5 Secrets to Help You Avoid Diabetes
I write about elements of health because to be a high-performing executive, you have to be in optimal health. The last time I wrote a health-related article [link to cholesterol article] , I reported my systematic exploration to lower my cholesterol. My cholesterol remains well-controlled to this day. In this article, I share how I monitor and develop insights through measuring glucose and understanding how managing glucose variability has a positive impact on energy, weight, sleep, and overall health. The driving force for me is to prevent the slow insidious destruction of organs and eyesight that my father experienced before he passed away due to a series of diabetes-related complications. Given my genetic predisposition, I felt drawn to study my patterns so that I could live my best healthful life. For me to be at my peak in performance, I have to be at my personal best in physical, mental, and spiritual health.
While I am sharing my personal journey with continuous glucose monitoring and the insights it has afforded me, it is crucial to remember that individual experiences with health and wellness can vary greatly. My story is unique to my lifestyle, biology, and choices, and the outcomes I’ve observed may not be universal. Health is deeply personal, and what works for one person may not work for another due to a myriad of factors, including genetic predispositions, environmental influences, and personal health histories. Therefore, I encourage each reader to consider their circumstances and consult with a healthcare professional to develop a plan that is tailored to their specific needs. This article is not a one-size-fits-all solution but rather a single narrative within the vast mosaic of health experiences. Your journey to health will be as unique as you are, and professional guidance is paramount to ensure safety and effectiveness in your health endeavors.
Diabetes Overview
Diabetes remains one of the most insidious chronic conditions today. Research evidence supports the gravity of this chronic condition[1]:
o Diabetes mellitus, both type 1 and type 2, is escalating at exponential rates worldwide, imposing substantial burdens on healthcare systems[2].
o Lifestyle modifications, including dietary changes and regular exercise, play a crucial role in managing diabetes by improving insulin sensitivity and overall health outcomes.[3]
o Studies have shown that structured lifestyle education programs led by healthcare professionals are effective in managing diabetes, emphasizing the importance of education and support in disease management[4]
o Recent research funded by the American Diabetes Association has identified new insights into type 1 diabetes risk factors and the biological mechanisms regulating body weight in children, highlighting the ongoing efforts to advance the understanding and treatment of diabetes[5].
These findings underscore the complex nature of diabetes and the pressing need for continued research and innovative approaches to combat this pervasive chronic condition. The question for me was to explore what actions positive results and which ones have less optimal results. This outline summarizes the highlights of my journey.
Nothing that is written here should be taken as medical advice nor should it lead you to take actions that you have not discussed with your medical doctor. The first thing I did was enroll my doctor. Fortunately, he is forward-thinking and believes in being a partner in my health and well-being. He prescribed the Freestyle Libre3 CGM(continuous glucose monitor) by Abbott[6]. Since I’m not diabetic, I had to pay out-of-pocket for the CGMs. It was well worth the cost to learn about how my body metabolized blood sugar. My doctor was a great partner, but we disagreed on one point. He claims “It’s not a question of if you will develop diabetes, it’s a question of when. “ Maybe that’s true, I’ll let you know how it goes over the next 25 years. You can be sure that I will be doing everything in my power to postpone that day as long as possible.
Before we review my insight and results, let’s start with a little background.
What is a CGM?
CGMs, or Continuous Glucose Monitors, are advanced devices used to continuously track blood sugar levels in real-time, 24/7. These gadgets work through a small sensor inserted under the skin, usually on the belly or arm, which measures the glucose levels in the interstitial fluid (the fluid between the cells). The sensor sends this information to a receiver or a smart device (like a smartphone or a smartwatch) through wireless technology, providing the user with real-time glucose readings. It can show whether the glucose is going up or down and how quickly, making it easier for the user to manage their diabetes on a day-to-day basis. CGMs are especially helpful because they can alert the user if their blood sugar levels are getting too high or too low, even during the night.
What Does the Research Say?
The research in the field of glucose management and diabetes is complex and ever evolving. Each study comes with its own set of limitations, such as sample size, methodology, and applicability to diverse populations. It is not only critical to interpret these studies with an understanding of their context but also to consider them as pieces of a larger puzzle. The conclusions drawn from these studies should be viewed as steppingstones toward a more comprehensive understanding rather than definitive answers.
It’s worth noting that while my findings and the cited research suggest certain trends and correlations, there are counterarguments and differing opinions in the scientific community regarding glucose management. Some experts may argue that for individuals without diabetes, the focus should perhaps be more on overall lifestyle choices rather than on monitoring glucose variability. Engaging with these counterarguments is crucial for a holistic understanding and underscores the importance of personalized medical advice.
In referencing studies within this article, I strive for each citation to substantiate the associated claim directly. Where there may be room for interpretation, I invite readers to delve into the sources themselves for a deeper understanding. The research is a resource from which we can draw various insights, and direct quotes from these studies can often illuminate the subtleties that a summary may not capture.
Research Excerpts
An article in the Diabetes Research and Clinical Practice Journal talks about how people with diabetes have to watch not just their high blood sugar levels and HbA1c (a test that shows the average level of blood sugar over the past 2-3 months) but also how much their blood sugar levels go up and down, which is called glucose variability. Understanding glucose variability is tough because it’s not easy to define or measure, and scientists are still figuring out how it affects someone’s health and how to best treat it.
What is Glucose Variability?
Glucose Variability or GC explains that changes in blood sugar levels throughout the day are normal but can be a big deal for people with diabetes. It’s important because it can affect how the disease progresses and how it should be treated. The studies suggest a strong correlation between glucose variability and the development of diabetes complications, suggesting that fluctuations may be as critical, if not more so, than average glucose levels (HbA1c) in predicting outcomes.
How Do We Measure Glucose Variability
There are many ways to measure how much someone’s blood sugar levels change, but there’s no agreement on the best way. This makes it hard to study and understand. Since the article was printed, continuous glucose monitor (CGM) technology greatly approximates this measure.
Why Does Variability Matter?
The research says that how much and how often blood sugar levels change can be just as important as the average blood sugar level. These changes can affect the risk of diabetes-related problems. The paper shares findings from different studies, showing that big ups and downs in blood sugar levels can lead to complications from diabetes, like heart disease or nerve damage. It also talks about how these changes can cause stress on the body, leading to inflammation and damage to blood vessels. We typically refer to this as oxidative stress. The study explored how glucose fluctuations can induce oxidative stress and endothelial dysfunction, emphasizing the relationship between daily glycemic fluctuations and increased oxidative stress in type 2 diabetes.
What Can Be Done About Variability?
An article in Diabetes Research and Clinical Practice argues that treating diabetes should include trying to keep blood sugar levels more stable, not just focusing on lowering the average blood sugar level. This might help prevent some of the complications of diabetes. By extension, it makes sense that reducing variability is potentially beneficial for healthy people too. If it’s important for people with diabetes to reduce variability in order to stay healthy and avoid health complications, it follows that it can’t hurt to do it while you’re still in good health.
In addition, the research explored how much and how quickly blood sugar levels change throughout the day both in people with diabetes and without it. This glucose variability (GV) tells us whether these ups and downs in blood sugar reveal more about a person’s health than just checking their average blood sugar level over time, which is what the HbA1c test does. [7]
Another study in Heliyon claimed that those with brain health issues had more blood sugar fluctuations, more inflammation, and less protection against harmful molecules compared to those with normal brain function.[8]
And a research paper in Nutrition, Metabolism and Cardiovascular Diseases, explores whether these blood sugar swings could affect the heart differently than just having high blood sugar all the time. While experiments in labs and on animals suggest that these swings might be more harmful, it’s still not clear if that’s true for people too. More research is needed to understand how these blood sugar changes impact heart health, especially using tools like CGM that continuously track blood sugar levels.[9]
The questions of how everyday habits like what time people eat their meals, how long they sit, and how much they sleep can affect blood sugar levels in adults who don’t have type 2 diabetes. The researchers found out that when people eat dinner early and keep a short time frame for eating during the day, their blood sugar levels are better. Eating breakfast later can lead to higher blood sugar throughout the day because it might make people eat over a longer period. This point may support the theory of intermittent fasting which I also do. We’re not going to discuss it here but essentially your food intake is limited to an 8-hour continuous period in the day. In my case that’s 10am to 6pm. Other factors such as sitting for a long time without moving much can make blood sugar levels change more throughout the day, which isn’t good. On the other hand, getting enough sleep can help keep blood sugar levels more stable.[10]
The researchers discovered that not only the amount of food people eat but also the timing of their meals can impact their blood sugar. For example, eating too much or having lots of carbohydrates can make average blood sugar levels go up. Also, how much someone weighs in the morning and evening can give hints about their blood sugar levels.
The study from Diabetes Research and Clinical Practice claimed that small daily choices, like when to eat and move around, can affect blood sugar levels even in people who don’t have diabetes. This information can help people make better choices to keep their blood sugar at a healthy level and possibly prevent diabetes in the future.
Insulin Resistance
Insulin resistance is a condition where the body’s cells don’t respond properly to insulin, a hormone produced by the pancreas that allows sugar (glucose) in the blood to enter cells. Insulin acts as a key, unlocking cells to let glucose in for energy. When cells become resistant to insulin, more insulin is needed to open the glucose gates. This condition leads to higher levels of insulin and glucose in the blood.[11]
Over time, insulin resistance can lead to several health problems, including:
Type 2 diabetes: If insulin resistance progresses, the pancreas may not be able to produce enough insulin to keep blood sugar levels within a healthy range, leading to type 2 diabetes.
Heart disease: Insulin resistance is associated with other conditions like high blood pressure, abnormal cholesterol levels, and obesity, which increase the risk of heart disease.
Metabolic syndrome: This is a group of conditions that occur together, increasing your risk of heart disease, stroke, and type 2 diabetes. Insulin resistance is often a component of metabolic syndrome.
Factors that can increase the risk of developing insulin resistance include obesity, especially excess fat around the waist, a sedentary lifestyle, a diet high in sugars and refined carbohydrates, smoking, age, and certain genetic factors.
Preventing or managing insulin resistance typically involves lifestyle changes like regular physical activity, a balanced diet rich in fiber and low in refined carbs and sugars, maintaining a healthy weight, and stopping smoking. These measures can improve the body’s sensitivity to insulin and reduce the risk of developing more serious health conditions.
Lessons Learned
Secret #1:The order that you eat your foods in matters...
The order I ate my food in affected the variabiity of glucose measurements. If I ate vegetables, proteins, and fats (V-P-F) first my blood sugar would rise to about 120 and then slowly descend. The rise and fall were slow and gradual. If I started my meal with fruit or bread, there was greater variability in my readings. In fac t, reading would climb more rapidly to about 140, decline sharply to about 115, and then rise sharply again to about 135, and then come back down on a steeper trajectory than when I ate V-P-F first. In fact, if I had a solid base of V-P-F, I could share a dessert without having increased glucose variability.
Figure 1: Typical day of eating V-P-F prior to fruit and bread. Notice the near-flat line representing the glucose readings. On these days, I had energy for all my activities, clear thoughts, and good sleep.
Figure 2: Eating small carb snacks at bedtime causes excess insulin secretion which continues through the night and into the next morning causing hypoglycemic drops. When this happened, I experienced foggy thoughts, dizziness, and extreme fatigue.
Figure 3: Eating a late pasta dinner continues to have rolling waves of glucose readings throughout the night. Data for 11.22.23 not available as CGM started at 11 pm and was not reading until midnight.
Figure 4: Eating a late pasta dinner around 6 pm 12.02.2023
Secret #2: Activity helps...
A 20-minute walk after eating kept the variability lower than sitting after a meal.
Figure 5: Taking a 20-minute walk after meals keeps line relatively curve flat.
Secret #3: Red wine had little impact...
Red wine had no increase in blood sugar but for some reason, white wine, vodka and tequila caused higher readings and increased variability which lasted up to 48 hours.
Figure 6: Glass of wine with V-P-F meal. While wine does not appear to have increased glucose, it does appear to drop glucose. Since I rarely drink, I don’t know if this is a pattern or an anomaly. The break in the 12th is the end of the sensor and the start of a new one.
Secret #4: Proteins before bed reduces hypoglycemic dips overnight...
Protein at bedtime reduced hypoglycemic dips overnight. Eating a handful of nuts at bedtime kept my blood sugar from dropping below normal levels. Eating half a slice of bread caused sharp and sustained drops.
Figure 7: Eating a handful of cashews before bed keeps glucose level through the night. A V-P-F breakfast continues the trend. Nuts eaten 12.06.2023.
Notice in the above chart that without vegetables, the lunch meal caused an extended higher-level plateau. The researchers found that people who ate more fiber had a lower chance of developing problems with insulin resistance, which is when the body doesn’t use insulin properly. Insulin is a hormone that helps control blood sugar levels. Eating more fiber didn’t seem to change how much insulin the body makes after eating or the levels of sugar in the blood. But the main takeaway is that eating lots of fiber can make your body better at using insulin, which might help prevent diabetes. This study is part of a bigger research project in Finland that’s trying to understand more about diabetes and how to stop it from happening. An added benefit was that my weight stabilized, and the extra 10 pounds melted off with little effort. I suspect that reduced variability contributed to increased glucose metabolism. That’s a project for another day. I don’t know if the weight loss is an unintended consequence, but I was certainly happy.
Secret #5: A good night's sleep reduced variability
In my experiment, when I slept my normal 7 to 8 hours, all of the above insights were consistent. When my sleep was distrubed or I had 6 or less hours of sleep, the variability increased. It has long been reported that craving carbs is common when sleeping less than your normal amount of time. I don’t have enough data points to make any broad generalization, however, I suspect sleep is needed for proper metabolism of glucose and for maintaining homeostasis in the body. Next time I expoeriment, I’ll record more sleep-based findings.
Changes over time...
Summary changes over time. Below is a table of the difference between the start of the process (Figure 7) and the end of the process (Figure 8), I used the CGM for over 16 months. Both my variability and my average readings were lower. Health and wellbeing are a lifelong journey.
Table 1: Summary (see supplementary details below)
|
|
First 90 Day |
Final 90 Days |
|
Average Glucose |
103 |
96 |
|
GMI (similar to A1C) |
5.8% |
5.6% |
|
Glucose Variability |
12.5% |
12.1% |
Summary
My personal experience, as depicted in the figures and anecdotes within this article, represents a single data point within a vast spectrum of individual experiences. These personal observations should be considered as illustrative examples rather than statistically significant evidence. Broader, more diverse studies would be necessary to derive conclusions that could be broadly applicable. I invite you to start your own exploration.
My interpretation of my CGM data and its health implications is based on my individual experience and understanding. I acknowledge that professional healthcare providers may analyze and interpret this data differently, potentially drawing different conclusions based on a wider clinical perspective. Talk to your healthcare provider.
My father’s struggle was not in vain; it ignited a spark within me to delve deeper into the workings of my own body, to understand and mitigate my risks. I have learned that through discipline, consistent monitoring, and a willingness to adapt, I can influence my health outcomes. As I continue to apply these lessons, I hope that sharing this journey will inspire others to take charge of their health, armed with the knowledge that small, daily decisions can have profound effects on our long-term well-being. Let’s not wait for a dire diagnosis to make changes; let’s harness the power of prevention and personalization in our health journey today. My story is unique to my lifestyle, biology, and choices, and the outcomes I’ve observed may not be universal. Health is deeply personal, and what works for one person may not work for another due to a myriad of factors, including genetic predispositions, environmental influences, and personal health histories. Remember, always consult with your healthcare provider before making any changes to your health regimen. Your health journey will be as unique as you are, and professional guidance is paramount to ensure safety and effectiveness in your health endeavors.
Some topics such as insulin resistance and dietary fiber’s role in glucose metabolism are complex and multifaceted. In my initial discussion, I aimed to provide an overview that was informative yet digestible for the lay reader. However, I understand the importance of depth and detail in such discussions. Use the info here to start your research journey and feel welcome to share with me.
In closing, my personal journey into the intricate world of glucose monitoring has been eye-opening and profoundly transformative. The marriage of science and self-experimentation has provided me with unique insights into the nuanced ways our bodies handle sugar. It’s clear that managing glucose is not just about avoiding the extremes of high and low blood sugar, but also about minimizing variability for optimal health. My experiences have led to actionable knowledge, empowering me with the tools to protect and enhance my health proactively. I now stand as a testament to the power of informed, deliberate lifestyle choices in altering what once seemed like an inexorable genetic destiny.
Supplementary Details
Figure 8: First 90 days of wearing CGM
Figure 9: Final 90 days of wearing CGM
Citations:
[1] Simona Frontoni, Paolo Di Bartolo, Angelo Avogaro, Emanuele Bosi, Giuseppe Paolisso, Antonio Ceriello,
Glucose variability: An emerging target for the treatment of diabetes mellitus,
Diabetes Research and Clinical Practice, Volume 102, Issue 2, 2013, Pages 86-95,
[2] Satin LS, Soleimanpour SA, Walker EM. New Aspects of Diabetes Research and Therapeutic Development. Pharmacol Rev. 2021 Jul;73(3):1001-1015. doi: 10.1124/pharmrev.120.000160. PMID: 34193595; PMCID: PMC8274312.
[3] Borse SP, Chhipa AS, Sharma V, Singh DP, Nivsarkar M. Management of Type 2 Diabetes: Current Strategies, Unfocussed Aspects, Challenges, and Alternatives. Med Princ Pract. 2021;30(2):109-121. doi: 10.1159/000511002. Epub 2020 Aug 20. PMID: 32818934; PMCID: PMC8114074.
[4] Satin LS, Soleimanpour SA, Walker EM. New Aspects of Diabetes Research and Therapeutic Development. Pharmacol Rev. 2021 Jul;73(3):1001-1015. doi: 10.1124/pharmrev.120.000160. PMID: 34193595; PMCID: PMC8274312.
[5] Rocky L. Baker, Marynette Rihanek, Anita C. Hohenstein, Maki Nakayama, Aaron Michels, Peter A. Gottlieb, Kathryn Haskins, Thomas Delong; Hybrid Insulin Peptides Are Autoantigens in Type 1 Diabetes. Diabetes 1 September 2019; 68 (9): 1830–1840. https://doi.org/10.2337/db19-0128
[6] https://www.abbott.com/corpnewsroom/strategy-and-strength/freeStyle-libre-3-worlds-smallest-sensor-is-here.html
[7] Simona Frontoni, Paolo Di Bartolo, Angelo Avogaro, Emanuele Bosi, Giuseppe Paolisso, Antonio Ceriello,
Glucose variability: An emerging target for the treatment of diabetes mellitus,
Diabetes Research and Clinical Practice, Volume 102, Issue 2, 2013, Pages 86-95.
[8] Si-Cong Si, Wei Yang, Hong-Yu Luo, Yi-Xin Ma, Huan Zhao, Jia Liu,
Cognitive decline in elderly patients with type 2 diabetes is associated with glycated albumin, ratio of Glycated Albumin to glycated hemoglobin, and concentrations of inflammatory and oxidative stress markers, Heliyon, Volume 9, Issue 12, 2023, e22956.
[9] F. Picconi, A. Di Flaviani, I. Malandrucco, I. Giordani, S. Frontoni,
Impact of glycemic variability on cardiovascular outcomes beyond glycated hemoglobin. Evidence and clinical perspectives, Nutrition, Metabolism and Cardiovascular Diseases, Volume 22, Issue 9, 2012, Pages 691-696,
[10] https://doi.org/10.1016/j.diabres.2022.110231
[11] Katriina Ylönen, Carola Saloranta, Carina Kronberg-Kippilä, Leif Groop, Antti Aro, Suvi M. Virtanen, the Botnia Research Group; Associations of Dietary Fiber With Glucose Metabolism in Nondiabetic Relatives of Subjects With Type 2 Diabetes: The Botnia Dietary Study. Diabetes Care 1 July 2003; 26 (7): 1979–1985. https://doi.org/10.2337/diacare.26.7.1979
Gina is a certified executive coach specializing in helping business leaders and executives reach their optimal performance by balancing health, work, relationships, and mindset. She has over three decades of experience in coaching, implementation, and execution and a Wharton MBA under her belt.
Gina’s holistic approach is comprehensive and covers various executive management positions such as sales, business development, HR, OD, marketing, client services, events, financial budgeting and planning, technology, and individual projects within corporate and small business settings. She helps break down strategies and plans into actionable and achievable steps that create powerful personal transformation. Her dedication to continuous personal evolution and an extensive toolkit of continuous improvement strategies for her clients create powerful cultural shifts. “Organizations don’t get better until their people do.” Email her at gina@mach4ventures.com.