabolism, potentially leading to unstable blood sugar levels.
- Medications: Certain medications, such as steroids, diuretics, and antidepressants, can influence blood sugar levels and contribute to fluctuations.
- Erratic eating and sleeping schedules: Irregular patterns of eating and sleeping can disrupt the body’s natural rhythm and affect insulin production and utilization, leading to blood sugar fluctuations.
- Blue light exposure at night: Exposure to blue light, particularly at night, can interfere with the body’s circadian rhythm and disrupt pancreatic beta cell function, affecting blood sugar regulation.
- Chronic stress: Prolonged periods of stress can lead to increased levels of stress hormones like cortisol, which can interfere with insulin sensitivity and contribute to blood sugar fluctuations.
It’s important to consider these various factors in maintaining stable blood sugar levels and to make appropriate lifestyle modifications or seek medical advice if necessary.
How can we minimize fluctuating sugar levels due to diet?
To minimize fluctuations in blood sugar levels, it is recommended to consume foods with a low glycemic index (GI) and low glycemic load (GL). The glycemic index indicates the speed at which a specific food can raise blood sugar levels, while the glycemic load takes into account both the glycemic index and the portion size, providing an estimate of how much blood sugar levels will increase.
By opting for low GI and low GL foods, one can help maintain more stable blood sugar levels throughout the day.
Ultra-processed foods comprise mostly of refined carbs and excess sugar. They have a high GI and GL, and can cause a sudden spike in blood sugar level. On the other hand, minimally processed and unprocessed foods are complex carbs (carbs + fiber). Since complex carbs have lower GI and GL, the rise in blood sugar level is slow and steady. So, people with diabetes should prefer complex carbs and get rid of gluten-rich foods and white polished rice.
Meal sequencing also reduces postprandial increase in glucose levels. It is advisable to eat veggies first, followed by fibers, proteins and fats. Carbs should be eaten last of all. Such sequencing enhances satiety and reduces the GI and GL of food and hence avoids sudden rise in blood sugar levels.
And finally, we should optimally eat 1g of protein per kg of our body weight for the proper functioning of the body and we should consume more essential fats (Omega 3) in order to strike the right balance with Omega 6 (which is in surplus in our food system).
What is the relation between stress and blood sugar?
There is a direct relation between stress and blood sugar. Stress hormones, such as adrenalin, non-adrenalin and cortisol, are secreted to protect our body. It is noteworthy here that our body cannot differentiate between emotional, physical or chemical stress. Therefore, when emotional stress is prolonged, it leads to chronic stress response that produces elevated stress hormones.
Chronic activation of the HPA axis (Hypothalamus-Pituitary-Adrenal Axis) leads to beta cell dysfunction, preventing insulin production and resulting in insulin resistance and metabolic complications. Elevated stress hormones play a role in this process, further contributing to insulin resistance.
Grounding can regulate cortisol release and decrease unwanted stress response. Simple breathing techniques of Yoga can strengthen the vagus nerve, which controls body functions such as digestion, heart rate and immune system. It also strengthens the parasympathetic system or PNS, which conserves energy and regulates functions like digestion and urination. It is recommended to take 3-5 deep breaths (paying attention to your breathing) at frequent intervals during the day, especially when stressed.
Other coping mechanisms are visualizing, affirmations, journaling etc. Most importantly, we should have a meaningful purpose in life and an emotional IQ. These help us steer clear of negative thoughts and unwanted chronic emotional responses.
How does exercise help to control fluctuations in blood sugar?
Modern lifestyle has made us victims of sedentarism (sitting down inactive) and sarcopenia (loss of muscle mass and strength with age). Skeletal muscle is essential for glucose clearance and is responsible for over 80% of ingested glucose from food. When there is loss of skeletal muscle bulk and tone, metabolism is affected.
Exercise helps to maintain muscle tone and bulk which increases basal metabolic rate. 75% of the exercise time should ideally be allotted for resistance training (anaerobic or weight bearing exercises) and 25% to aerobic activities (like walking, jogging, swimming).
Secondly, when we exercise the muscle cells can take up sugar from the blood without insulin. It is therefore advisable for diabetics to walk for 10-15 minutes an hour after every meal. We should also reduce our sedentary time on a day-to-day basis.
How does sleep impact blood sugar level?
Adequate rest and proper sleep are natural healers for the body. Insufficient sleep can lead to increased levels of the stress hormone cortisol, which in turn can contribute to insulin resistance. Sleep disturbances can also cause elevated blood sugar levels.
To align with the body’s natural circadian rhythm, it is recommended to aim for at least 7-8 hours of sleep between 9.30 pm or 10.30 pm and 4 am or 5 am. This timeframe is considered optimal for promoting overall health and well-being.
It is advisable to minimize exposure to blue light emitted by electronic devices and artificial lights in the evening as it can disrupt the circadian rhythm. Ideally, digital devices should be turned off 1-2 hours before bedtime. Additionally, it is recommended to avoid consuming coffee or other stimulants in the late afternoon or evening, as they can interfere with sleep.
Creating a sleep-friendly environment involves sleeping in a dark room, free from electronic gadgets. It is also beneficial to turn off Wi-Fi before going to bed, reducing potential electromagnetic interference. These practices can help promote better sleep quality and support the body’s natural sleep-wake cycle.
What medical conditions affect our blood sugar? Does antibiotic increase blood sugar?
The medical conditions that cause high blood sugar are Cushing’s syndrome, pancreatic diseases, surgery and acute stress, physical stress (trauma, burns etc.), infections, inflammations, and Thyroid disorders.
Steroids taken mainly for chronic conditions like autoimmunity or COPD, diuretics (water pills) and beta-blockers for hypertension, cholesterol lowering drugs (statins), anti-depressants, anti-psychotics like Clozapine and Olanzapine, immunosuppressant drugs like Tacrolimus and Cyclosporine can increase blood sugar levels.
What are the complications of fluctuating blood sugar levels?
Blood sugar going up and down rapidly can lead to diabetic macro and micro vascular complications, risk of hypoglycaemia and cardiovascular complications. Moreover, the metabolic control network is degraded and the antioxidant response is defective which in turn leads to higher exposure of tissues and cells to oxidative stress.
How to manage fluctuations in blood sugar?
It is important to maintain blood sugar levels in the normal range if we want to avoid complications. The body maintains blood sugar level by the action of insulin and glucagon hormones that work in tandem. Some of the salient factors that cause blood sugar level fluctuations are ultra-processed diet, poor sleep, certain medications, stress, dehydration, and blue light exposure.
Apart from those explained above, we can take some more simple steps to reduce random fluctuations in our blood sugar levels. For starters we can practice late breakfast and early dinner. We should stay hydrated. Thirst is often mistaken as hunger and we end up overeating. As a result, our blood sugar level fluctuates. We should also regularly monitor our blood sugars in such cases, so as to avoid complications well beforehand.