Blood Sugar and Your Health: What You Need to Know

Glucose circulating in the blood (blood sugar) is an essential source of energy for the body. Most of it comes from food, and it is mainly regulated by insulin, which is secreted by the beta cells of the pancreatic islets. Insulin lowers blood sugar, and in a healthy person insulin levels are regulated with great precision. Other substances also influence blood sugar, including glucagon, amylin, adrenaline (epinephrine), cortisol and growth hormone. Glucagon raises blood sugar, while adrenaline, cortisol and growth hormone are known as “stress” or “counter-regulatory” hormones, which also tend to raise blood sugar. Together, these hormones keep blood sugar at just the right level.

What Is Diabetes? Causes and Types of High Blood Sugar

When blood sugar rises above a certain level, glucose spills into the urine and the body begins to develop a range of problems. This is diabetes. Western medicine has identified dozens of causes, all of which lead to insufficient insulin or reduced insulin effectiveness, and these determine whether diabetes is type 1, type 2, gestational or another type. In type 1 diabetes, the immune system mistakenly attacks the islet cells, sharply reducing insulin production. In type 2 diabetes, the problem is insulin resistance: the body may still secrete a similar amount of insulin, but that insulin works less effectively.

More than 500 million people worldwide live with diabetes. In the United States, roughly 65% of people with diabetes eventually die of cardiovascular disease or stroke, which is why understanding the relationship between blood sugar and health is so important.

Conventional treatment for diabetes focuses mainly on lowering and controlling blood sugar. People with any type of diabetes may need insulin at some stage of the condition. During treatment, blood sugar can swing too high or too low for many reasons, which can lead to health problems and even become life-threatening.

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Traditional Chinese Medicine (TCM) has its roots in Taoist thought. From the Taoist perspective, the human body is like a small universe that runs on complex, finely tuned mechanisms. Lowering and controlling high blood sugar with medication, exercise, diet restrictions and glucose monitoring, rather than addressing the underlying causes, touches many different systems at once. It is easy for the body to fall out of balance, and difficult to recreate the precise, finely balanced state of normal health.

1. How Eating, Blood Sugar and Insulin Secretion Are Connected

In a healthy person, blood sugar peaks after a meal, and insulin secreted by the pancreas into the bloodstream quickly peaks as well. Insulin moves sugar out of the blood and into muscle, fat and liver cells, where it is stored for later use, bringing blood sugar back to its pre-meal range. In healthy people, blood sugar does not exceed 140 mg/dL.

At night and between meals, blood sugar is lower and the body needs less insulin, so insulin levels fall. To supply the glucose the body needs, the alpha cells of the pancreatic islets secrete glucagon, which prompts the liver to break down starch and stored glycogen into glucose and ketones, raising blood sugar and encouraging fat cells to break down fat. The liver can also make glucose from amino acids, waste products and fat by-products, a process called gluconeogenesis. The morning high blood sugar commonly seen in type 2 diabetes is caused by excessive gluconeogenesis overnight.

After a healthy person eats, the liver does not need to produce sugar, so glucagon secretion from the alpha cells drops. In people with diabetes, the opposite happens: glucagon rises at mealtimes, pushing post-meal blood sugar even higher.

2. Early Signs of High Blood Sugar

When blood sugar climbs high enough, people may experience unexplained weight loss, excessive thirst or hunger, fatigue and weakness, frequent urination, blurred vision, and nausea and/or vomiting. These symptoms can appear gradually or suddenly. When they become severe enough, people see a doctor, and once blood sugar reaches a certain level, diabetes is diagnosed.

Taiwanese medical experts estimate that about half of people with high blood sugar may not yet know they have it. If you notice the following signs, it is worth checking whether your blood sugar is elevated:

1. Getting Tired Easily

When blood sugar is high, the blood becomes thicker and flows less smoothly, so oxygen is not delivered as easily to surrounding tissues, which can leave you feeling tired. High blood sugar also means your cells are not using glucose well, so they cannot produce energy efficiently.

In addition, long-term high blood sugar can impair kidney function, which may lead to anemia, and anemia also causes fatigue.

2. Dehydration, Thirst and Dry Skin

Very high blood sugar causes more frequent and larger amounts of urination, with sugar carried out in the urine (glycosuria). People feel thirsty, and their skin can become dry and cracked from lack of fluid. In some cases, the cracks can even become infected.

3. Numbness and Reduced Sensation in the Hands and Feet

High blood sugar gradually damages both large and small blood vessels, and the nerves in the hands and feet depend on a good blood supply. By the time nerve damage shows up as numbness or reduced sensation, a person has often had diabetes for 5 to 10 years or more. Numbness usually starts at the fingertips and toes. Because nerve damage dulls pain, people may not even notice a cut, scrape or bleeding wound.

4. Constipation, Diarrhea and Bloating

High blood sugar damages large blood vessels, such as those of the heart and brain, as well as small blood vessels throughout the body.

In people with diabetes, the blood supply to the sympathetic and parasympathetic nerves in the abdomen can become abnormal, so some people experience constipation, diarrhea or bloating when they are under stress, only to discover later that diabetes is the cause. Once blood sugar is well controlled, these symptoms usually fade gradually.

People with diabetes also cope less well with physical and emotional stress than healthy people. “Stress” here refers to the body’s response to infection, serious illness or severe emotional strain. Under stress, adrenaline, glucagon, growth hormone and cortisol all rise, and because these hormones raise blood sugar, people with diabetes should pay extra attention to keeping a relaxed, cheerful, gentle and regular lifestyle and to avoiding illness and infection.

3. Long-Term High Blood Sugar Damages Blood Vessels and Causes Many Health Problems

Research in Western medicine has found that high blood sugar can make blood vessel walls thicker, stiffer and less elastic. When arteries change in this way, fat and cholesterol build up on the artery walls and form plaque. This is atherosclerosis. It narrows the arteries and gradually reduces blood flow to organs and tissues, leading to a range of serious health problems.

• When atherosclerosis affects the arteries of the heart, it can cause chest pain or pressure, known as angina.
• When it affects the arteries that supply the brain, it can lead to stroke, with sudden numbness or weakness in an arm or leg, difficulty speaking or slurred speech, temporary loss of vision in one eye, or drooping facial muscles. These symptoms may signal a transient ischemic attack (TIA). Without treatment, part of the brain tissue can die, which is a cerebral infarction.
• When it affects the arteries of the arms and legs, it can cause leg pain when walking (claudication) or lower blood pressure in the affected limb.
• When it affects the arteries that supply the kidneys, it can lead to kidney disease, high blood pressure or kidney failure.
• When it affects the eyes, it can cause vision loss or blindness.

Long-term high blood sugar damages blood vessels and, in turn, nerves. It can lead to erectile dysfunction, which is more common in people with type 2 diabetes. Vascular damage can also injure the nerves outside the brain and spinal cord (the peripheral nerves). This is called peripheral neuropathy, and it shows up as weakness, numbness, pain, tingling or cramping in the hands, feet and legs.

• Poor blood supply weakens immune function, making infections more likely.
• Poor blood supply also slows wound healing, and in severe cases amputation may be necessary.

Atherosclerosis can be treated, however. Early diagnosis and treatment can stop it from getting worse and prevent or delay cardiovascular disease, cerebral infarction and other complications.

Keeping blood sugar close to normal can help avoid many of these problems. The American Diabetes Association recommends that people with diabetes aim for a blood sugar of 70 to 130 mg/dL before meals and below 180 mg/dL after meals.

4. Acute Complications of Diabetes

Acute complications of diabetes come on suddenly and can be life-threatening. Some require immediate medical attention, including:

1. Hypoglycemia (Low Blood Sugar)

Causes of low blood sugar include taking the wrong or too high a dose of glucose-lowering medication, delaying or skipping meals, not eating enough carbohydrates, doing unplanned or excessive exercise without eating extra or adjusting medication, and drinking alcohol. Recognizing hypoglycemia is very important, because it allows a person to get timely help and can even save their life.

Most people with diabetes experience shakiness, sweating, a rapid heartbeat, vision changes, hunger, headache or sudden mood changes in the early stage of low blood sugar.

Severe hypoglycemia affects the central nervous system and can cause unusual behavior, loss of coordination, poor concentration and confusion, seizures, and loss of consciousness. These symptoms are more common in older adults and require immediate medical care.

In most cases, low blood sugar can be prevented by:

• Checking blood sugar regularly
• Staying alert to the early signs of low blood sugar
• Always carrying sweets or candy to eat when needed

Even with every precaution, people taking medication for high blood sugar can still experience hypoglycemia. They should always wear a medical alert ID. If they use insulin, family members or friends should practice using a glucagon emergency kit.

2. Hypoglycemia Unawareness

People taking insulin or medications that stimulate insulin release may not experience the usual “warning signs” of low blood sugar, such as shaking, sweating or a racing heart. In other words, they have lost the ability to sense low blood sugar. This is called hypoglycemia unawareness.

After repeated episodes of low blood sugar, some people may slip into a hypoglycemic coma without warning. This is most common in older adults and people who have had type 1 diabetes for many years. Because of nerve damage, dulled sensation and reduced sympathetic nervous system response, they can lose consciousness without realizing anything is wrong. This often happens at night and can be fatal if not noticed in time. Older adults and people with type 1 diabetes should therefore check their blood sugar more often, add a nighttime check (usually around 3 a.m.) when needed, and work with their doctor on less strict blood sugar targets.

For many people, once chronic low blood sugar is stopped, the warning symptoms such as shaking and palpitations return and can once again serve as an alarm.

Prevention is the best way to avoid low blood sugar: 1) carry candy, crackers or a sugary drink so you can treat yourself immediately if your blood sugar drops; 2) have a small snack before bed to help prevent low blood sugar overnight and in the early morning; 3) if low blood sugar occurs, ask your doctor to adjust your medication; 4) wear a medical alert ID so people around you know you have diabetes and can help if your blood sugar drops.

If you have severe symptoms of low blood sugar, or feel confused or about to faint, take the following steps:

1. Call 911, or ask someone else to call.
2. While waiting, anyone who has been trained can give you an emergency glucagon injection before help arrives.
3. If possible, immediately take at least 30 grams of glucose or sugar, such as glucose gel.
4. After these emergency steps, that is, after the glucagon injection and/or eating sugar, check your blood sugar again with your meter.
5. Keep a glucagon emergency kit on hand and tell others where it is stored.

3. Hyperosmolar Hyperglycemic State (HHS)

HHS usually occurs in people who do not know they have diabetes, or in people with known diabetes who are dealing with another illness and have not been checking their blood sugar or drinking enough fluids. A vicious cycle of high blood sugar develops, causing excessive urination and dehydration. Dehydration makes the blood more concentrated, which pushes blood sugar even higher. The higher blood sugar climbs, the harder the body works to flush excess sugar out through the urine, which worsens dehydration. Severe high blood sugar combined with severe dehydration can cause confusion, coma and even death, and requires immediate hospitalization.

Symptoms include a large increase in urination, thirst, extreme fatigue, confusion, seizures, coma, blood sugar above 600 mg/dL, and negative or low ketones.

Treatment usually includes intravenous fluids and low-dose insulin under close monitoring in the hospital.

4. Diabetic Ketoacidosis (DKA)

Diabetic ketoacidosis is usually signaled by high blood sugar. When type 1 diabetes is undiagnosed or newly diagnosed, when insulin doses are missed or too low, or when insulin has gone bad, or with infection, steroid use or acute inflammation of the insulin-producing pancreas, the body cannot use glucose properly and releases fat from fat cells. Too much fat then reaches the liver, and too much glucose enters the blood. The liver converts the fat into ketoacids (ketones), and the body becomes poisoned by high blood sugar and ketoacids.

People with type 2 diabetes can also develop ketoacidosis when they have another serious illness, such as a severe infection, acute pancreatitis or steroid treatment. Symptoms include nausea, vomiting, abdominal pain, fruity-smelling breath (the smell of ketoacids), frequent urination, excessive thirst, weakness, fatigue, speech problems, confusion or loss of consciousness, and deep, labored breathing. If blood or urine tests show ketones, this indicates diabetic ketoacidosis and requires immediate medical care. Treatment includes intravenous insulin and fluids.

5. Chronic Complications of Diabetes

Chronic complications of diabetes are usually related to blood vessel damage and tend to appear years or even decades after diabetes develops. Routine screening is recommended so complications can be found and treated early, before organ damage progresses.

Chronic complications include vision loss or blindness, kidney damage or kidney failure, nerve pain or nerve damage, heart and blood vessel disease, high blood pressure, dental problems, and diabetic hand and foot problems.

People with diabetes also often have high blood pressure and high blood lipids, which can make chronic complications worse. Controlling blood pressure, cholesterol and triglycerides, and managing body weight, can help delay and lessen chronic complications.

Whether complications are acute or chronic, careful blood sugar control is essential.

6. Blood Sugar Monitoring

Because the goal of conventional diabetes treatment is to control blood sugar, monitoring is the foundation of care. People with diabetes are advised to check their blood sugar frequently throughout the day and to test for ketones when necessary.

Everyone with diabetes should learn how and when to check their blood sugar, and should know and understand a few key numbers.

Normal Blood Sugar Ranges

In healthy people, fasting (overnight) and pre-meal blood sugar stays between 60 and 100 mg/dL, and post-meal blood sugar stays below 140 mg/dL. The ideal goal of treating diabetes with medication is to keep blood sugar at non-diabetic levels, but this can also lead to blood sugar dropping too low (hypoglycemia). For this reason, the American Diabetes Association recommends keeping blood sugar slightly above non-diabetic levels.

For both type 1 and type 2 diabetes, the American Diabetes Association’s general guidelines are:

• HbA1c* < 7.0%
• Pre-meal blood sugar: 70–130 mg/dL
• Post-meal blood sugar: < 180 mg/dL

*Glycated hemoglobin (A1c) reflects average blood sugar control over the past three months. It represents a long-term blood sugar value and changes slowly.

To see how your blood sugar responds to treatment, use a glucose meter or continuous glucose monitor to check before and after meals, whenever you feel your blood sugar is too low or outside your target range, and whenever you feel unwell or change your level of activity.

Check more often when you change your daily routine, whether that means eating new foods, starting a new type of exercise, getting sick, traveling or changing medication. Fingertip blood testing is the most accurate way to measure blood sugar. Blood taken from other parts of the body does not reflect your “real-time” blood sugar.

People with diabetes should carry their glucose meter at all times. If you think your blood sugar might be low but are not sure, it is very important to check right away. Guessing your blood sugar can be dangerous, especially when doing activities that require concentration and coordination (such as driving or competitive sports) or working in jobs that require constant alertness (such as construction).

7. Diet for People with High Blood Sugar

People with high blood sugar should eat a balanced diet from six food groups: whole grains and starches; beans, fish, eggs and meat; dairy; vegetables; fruit; and fats, nuts and seeds.

Refined starches cause blood sugar to rise quickly, so people with diabetes should eat as little refined starch as possible and choose high-fiber, minimally processed carbohydrates instead, such as healthy fruits, beans and lightly processed whole grains. Choose low-fat foods, good-quality plant oils and healthy cooking methods: switch to low-fat or skim milk, eat more fish, and choose leaner cuts of meat. Favor steaming, boiling, cold-dressed dishes, braising, baking and low-temperature stir-frying with little oil. Good-quality plant oils such as olive oil and camellia oil, as well as nuts and seeds, are recommended. People with diabetes should also limit alcohol to no more than 30 grams of alcohol a day for men and 15 grams a day for women.

Everyday nutrients that may help with blood sugar control include calcium, magnesium, selenium, vitamins B1, C and E, and bitter melon peptide. These nutrients are involved in stimulating the pancreas to produce insulin, improving cells’ sensitivity to insulin, and supporting carbohydrate metabolism in the body.

Other Plants and Nutrients That May Benefit People with Diabetes:

• Triphala: an equal blend of three dried fruits, bibhitaki, haritaki and amalaki (amla). It is traditionally used to help lower cholesterol and prevent atherosclerosis. Among them, the superfood
• amla (Indian gooseberry) is rich in trace minerals (mainly selenium, zinc, calcium, phosphorus, iron and potassium) and vitamins that can help with blood sugar control.
• Turmeric and C3 curcumin: may help improve and regulate blood sugar, lower blood lipids and support immune function.
• Bitter melon peptide: may help boost metabolism and control blood sugar.
• Fenugreek: may help lower fasting and post-meal blood sugar, reduce HbA1c, lower total cholesterol and triglycerides, balance HDL and LDL cholesterol, and control blood sugar.
• Green tea: has anti-inflammatory and anti-aging properties and may help lower blood pressure, scavenge free radicals, reduce fat, lower cholesterol and increase bone density.
• Chromium yeast: may help lower fasting blood sugar and HbA1c, increase insulin sensitivity, lower triglycerides, raise HDL cholesterol and reduce fat accumulation.
• Zinc: a component of insulin that helps maintain normal metabolism of energy, carbohydrates, proteins and nucleic acids, and supports blood sugar control and healthy blood pressure and lipid levels.
• Siberian ginseng (eleuthero): may help improve microcirculation, regulate the endocrine system and help balance both high and low blood pressure.

Some supplements on the market, such as Herbtail GlucoMetabol made in Taiwan, contain plant-based ingredients including amla, curcumin, bitter melon peptide and fenugreek. In traditional health practice, these ingredients are regarded as supporting nutritional intake and overall balance.

8. Exercise for People with Diabetes

In addition to insulin or glucose-lowering medication, people with diabetes should do aerobic exercise 4 to 7 times a week for at least 30 minutes each time, such as brisk walking, swimming, cycling or dancing. Exercise can lower blood sugar and increase insulin sensitivity so the body’s insulin works more effectively (note: you may need to consult your doctor about adjusting oral medication or insulin doses to prevent low blood sugar). It can also lower blood lipids, reduce heart disease, improve circulation, help prevent osteoporosis, relieve stress and improve quality of life.

Daily activities such as shopping, cleaning, gardening, walking, swimming, jogging and playing tennis all increase insulin sensitivity and reduce the body’s need for insulin. People who do these activities may need to reduce their dose of insulin-stimulating oral medication or insulin, and may need to eat extra carbohydrates to keep their blood sugar stable.

Some exercises, such as bench pressing, may cause the body to release counter-regulatory hormones like adrenaline, which work against insulin and raise blood sugar. Competitive sports also tend to raise blood sugar. Someone getting ready for a race may get an adrenaline surge that raises blood sugar, while blood sugar falls during the race itself. Seemingly similar activities can have opposite effects on blood sugar, so for people with diabetes, regulating blood sugar is not a simple matter.

9. People with Diabetes Need to Manage Their Emotions

The effect of emotional stress on blood sugar is hard to predict. Tension, anxiety, anger, insomnia, extreme joy or sorrow, and overexcitement can all increase the release of blood-sugar-raising hormones and reduce insulin release, pushing blood sugar higher. Emotional problems can also make people overly focused on their condition, leading to fear of medication or fear of low blood sugar, which in turn can make blood sugar control harder.