Why Isn’t My Blood Sugar Going Down?!
“I’ve done everything, and it still isn’t working!”
Janice was exasperated because she was trying so hard to reverse her diabetes, but the numbers weren’t coming down. She was eating right, and had lost a little weight, but her HbA1c actually went UP one point. “This is so hard!” she was almost in tears.
Some people have little trouble reversing their blood sugar numbers with a small effort, however, there are many who seem to have a hard time. Those who make big changes in their lives, including diet and exercise, may have other issues preventing them from seeing the results they seek. Let’s talk about the things that get in the way of reversing diabetes. There may be many different factors that influence how sugar is used in the body, the most common include:
• Insulin
• Cortisol/stress
• Sex hormones and thyroid
• Drugs: diuretics, inhalers, steroids, statins, Caffeine, etc.
• Circadian Rhythm
• Protein
• Fat
• Exercise/activity
Insulin
The most important hormone associated with diabetes is insulin. Without insulin, there is no way for sugar to get into most cells to create energy, so the glucose stays in the blood. We always need some glucose in the blood to feed some cells, such as brain, heart, and kidney, but when we have too much, insulin will cause the liver, fat and muscle cells to take up the extra sugar and store it for later use.
Insulin opens the ports and allows sugar (glucose) into the cell. As the muscles cells fill with sugar, they start making a starch called glycogen for short-term storage. However, if there is not enough exercise to use up that excess energy, they get crammed with glycogen and block insulin receptors. The cell then cannot take up glucose, so the blood sugar levels stay high.
Fat cells use sugar to make fat as energy storage for the body. They can also become insulin resistant when they get too full of fat, but may continue to produce fat out of sugar.i
High insulin levels in the blood indicate insulin resistance, meaning your cells cannot take up the extra sugar from your blood. You will also tend to gain fat easily. Insulin resistance can keep your blood sugar high even if you have a perfect diet!
If your insulin is low, your pancreas may not be making enough to get the sugar from the blood into the cells, and the blood glucose will remain high. This is Type 1 diabetes. If you don’t make enough insulin, your blood sugar will remain high despite a low carb diet.
You may also have both, low insulin and insulin resistance, or Type 1.5 diabetes. In this case there is very little insulin, but you are resistant so the blood sugar stays high because it cannot get into your cells.
Insulin sensitivity is essential to get the blood sugar down and reverse diabetes. Most people on a ketogenic diet, such as “PHASE I” of the Diabetes Solution Kit will have immediate improvement in insulin resistance and will find their blood sugar comes to normal easily, however, for those who don’t they may have insulin resistance. It is important to test for this.
Cortisol
The second most important metabolic hormone is Cortisol. This is the adrenal hormone that controls your sleep/wake and metabolism. Cortisol affects every cell in the body, turning on the energy systems, turning off the immune system, and causing the “catabolic” state, where the body is working and breaking down food, muscles, bones, and connective tissue.
Cortisol also makes you resistant to insulin. This is essential to understand, because the problem is not primarily the cortisol, but the insulin. Remember that insulin causes the fat cells to make fat, and prevents the body from burning fat. Cortisol makes this worse. If you have a great diet and exercise program, but have a lot of stress, you may be making a lot of cortisol, which can cause diabetes.
Since stress raises cortisol, it can induce diabetes. I had one patient, Julie, who was overweight and couldn’t control her blood sugar no matter what diet she ate and what medications she was on. At one point, she had four diabetes medications and injecting a large amount of insulin, but it was still high all the time. Then one day her daughter moved out of the house and into her own apartment and suddenly Julie’s blood sugar dropped to normal – and she got off all her medications! She only had diabetes because of the stress of living with her daughter. Don’t underestimate how powerful stress is in insulin resistance. This is one hormone I always measure.
Sex Hormones and thyroid
The sex hormones aren’t just for reproduction, they affect metabolism, or the use of energy, to a great degree. For example, lower estrogen causes higher blood sugar, lower progesterone causes insulin resistance.ii This means that as women age, and go through menopause, they are at increased risk for getting both higher blood sugar and more insulin resistance, even if they have a good diet and exercise program.
On the other hand, men also benefit from estrogen and progesterone. Men make smaller amounts of estrogen from testosterone, and when testosterone is low, the estrogen is also lower, which increases insulin resistance and raises blood sugar.iii Progesterone in men only comes from the adrenal glands, and during times of stress, it goes down, increasing insulin resistance.
Testosterone is associated with better blood sugar and lower diabetes. Men with diabetes tend to have lower testosterone levels.iv So, keeping the testosterone up to normal is important for being able to reverse and prevent Type 2 diabetes.
Thyroid disorders also contribute to insulin resistance. But with the thyroid, either too high or too low can cause insulin resistance. Low thyroid makes the muscles resistant to insulin, causing the blood sugar to be high, and high thyroid causes the liver to be insulin resistant, with the same results!v
If your blood sugar is not coming down in spite of a good diet, consider a hormone imbalance as a possible cause.
Protein
There are a lot of people who try to go on a low carbohydrate diet by increasing protein. Some will eat over a hundred grams of protein per day (20 eggs, or a pound of meat). A high protein diet can increase insulin resistance.vi vii More is not better. If you are having trouble getting your blood sugar down, even though you are eating low carbs, try lowering protein as well.
Fat/oil
The oils we eat cause insulin resistance in the muscles.viii Saturated fats do considerably more damage as they increase inflammation as well.ix Within three hours of eating a meal high in fat the muscle cells become resistant to insulin. If you find you are eating a ketogenic diet with high fat, and you still have high blood sugar, you may be insulin resistant due to a diet high in fat. The answer, then, is to eat a low fat and low carbohydrate diet by adding a lot of fiber.
Fiber
Actually, since type 2 diabetes is a disease of calorie toxicity, it is best to detox from ALL calories, including carbohydrates, fat, and protein. People ask, “then what will I eat?” Fiber. Eat foods that are high in fiber and low in calories: Spinach, lettuce, celery, cucumbers, avocado, tomatoes, peppers, and so forth. Beans and lentils are quite high in fiber, as are nuts and seeds. There are no limits to the amount of fiber you can eat, and it does wonders to bring down blood sugar, even if you have some calories (carbohydrates, fat, protein) with it.x Aim for about 40 grams of fiber daily.
Drugs
There are many drugs that affect blood sugar metabolism. Some actually cause diabetes. Diuretics of all kinds increase insulin resistance and can contribute to high blood sugar. Statins increase insulin resistance and impair the function of the pancreas.xi The medications specifically given for type 2 diabetes often increase insulin production by the pancreas causing insulin resistance. Also, remember that cortisol has a huge effect on blood sugar – this means that all the “steroids” including creams and asthma medications may have this same effect. If you are having trouble controlling your blood sugar, despite a low-carb, low-calorie diet, look to see if your medications are the cause.
Circadian Rhythm
Our sleep-wake cycles are connected to the metabolic system intricately. When we don’t keep a good circadian rhythm, when we stay up late, or eat before bed, we don’t go into “anabolic” or repair mode at night, and we continue to have inflammation that makes us more insulin resistant. Stop eating after 6pm and go to sleep by 10pm to put your body in repair mode. This will also lower your cortisol and improve insulin resistance.
Activity
Your amount of activity has a large influence on the blood sugar and insulin resistance. Insulin causes more sugar to go in the cells, eventually causing resistance to insulin. Any type or amount of exercise uses up the sugar in the muscle cells, allowing the insulin to work better and decreasing insulin resistance.xii Exercise can also allow muscles to take in glucose without insulin.xiii This effect is increased by heavy exercise, such as lifting weights or interval training. If you are on a low carb diet and find that your blood sugar is not going down, try more exercise!
Make a plan
As you can see, there are many reasons your blood sugar is not coming down easily with the PHASE I diet on the Barton Publishing Diabetes Solution Kit. It’s not just about food, as hormones and stress also have a large effect on your blood sugar. Testing is essential. It turned out that Janice had autoimmune diabetes – she was making antibodies against her insulin, so even though she was making insulin, it wouldn’t work because the antibodies were inactivating it. If you don’t test, then you won’t know what to do.
Plan: If you are having difficulty lowering blood sugar, you may need to test for the following:
• Insulin level
• C-peptide
• Insulin antibodies
• Islet-cell antibodies
• Hemoglobin A1c
• Blood glucose
• Morning Cortisol
• DHEAS
• Estrogen
• Progesterone
• Testosterone
• Thyroid panel (Free T3; Free T4; TSH)
The results of these tests will tell you if you have a biochemical abnormality that needs to be corrected first. At the same time, make sure you are also doing the following:
• Increase fiber and lower fat and protein. Try for 40 grams of fiber daily.
• Exercise daily, ideally with HIIT (High Intensity Interval Training) where you exercise hard for 10 seconds, and then lightly for 30 seconds for twenty minutes per day.
• Lower stress with yoga, meditation, connecting with others, letting go of pain and excess.
• Get off all unnecessary drugs.
• Don’t eat after 6pm
• Go to sleep by 10pm
• Be patient – sometimes it just takes time. :)
………………..
i Diabetes and the Endocrine Pancreas I: Edited by David Harlan: What causes the insulin resistance underlying obesity?; Hardy, Olga T.a,b; Czech, Michael P.a; Corvera, Silviaa
ii https://prescriptionhope.com/blog-does-estrogen-affect-blood-sugar-levels-estrogen-and-insulin-resistance/
iii Science News; Role of estrogen in controlling Type 2 diabetes; February 12, 2019
iv Meta-Analysis Int J Androl; 2011 Dec;34(6 Pt 1):528-40. doi: 10.1111/j.1365-2605.2010.01117.x. Epub 2010 Oct 24. Type 2 diabetes mellitus and testosterone: a meta-analysis study
G Corona 1, M Monami, G Rastrelli, A Aversa, A Sforza, A Lenzi, G Forti, E Mannucci, M Maggi
v Review Endokrynol Pol. 2014;65(1):70-6. doi: 10.5603/EP.2014.0010.
Insulin resistance and thyroid disorders; Marcin Gierach 1, Joanna Gierach, Roman Junik
vi J Nutr. 1982 Apr;112(4):681-5. doi: 10.1093/jn/112.4.681.
Effects of high protein diet on insulin and glucagon secretion in normal rats
M Usami, Y Seino, S Seino, J Takemura, H Nakahara, M Ikeda, H Imura
vii https://www.nature.com/articles/ejcn2014123
viii Diabetes. 1999 Feb;48(2):358-64. doi: 10.2337/diabetes.48.2.358.
Rapid impairment of skeletal muscle glucose transport/phosphorylation by free fatty acids in humans M Roden 1, M Krssak, H Stingl, S Gruber, A Hofer, C Fürnsinn, E Moser, W Waldhäusl
ix https://nutritionfacts.org/video/lipotoxicity-how-saturated-fat-raises-blood-sugar/
x Review J Nutr. 2018 Jan 1;148(1):7-12. doi: 10.1093/jn/nxx008.
Impact of Dietary Fiber Consumption on Insulin Resistance and the Prevention of Type 2 Diabetes Martin O Weickert 1 2, Andreas F H Pfeiffer 3 4
xi https://www.peoplespharmacy.com/articles/atorvastatin-lowers-cholesterol-but-raises-blood-sugar
xii Review Adv Exp Med Biol. 2020;1228:137-150. doi: 10.1007/978-981-15-1792-1_9. Exercise and Insulin Resistance; Stephney Whillier
xiii Review Int J Sports Med. 2000 Jan;21(1):1-12. doi: 10.1055/s-2000-8847. Exercise and insulin sensitivity: a review; L B Borghouts 1, H A Keizer