Keeping blood sugar near normal will result in improved strength, speed, flexibility, and endurance.
Sugar is our muscles’ favorite fuel for making short, rapid movements, so limiting access to sugar is a detriment to one’s strength. Extra sugar in the bloodstream also leads to something called glycosylation—sticking of sugar to connective tissues like tendons and ligaments, thus limiting their ability to stretch properly. Muscle stiffness, strains, and pulls are common in people with high blood sugar levels. High sugars block the connection between muscles and nerves, resulting in slower reaction times and reflexes. Extra sugar in the bloodstream limits our red blood cells’ ability to pick up oxygen in the lungs and transport it to our muscles. This can cause fatigue and limited cardiovascular/aerobic capacity. Dehydration and cramping are also common side effects of hyperglycemia (high blood sugar).
When glucose levels are near normal, your reaction times will be quicker and you will recover from injuries more rapidly. Many of my clients have tracked their performance in a variety of sports and have consistently performed best when their blood glucose is in the 80–140 mg/dl range (4.5–8 mmol/l). One young man’s first MVP trophy in an ice hockey tournament coincided with the first time he managed to keep his blood sugar from going high or low throughout (we’ll discuss details regarding sports/exercise control later on). Overall, you’re likely to see improved performance in all sorts of activities—from carrying groceries to playing soccer to lovemaking—when your blood sugars remain near normal.
Appetite Reduction
This might sound totally bass-ackwards, but high glucose levels tend to make us crave more food, especially carbohydrate-rich foods. Remember, the amount of sugar in the bloodstream is not what counts but rather how much gets into our cells, and if not enough is getting into our cells, our hunger will increase. So controlling glucose levels is a good way to keep your appetite in check.
Brain Power
High and low glucose limits our ability to focus, remember, perform complex tasks, and be creative. Research studies have repeatedly and consistently shown that as blood sugars go up, so do mental errors and the time it takes to perform basic tasks. Wide variations in blood sugar levels, such as postmeal spikes, have also been shown to hinder intellectual function. Likewise, if glucose levels are too low (typically below 55 mg/dl, or 3 mmol/l), the entire nervous system lacks the fuel it needs to operate correctly. So if you want to perform as well as possible at work, in school, or in a friendly game of Guitar Hero, watch those sugar levels.
Stable Moods and Emotions
Besides intellectual performance, the brain is also responsible for maintaining our emotional balance. The fact is our moods often change along with our blood sugars. If you don’t believe me, ask those around you! (My wife didn’t take long to realize that.) High glucose levels can make us impatient, irritable, and generally negative. Achieving normal blood sugars and keeping them there can go a long way toward improving your mood and emotional stability. This is not to say that you will become an instant socialite, but the way you interact with your family, friends, coworkers, classmates, and even perfect strangers can impact your happiness and success in life.
Fewer Sick Days
Bacteria and viruses love sugar. They gobble it up and use it to grow and multiply. When blood glucose levels are up, the amount of sugar in virtually all of our body’s tissues and fluids rises as well. This makes us ideal breeding grounds for infection. Think of it as “aiding and abetting the enemy”—supplying extra nutrients to the bad guys. Everything from common colds to sinus infections to flu and vaginal yeast infections are more common when blood sugars are elevated. And once illnesses and infections set in, they are much harder to shake when the blood sugar is high. Research has shown that people with better blood sugar control spend significantly fewer days absent from work, sick in bed, and restricted from their usual activities. So if you want to keep from getting sick, take better care of your diabetes!
Softer Skin, Healthier Gums
Two body parts that changes in glucose levels affect immediately are the skin and gums. Our level of hydration greatly influences our skin. When blood sugars are high, skin tends to become dry and cracked. This can not only be uncomfortable and unsightly, but it also sets us up for potential infections because the skin is the first line of defense against harmful bacteria. Keeping glucose levels in control helps to prevent dehydration and keep our skin soft and intact.
Changes in sugar levels also immediately affect our gums. Bacteria that live below the gum line grow quickly when exposed to high sugar levels in our blood vessels. These bacteria then form plaque at an accelerated rate, contributing to bleeding gums and loose teeth. Controlling your diabetes will help cut back on plaque buildup immediately.
Personal Safety
If you happen to drive a car, operate power equipment, play a sport, or just walk across the street from time to time, having out-of-control blood sugar can put you and those around you at risk. We have already discussed how high glucose can cause sleepiness and slow reaction times (a recipe for disaster when driving), but the opposite extreme—hypoglycemia (low blood sugar)—can be even more dangerous. Hypoglycemia can occur in anyone taking insulin, even if it’s just once daily. Below-normal glucose levels will usually cause a surge of adrenaline and some degree of temporary brain impairment. Decision making and judgment will be off. Coordination suffers, and trembling can occur. To keep yourself and those around you safe, you must manage your blood sugar properly.
Predictable Menstrual Cycles
Research has shown that women with near-normal HbA1c levels tend to have more consistent, regular menstrual cycles than do women with an elevated A1c. And with predictability comes power. As you will learn later in this book, the ability to predict events that influence glucose levels allows us the opportunity to make effective adjustments.
What’s in It for Me Later?
We all know of someone who has (or had) diabetes and wound up going blind, losing a foot, or needing to go on dialysis for failing kidneys. If not, someone is sure to come along and ever-so-delicately share a diabetes horror story with you. If the thought of your vital organs decaying and body parts falling off bothers you, then good: Fear and anger can be powerful motivators. They are what keep us from doing stupid things like picking fights with people twice our size, and they give us the power to take on someone who might be trying to hurt us or our kids. Use it as your “management fuel.”
Let the fear and anger associated with long-term diabetic complications serve as a positive motivator.
Long-Term Benefits of Blood Sugar Control
•healthy eyes
•healthy kidneys
•a strong heart
•adequate blood flow
•proper nerve function
•protective nerve sensation
•minimal pain
•healthy feet
•intact memory
•flexible joints
•mental health
•successful pregnancy
One might think that sugar is a good thing—it sure tastes good! But too much of a good thing is, well, not so good. Glucose levels that are too high over a period of many years cause damage to virtually every major system of the body. But there is good news. Major long-term multicenter research projects such as the Diabetes Control and Complications Trial (DCCT) and the United Kingdom Prospective Diabetes Study (UKPDS) have proven beyond a reasonable doubt that tight glucose control does make a difference.
Maintaining a hemoglobin A1c (HbA1c, or simply A1c) as close to normal as possible has been shown to greatly reduce the health risks associated with diabetes over the long term. Likewise, minimizing glucose variability (dramatic swings into high and low glucose ranges) is believed to have a stabilizing effect on blood vessels and the organs they nourish.
Of course, there are going to be some ups and downs when it comes to your blood sugar levels; we’re not yet at the point at w
hich perfection is possible. But over the long term, if you take good care of your diabetes, here’s what you can most likely look forward to:
Keen Eyesight
In the back of the eye is a sensitive layer called the retina. Like the film in a camera, the retina receives light from the outside world and transmits signals to the brain to produce vision. Many small blood vessels (capillaries) provide the living cells of the retina with oxygen and nutrients, but elevated blood sugar levels make these capillaries very fragile. The capillaries can swell, leak, or grow in unhealthy ways, thereby blocking light from reaching the retina. This is called diabetic retinopathy.
Diabetes is the leading cause of blindness among adults aged twenty to seventy-four. Diabetic retinopathy accounts for approximately twenty thousand cases of blindness each year. Glaucoma, cataracts, and corneal disease are also more common in people with diabetes, and they contribute to the high rate of blindness.
The good news is that tight blood sugar control reduces the risk of retinopathy. The DCCT trial showed a 30 percent reduction in the risk of developing retinopathy for every one-point reduction in A1c, corresponding with approximately a 30 mg/dl or 1.7 mmol/l reduction in average blood glucose. And for those with existing retinopathy, tightening blood sugar control slows the progression significantly.
Fabulous Filters
Visit any kidney dialysis center and check the charts of the people who sit there for hours every week with tubes in their arms so that their blood can be siphoned out, pumped through machines, and filtered clean. You’ll see: diabetic, diabetic, not diabetic, diabetic, diabetic.
You get the idea.
Diabetes is the leading cause of kidney failure. Approximately fifty thousand Americans with diabetes begin treatment for end-stage renal disease each year. Elevated blood sugar does damage to the tiny blood vessels (capillaries) that form and nourish the filters within the kidneys. The good news is that tightening blood sugar control reduces the risk of kidney disease dramatically. As was the case with retinopathy, every 30 mg/dl (1.7) drop in average blood sugar leads to a 30 percent reduction in kidney disease risk.
Heart Health
Despite the long list of health problems diabetes can cause, heart disease is what ultimately kills the majority of people with diabetes. People with diabetes are two to four times more likely to develop heart disease and five times more likely to die from heart disease compared to people without diabetes. Why? Having excessive amounts of sugar in the bloodstream causes problems. Sugar is a sticky substance (think of the last time you ate cotton candy or spilled some juice). It makes things like cholesterol stick to the walls of blood vessels, thereby causing the formation of plaques. These plaques make the blood vessels thick and rigid, a condition known as atherosclerosis. When pieces of the plaques break off, clots can develop, and these restrict blood flow to vital organs such as the heart.
The good news is that improving blood sugar control reduces the risk of heart disease dramatically. Besides eliminating a great deal of the cement that clogs up blood vessels, it can also lead to reductions in cholesterol and blood pressure levels. And don’t forget: The things we do to control blood sugar, such as exercising, eating healthier, and cutting back on stress, also reduce our risk for heart disease.
Sound Circulation
Besides the heart, a number of other body parts require large amounts of oxygen and nutrients. The brain, for example: When blood vessels leading to the brain become clogged, the brain does not receive enough oxygen, and then brain cells begin to die. This is called a stroke. The risk of stroke is two to four times higher among people with diabetes.
The muscles in the legs also depend on significant blood flow, particularly during exercise. When blood vessels serving the leg muscles become clogged and oxygen delivery is limited, pain or cramping can occur when exercising, walking, or simply standing. This condition is called claudication. Blood vessel disease in the legs is twenty times more common in people with diabetes, and some degree of claudication occurs in 45 percent of people who have had diabetes for more than twenty years.
Again, the good news is that tightening blood sugar control, along with all the other lifestyle improvements that come with it, will improve circulation to vital body parts.
All Systems Go
Our nervous system, for lack of a better phrase, serves as the wiring for our bodies. More specifically, the autonomic portion of our nervous system controls the behind-the-scenes functions that are going on—things like heart rate, digestion, temperature regulation, balance, and sexual function.
Nerves are like any other living tissue in the body: They burn sugar for energy and require a blood supply for oxygen and nutrients. Elevated blood sugar levels seem to cause two problems for nerves: They interfere with the blood supply, and energy metabolism is altered such that the nerves swell and lose the waxy coating that normally provides insulation for the nerve fibers. Damage to the nerves that regulate basic body functions is called autonomic neuropathy.
Population-based studies have shown that 60 to 70 percent of people with diabetes will develop some form of nerve damage in their lifetime. Nearly 50 percent of all men with diabetes develop impotency, due mainly to malfunction of the nerves that produce an erection. Women with diabetes are more likely than nondiabetic women to suffer from vaginal dryness. Delayed digestion (gastroparesis) affects nearly 30 percent of people with diabetes. This condition can cause painful bloating, and the extremely slow rate of digestion can make diabetes even more difficult to control. Postural hypotension (low blood pressure upon sitting or standing) is twice as common in people with diabetes.
The good news is that blood sugar control is an effective means for preventing all forms of autonomic neuropathy. And here’s more good news for those who already have neuropathy: Although it is not always reversible, the condition may regress slightly or cease to progress further once blood sugar levels return toward normal.
Freedom from Pain
As mentioned above, 60 to 70 percent of all people with diabetes develop some form of nerve damage in their lifetime. Most develop a form called peripheral neuropathy—malfunction of the nerves leading to the extremities such as the feet and lower legs. In its early stages peripheral neuropathy takes the form of tingling or numbness. But as it progresses and nerve inflammation develops, it can cause constant and sometimes severe pain. Although there are many medical and alternative medicine treatments for painful neuropathy, many people find little or no relief.
The good news is that tight blood sugar control can help to minimize the pain, slow the progression of painful neuropathy, and prevent it from developing in the first place.
Fit Feet
Neuropathy, combined with poor circulation, can lead to serious foot infections and deformities. When you cannot feel a minor foot injury, such as a bruise, burn, cut, or callous, and continue to use that foot, the injury becomes more severe. Furthermore, if there is inadequate blood flow to the injured area to aid in the healing process, an infection can develop easily. As the infection spreads into the underlying tissue and bone, portions of the foot succumb to cell death—a condition known as gangrene. Sometimes, the only way to keep gangrene from spreading is to amputate the infected body part.
Foot deformities often develop because the nerves that coordinate complex movements in the feet fail to do their job. We may put pressure on inappropriate (or injured) spots, thus causing further damage that then goes unnoticed because of a lack of pain sensation.
Each year more than seventy thousand people with diabetes require lower-limb amputations. Diabetes causes more amputations than all other causes combined, and loss of protective nerve sensation is the most critical factor. Even more disturbing is the fact that most people with diabetes die in less than three years after having a toe, foot, or limb amputated.
The good news is that tight blood sugar control helps to preserve healthy nerve function and blood flow to the feet. Lowering blood sugar levels also reduce
s the risk for infection. That’s really good news for those looking to prevent foot problems as well as those recovering from existing foot ailments.
A Sound Mind
As we age, we’re at risk for a number of health problems. Few instill as much fear as Alzheimer’s disease, a progressive and fatal disease that destroys brain cells, thereby causing problems with memory, thinking, and behavior. Today, Alzheimer’s is the sixth-leading cause of death in the United States, affecting more than five million Americans. Currently, there is no cure for the disease. Damaged blood vessels in the brain are believed to play a role in the development of Alzheimer’s. Uncontrolled diabetes, which contributes to blood vessel damage, greatly increases the risk of developing the disease. The good news is that tight blood sugar control can reduce the risk of Alzheimer’s to the nondiabetic population.
Flexible Joints
Joint mobility problems, including frozen shoulder, trigger fingers, and clawed hands, affect approximately 20 percent of people with diabetes. At the root of joint mobility problems is high blood sugar. Excess sugar sticks to collagen, a protein found in bones, cartilage, and connective tissue throughout the body. When collagen becomes sugarcoated, it thickens and stiffens, forming adhesions between adjoining muscles. This keeps joints from moving smoothly through the full range of motion. In addition to limiting movement, it can also cause pain in the joint.
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