BY Samuel Mathis, MD, MBA
Over the last month, I had the opportunity to try out a commercial continuous glucose monitor. This device was attached to the back of my arm and provided constant feedback on my blood glucose levels. I found the experience enlightening. I learned that rice significantly raises my blood sugar levels. I also learned how certain drinks and sweets affect my blood sugar levels. I thought I would share some of what I experienced and learned about blood glucose levels.
Blood glucose levels naturally fluctuates throughout the day and after we eat. Patients with Type 2 diabetes mellitus have impaired glucose regulation due to insulin resistance at the cellular level. This impairment is caused by dietary choices, obesity, metabolic abnormalities, or hormonal changes that either affect the cellular absorption of glucose or the pancreas ability to secrete insulin. When blood glucose levels remain elevated, the body works to expel the excess glucose through the kidneys and converts the sugars to adipose tissue. Proper management of glucose levels is vital to healthy functioning of our body and to prevent the numerous complications of diabetes.
One of the best ways to improve blood glucose levels is through healthy dietary choices. High fiber foods such as fruits, vegetables, and whole grains have a lot of fiber in addition to their sugar content. This slows down the absorption of sugar into the blood stream. Another way to slow down our absorption of sugar (thus reducing a sugar spike) is to pair any carbohydrates with a protein. Recommending adding protein (either plant or animal based) to any carbohydrate helps to slow down the absorption of glucose and lowers glucose spikes in the bloodstream. The third recommendation regarding food would be to cut highly processed foods from our diet. Unfortunately, this is easier said than done due to significant food insecurity that many Houstonians face. A 2021 study found that approximately 68% of diabetic adults consumed a poor quality diet and 32% of adults had food insecurity (1). These food choices and subsequent inability to obtain healthy foods play a large role in both the development and difficulty in treating those with diabetes.
Another way to keep blood sugars from spiking after meals is to incorporate movement following a meal. A position statement from the American Diabetes Association found that regular physical activity such as moving every 20-30 minutes or taking a short walk after a meal reduced glucose spikes in sedentary overweight patients or those with impaired glucose regulation (2). While any form of physical activity can improve glycemic control, it is recommended to engage in daily aerobic and resistance exercise to reach the recommended 150 minutes per week of physical activity. Physical activity increases muscle cell’s sensitivity to insulin and activates various glucose transporters to improve glucose intake into cells.
The third way to help maintain healthy blood glucose levels is to encourage appropriate hydration. Water is key to helping maintain appropriate glucose levels in our bloodstream. A 2021 systematic review found that water consumption was in early related to the risk of developing diabetes (3). While the overall relative risk reduction was small (0.94), the fact remains that appropriate water consumption plays a role in glucose metabolism. Physicians intrinsically recognize the importance of euvolemic status in diabetic patients. This is why IV hydration is the cornerstone of hyperglycemia management.
With a few small changes, we can help our patients maintain appropriate blood glucose levels and lower their risk of developing or worsening their diabetes. Proper management and control of diabetes plays a huge role in the health of our patients. These interventions are not curative, but when coupled with other health interventions, they have the potential to help patients lower their need for medications or suffering from the numerous co-morbidities associated with diabetes.
References
Shaheen M, Kibe LW, Schrode KM. Dietary quality, food security and glycemic control among adults with diabetes. Clin Nutr ESPEN. 2021 Dec;46:336-342. doi: 10.1016/j.clnesp.2021.09.735. Epub 2021 Sep 28. PMID: 34857217; PMCID: PMC8646986.
Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, Horton ES, Castorino K, Tate DF. Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016 Nov;39(11):2065-2079. doi: 10.2337/dc16-1728. PMID: 27926890; PMCID: PMC6908414.
Janbozorgi N, Allipour R, Djafarian K, Shab-Bidar S, Badeli M, Safabakhsh M. Water intake and risk of type 2 diabetes: A systematic review and meta-analysis of observational studies. Diabetes Metab Syndr. 2021 Jul-Aug;15(4):102156. doi: 10.1016/j.dsx.2021.05.029. Epub 2021 May 29. PMID: 34186361.