For diabetics, keeping blood sugar within a safe range can be life-or-death. While for non-diabetics this may not be the case acutely, unregulated blood glucose over time can certainly lead to a premature death. Heart disease and cancer account for nearly half of all deaths in the United States, and having high blood sugar significantly increases your risk of developing both. In fact, it’s hard to think of a disease that is not fueled by high levels of blood glucose. You may have seen that people with diabetes are at high risk of severe complications from COVID-19.
The mechanisms of action are largely unknown, but it’s clear in my mind that having high blood sugar over time is detrimental to your health. It also may be the case that, beyond high average blood sugar, temporary glucose spikes are specifically harmful. After a meal, your blood sugar rises, and there’s growing evidence that higher peaks (and more of them) could lead to worse health outcomes. Evidence for this comes from the National Institute for Aging’s Interventions Testing Program (ITP), which rigorously tests drugs for their ability to extend lifespan in mice. Very few molecules have been successful in the ITP, but one that has is acarbose, which flattens glucose peaks by inhibiting an enzyme that breaks down carbohydrates.
Based on the evidence that we have so far, it seems immensely important to both keep average glucose low and prevent large spikes in your glucose levels. On a continuous glucose monitor (CGM), the ideal presentation is a fairly flat curve that remains largely below 100 mg/dL. An example of a suboptimal CGM output can be seen in Figure 1. Note that the peak glucose is nearly 300 mg/dL (should be 150 maximum), and the curve levels off around 150 mg/dL (should be below 100).
Figure 1: An example of a CGM output showing poor glucose regulation (image: Dexcom)
Unfortunately, it’s exceptionally difficult to obtain a CGM if you haven’t been diagnosed with diabetes. I hope that this changes, because it’s really helpful to know where you’re at and to see how your body responds to things like food and exercise, or even sleep and stress. Testing blood from finger pricks is the next best option, and can be done with a glucometer which is relatively affordable. I think it is easily worth the investment, but the reality is that not everyone reading this post will run to their local pharmacy for a glucometer. At the very least, make sure you’re getting routine blood tests from your primary care provider and pay close attention to the glucose and hemoglobin A1c (HbA1c) readings.
The reality is that many people will be unpleasantly surprised. Estimates suggest that more than one out of every 3 Americans is either diabetic or prediabetic. Even those that aren’t may have suboptimal glucose regulation. Regardless, we feel strongly that everyone ought to take this seriously. By the time your fasting glucose or HbA1c is irregular, some damage has likely already been done.
The simplest thing each of us can do is to minimize sugar splurges, and specifically steer clear of sugar in liquid form. It will take a lot more than this to avoid glucose dysregulation, however. Substantial amounts of carbohydrates will surely lead to a spike, and many people get into trouble simply by overeating and giving the sugar nowhere to go. Tools like fasting can help prevent this buildup, and exercise is a great way to convert sugar into energy and clear it from your body. Individual approaches will vary, but please take this opportunity to see where you’re at and aim to improve from there. My bet is that, in the future, we’ll look back on this time and wish that we had paid more attention to blood sugar’s role in almost every disease.
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