RT3-Adrenals Glucose

Blood glucose (which can be abbreviated BG) or blood sugar is our

constant source of energy and maintaining healthy levels of glucose is

intrinsic to good health. In particular, the brain requires a constant

supply of glucose.

When the body is functioning properly, glucose is maintained in a fairly

narrow range. When glucose levels rise, the pancreas releases insulin

which moves glucose from the blood to the cells. When glucose levels

are too low, the body has a variety of ways to correct them.

Blood glucose levels are directly affected by:

• food

• cortisol levels

• exercise

• medications

• supplements

Glucose levels and insulin resistance

Glucose levels fluctuate throughout the day, as it is normal for glucose

to rise after eating and then return to fasting levels over a period of

time. Gludose in the blood is controlled by Insulin and glucagon,

hormones secreted by cells within the pancreas.

Insulin, which allows glucose is be absorbed by cells from blood, is

increased in response to the elevation of glucose levels and/or the

need of glucose in the body. As blood glucose falls, insulin secretion is

reduced. When blood glucose is low, such as between meals or during

sleep, glucagon is secreted to make the liver release the glucose

stored in its cells, which results in increased blood glucose.

It is very common for someone with ongoing high blood glucose levels

to develop insulin resistance, requiring more and more insulin to control

blood glucose.

Excess insulin can:

• elevate sodium

• elevate blood pressure

• cause edema

• contribute to congestive heart failure

• contribute to cardiovascular disease

• negatively affects magnesium storage

• causing blood vessels to constrict

• elevating blood pressure

• possibly causing coronary arterial spasm and heart attack

Insulin resistance is made worse by:

• low thyroid

• high reverse T3

• low estrogen and/or testosterone

While insulin itself cannot be accurately tested, C peptide levels are a

useful substitute.

Elevated Insulin may indicate a need for testosterone or estrogen, and

insulin resistance may be helped by optimizing testosterone and

thyroid.

Insulin resistance leads to impaired glucose tolerance resulting in Type

2 Diabetes. The insulin resistance can develop as much as ten years

before the diagnosis of Type 2 Diabetes. People with insulin resistance

will often have normal fasting glucose levels for many years, while

having high post-prandial (after meal) glucose that isn't caught on

fasting glucose labs, which are included as part of a BMP or CMP for

routine screening.

A Hemoglobin A1c (HbA1c or A1c) lab that provides a measure of

average glucose over the previous two to three months is used to

diagnosis Type 2 Diabetes. The dysregulation of glucose is often first

recognized when an A1c lab is ordered because the patient complains

of other issues that have resulted from chronically-high glucose levels.

These can include:

• obesity (glucose not moved into cells for energy is stored as fat)

• atherosclerosis

• peripheral neuropathy (nerve damage and pain, particularly of hands

and feet)

• diabetic retinopathy (eye damage)

• diabetic nephropathy (affecting kidneys)

There is a wide range of both fasting glucose and HbA1c results that

are considered "normal" by medical standards that are, in fact, not

healthy. By the time a person receives a diagnosis of Type 2 diabetes,

she or he will often be suffering from many serious complications

caused by chronically elevated glucose and insulin.

Studies have demonstrated an approximately 35 percent decrease in

relative risk for microvascular disease for every one percent reduction

in A1c.

Intensive home glucose testing

Testing at home can help identify how the foods eaten affect blood

glucose, allowing informed choices about what to eat and drink. A

home blood glucose meter and test strips are needed. The strips are

generally quite expensive. However, this testing is for a limited time,

after which a daily check of fasting glucose may be enough to monitor

BGs. Some large chain stores offer store brands of meters and strips,

which are less expensive. Google the accuracy of the meters before

choosing.

Method

• Just before a meal that is high in carbohydrates (starches, including

whole grains, and sweets, including fruits), test glucose and write down

the result

• Weigh the foods to be eaten and record the result

• Set a timer to go off every 15 minutes beginning with the first bite

• Every 15 minutes, test BGs again and write that down

• Test for at least two hours; more is better, particularly as hypothyroid

people tend to have slower digestion than others

Do this around several meals over the course of a few days. If BGs

routinely rise above 120 mg/dL (6.7 mmol/L), reduce the carbs in meals

and test some more

Addressing high glucose

• Reduce carbohydrates, particularly starches and sweets

• Magnesium may help reduce insulin resistance

• Supplements may help control glucose

• Some also lower cortisol; not appropriate for those with low

cortisol issues or who are taking a replacement dose of

hydrocortisone

• Exercise

• Use of the large muscles of the body depletes glucose in those

muscles, in turn causing glucose to be drawn out of the blood to

restore glucose in the muscles

• For those with issues with cortisol production or taking

replacement glucocorticoids, should be very mild and gentle such

as slow walks, yoga, T'ai Chi, and similar activities (without

breaking a sweat)

• Prescription medication

• Metformin to improve insulin resistance

• Medication which primarily causes the pancreas to excrete more

insulin can have two negative consequences and should be

avoided:

• hypoglycemia becomes more likely

• over the long term, beta cells which create and store insulin will

burn out, becoming less effective, a consequence that is not

reversible

For more information on achieving truly healthy levels of glucose

control, visit Dr Bernstein's website, http://www.diabetes-book.com/.

For someone with an HbA1c over 5.0 (US) or 30 (outside the US),

consider following Dr Bernstein's guidelines to control BG levels and

get ones A1c down to a truly non-diabetic level.

Hypoglycemia

Blood glucose levels below 65 mg/dL (or 3.6 mmol/L) are considered

hypoglycemic. (A person whose glucose levels are usually elevated

above 100 mg/dL may feel hypoglycemic at levels above 65, but not

actually be suffering from hypoglycemia.) Hypoglycemia occurs when

the usual mechanisms which correct low glucose do not work properly.

Hormonal dysfunction is the most common cause. It can also occur in

diabetics from too much insulin or other diabetes medications such as

sulfonylureas.

Other medications which can cause hypoglycemia include:

• quinine

• quinidine

• haloperidol

• trimethoprim-sulfamethoxazole

• pentamidine

• the antibiotic bactrim

• MAO inhibitors

• diuretics

Hypoglycemia can also be caused by:

• disease or dysfunction of the liver, the pancreas and pituitary or

adrenal glands

• excessive alcohol without eating

Fasting hypoglycemia occurs after not eating for a period of time, such

as overnight. Reactive hypoglycemia usually occurs after eating a meal

high in carbohydrates.

Symptoms of hypoglycemia can include

• shakiness

• severe hunger

• confusion

• becoming weak, tired, sleepy or dizzy

• difficulty speaking

• "brown-out" of vision

• headache

• trouble concentrating

Someone suffering from severe hypoglycemia may appear drunk.

If adrenaline is released by the body to combat hypoglycemia,

symptoms can include:

• anxiety

• sweating

• elevated heart rate

• nausea

• trembling

Nighttime hypoglycemia may cause awakening between 2 and 3 a.m.

as a result of the adrenal reaction to very low glucose.

In pregnancy, hypoglycemia can occur from gestational diabetes.

Hypoglycemic symptoms can come on gradually or suddenly.

Severe hypoglycemia can be life-threatening. Anyone suspecting

hypoglycemia should treat it immediately with fast-acting glucose

tablets or a beverage such as juice or milk. The best approach is to test

glucose with a home meter, then take just the amount of glucose

tablets needed to raise glucose to about 80-85 mg/dL (or 4.4-4.7

mmol/L). If the hypoglycemia is due to an overdose of insulin,

emergency responders should be immediately called.

Glucose control