The incidence of diabetes is rising at an alarming rate in the United States; in 2022, the CDC reported an estimated 37.3 million cases of diabetes. With these growing numbers, there is an increasing demand for integrative and personalized approaches for the early detection and treatment of high blood sugar to prevent the development of diabetes and the associated health complications of hyperglycemia. This article will explore the benefits of various integrative approaches to address the underlying causes of high blood sugar.
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Understanding High Blood Sugar
Hyperglycemia is a medical condition characterized by abnormally high levels of glucose (sugar) in the blood (2). A fasting blood sugar greater than 100 mg/dL is considered to be elevated. A fasting blood glucose between 100-125 mg/dL falls within the prediabetic range. Prediabetes, or impaired glucose metabolism, means blood sugar is high but not too high to be considered diabetes. Diabetes occurs when blood sugar exceeds 125 mg/dL fasting or 180 mg/dL two hours after eating. (3)
Early detection and management of hyperglycemia are paramount to preventing serious complications. Persistent hyperglycemia that goes untreated leads to diabetes and other long-term health problems such as cardiovascular disease, kidney damage, nerve damage, and vision impairment (4). Timely identification and appropriate management of hyperglycemia can prevent disease progression and minimize the risk of associated health complications.
What Causes Hyperglycemia?
A disruption in glucose homeostasis, influenced by reduced insulin secretion, decreased cellular glucose utilization, and increased glucose production, leads to hyperglycemia. Most commonly, hyperglycemia is associated with type 1 or 2 diabetes mellitus. Type 1 diabetes occurs when genetic, environmental, and immunologic factors lead to the autoimmune destruction of pancreatic beta cells and insulin deficiency. Type 2 diabetes is said to be a lifestyle disease resulting from insulin resistance caused by poor dietary habits and a sedentary lifestyle. (2)
There are other secondary causes of hyperglycemia to consider. Destruction of the pancreas from pancreatitis, hemochromatosis, pancreatic cancer, and cystic fibrosis can lead to high blood sugar. Endocrine disorders like Cushing's syndrome, acromegaly, pheochromocytoma, and hyperthyroidism, can also cause peripheral insulin resistance. (1, 2)
Physiologic stress results in the release of cortisol, the body's stress hormone, which counteracts insulin to raise blood sugar levels. Reactive hyperglycemia can occur due to stress from illness, trauma, and surgery (1).
Certain medications, including glucocorticoids, beta-blockers, thiazide diuretics, phenytoin, and estrogens, can also contribute to hyperglycemia (1).
Symptoms of Hyperglycemia
Early symptoms of hyperglycemia include (5, 6):
- Increased thirst and hunger
- Frequent urination (especially at night)
- Headache
- Blurred vision
- Fatigue
Later signs and symptoms that tend to develop in cases of chronic, uncontrolled elevated blood sugar include (5, 6):
- Unintentional weight loss
- Frequent infections
- Slow and poor wound healing
- Numbness, pain, and tingling in the hands and feet
- Areas of darkened skin, often appearing in the armpits, groin, and neck
Health Risks Associated With Prolonged High Blood Sugar Levels
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes that occurs when insufficient insulin causes the production of acidic compounds called ketones for energy. As ketone levels rise, the blood becomes acidic, disrupting the normal function of vital organs. Signs and symptoms of DKA include fruity-smelling breath, abdominal pain, nausea and vomiting, labored breathing, rapid heartbeat, confusion, and loss of consciousness. Without treatment, DKA can cause coma and death.
Prolonged hyperglycemia in the absence of ketoacidosis also poses significant health risks. High blood sugar causes damage to blood vessels over time, increasing the risk of cardiovascular diseases such as heart attack, stroke, and peripheral artery disease. Additionally, damage to capillaries within the kidneys and eyes can lead to kidney disease (diabetic nephropathy) and eye damage (diabetic retinopathy). These increase the risk of kidney failure and vision loss, respectively. (7)
Nerve damage, known as diabetic neuropathy, is another common consequence of hyperglycemia, resulting in numbness, tingling, and pain in the extremities. Nerve damage to the enteric nervous system, which governs the function of the gastrointestinal tract, leads to digestive problems, most commonly related to slow intestinal transit (gastroparesis).
Finally, hyperglycemia weakens the immune system. In conjunction with poor circulation due to endothelial damage within the blood vessels, immune dysfunction makes individuals more susceptible to infection and slower wound healing. (7)
Functional Medicine Labs to Test for Root Causes of Hyperglycemia
Patients with hyperglycemia are often diagnosed incidentally through a routine wellness panel consisting of a complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid panel. These panels evaluate blood cells, blood sugar, electrolyte balance, and liver, kidney, and thyroid function. They are helpful labs for patients with hyperglycemia and diabetes to rule out underlying infections and hyperthyroidism, monitor kidney health, and assess blood pH.
Additional functional labs can help to better get to the root cause of hyperglycemia and diabetes, making treatment protocols more effective. Functional doctors commonly order the following labs for patients with hyperglycemia and diabetes.
Diabetes Panel
A diabetes panel offers a more accurate assessment of hyperglycemia and diabetes by measuring multiple markers associated with glucose metabolism, including the most common biomarkers: glucose, hemoglobin A1c, and insulin.
While these biomarkers are valuable, this panel lacks the ability to track blood glucose levels in real-time. This is why many functional practitioners turn to continuous glucose monitoring (CGM). CGMs are sensors that monitor glucose levels in the interstitial fluid every five minutes. The glucose patterns obtained through CGM better inform individuals and their doctors about how diet, physical activity, and medications/supplements influence glycemic control.
Adrenal Function
Cortisol can be measured through serum, saliva, or urine. While serum and urinary cortisol are preferred to rule out pathologic disorders related to adrenal function (e.g., Cushing's), salivary cortisol is preferred by functional doctors to evaluate functional disorders related to the stress axis.
Genetic Panel
Genetic factors may mediate alterations in glucose homeostasis. A genetic panel assesses for genetic variations that influence the efficacy of insulin and glucose pathways in the body and can predispose an individual to type 1 and 2 diabetes mellitus.
Functional Medicine Labs That Can Help Individualize Treatment Options for Patients With Hyperglycemia
Functional labs can help doctors personalize dietary, lifestyle, and supplemental treatment options. The following labs could be considered on an individual basis for patients struggling with hyperglycemia.
Micronutrient Panel
Nutritional deficiencies associated with high blood sugar and insulin resistance include inositol, vitamin D, magnesium, zinc, and chromium (2). A micronutrient panel can identify deficiencies or insufficiencies of these (and other) essential nutrients that may contribute to poor glucose control and health outcomes.
Comprehensive Stool Test
Numerous studies have examined the human gut microbiota in relation to type 2 diabetes. The data from these studies suggest gut bacteria directly affect the mechanisms underlying the development of type 2 diabetes and that intestinal dysbiosis contributes to blood sugar dysregulation and hyperglycemia. Additionally, intestinal hyperpermeability and digestive dysfunction can contribute to immune dysregulation, systemic inflammation, and nutrient deficiencies associated with type 1 diabetes, glucose metabolism, and poor cardiovascular outcomes. Therefore, a comprehensive stool analysis can be valuable to thoroughly evaluate gastrointestinal health as it pertains to whole-body functioning.
Sleep Assessment
The sleep-stress cycle refers to the bidirectional relationship between the two and how they affect each other. High stress and cortisol negatively impact sleep by dysregulating the body's circadian rhythm. Poor sleep, in turn, sustains cortisol hypersecretion and the psychoemotional perception of stress. This sleep-stress cycle can quickly perpetuate hyperglycemia.
In addition to a functional salivary cortisol test (discussed above), ordering a sleep study and measuring melatonin, the body's master sleep hormone, can help to unravel the sleep-stress cycle.
Integrating Testing, Lifestyle Modifications, and Integrative Therapies
The importance of personalized approaches in managing high blood sugar cannot be overstated. Every individual's response to treatment, underlying health conditions, and lifestyle factors can vary significantly. By adopting personalized approaches that consider test results and the patient's goals, preferences, and unique circumstances, healthcare providers can tailor interventions to optimize outcomes. By combining the expertise of different healthcare disciplines, patients can benefit from a comprehensive treatment plan that integrates conventional medical interventions with lifestyle modifications, dietary changes, stress management techniques, and other complementary therapies. Such an approach empowers patients to actively participate in their care and increases the likelihood of achieving desired health outcomes in managing high blood sugar.
Conventional Treatment for Hyperglycemia
The treatment goals of hyperglycemia involve controlling blood sugar, eliminating symptoms related to high blood sugar, and preventing long-term complications. Depending on the cause of hyperglycemia, different conventional approaches may need to be taken. These approaches often incorporate diet and lifestyle counseling, oral glucose-lowering medications, and insulin therapy. (1)
Nutrition for Hyperglycemia
Nutrition plays a critical role in managing hyperglycemia. Dietary choices can prevent high blood sugar spikes and help the body return to a healthy baseline after eating. Processed foods rich in simple carbohydrates, added sugars, and unhealthy fats contribute to the development of insulin resistance and rapid spikes in blood sugar. Alternatively, well-balanced meals composed of healthy ratios of complex carbohydrates, fiber, lean proteins, and unsaturated fats lead to steadier blood sugars, improved insulin sensitivity, and increased satiety (helping to curb sugar cravings and overeating). Evidence-based, anti-inflammatory, and low-glycemic dietary patterns proven to support healthy blood sugar levels include the Mediterranean, DASH, low-carbohydrate, and plant-based diets. (8)
Supplements and Herbs for Hyperglycemia
Several supplements have been shown to decrease blood sugar levels and can be added to a treatment plan in addition to lifestyle and dietary modifications to expedite treatment success.
Berberine
Berberine is a naturally occurring plant compound with antimicrobial, anti-inflammatory, anti-lipidemic, and hypoglycemic properties. A meta-analysis of 27 randomized controlled trials and over 2,500 patients found that supplemental berberine increased the therapeutic effects of lifestyle modifications, dietary changes, and oral diabetes medications. Positive clinical outcomes noted in this meta-analysis included reductions in fasting glucose, post-prandial glucose, and hemoglobin A1c.
Cinnamon
Cinnamon is a common household pantry spice that has medicinal properties. The active component of cinnamon, cinnamaldehyde, has been attributed to positive glucose-managing effects. It is believed that cinnamaldehyde promotes insulin release and enhances insulin sensitivity, promoting cellular uptake by cells. Studies have shown that therapeutic doses of cinnamon decrease fasting blood sugar levels. (9)
Chromium
Chromium has been shown to enhance insulin's metabolic effect; chromium deficiency has been linked to type 2 diabetes. A meta-analysis of 28 studies revealed that oral chromium supplementation significantly reduces fasting blood sugar, insulin levels, hemoglobin A1c, and HOMA-IR (a marker of insulin resistance).
Gymnema
Gymnema is an interesting herb thought to act by multiple mechanisms to lower blood sugar levels successfully. Perhaps the most interesting characteristic of this herb is its ability to interfere with perceiving the sweet taste; by inhibiting the sweet taste of foods, people may naturally limit their intake of sweet foods. Additionally, gymnema decreases gastrointestinal absorption of sugar, stimulates pancreatic insulin production, and improves signaling for peripheral uptake of blood glucose. Research has shown that the culmination of these properties reduces fasting blood sugar and hemoglobin A1c levels. (10)
Exercise for Managing High Blood Sugar
Exercise offers numerous benefits for managing high blood sugar and is crucial to diabetes management. Regular physical activity helps improve insulin sensitivity, allowing the body to utilize glucose for energy effectively. It also promotes weight loss or weight management, reducing the risk of insulin resistance. Engaging in exercise can lower blood sugar levels, enhance cardiovascular health, and decrease the risk of developing complications associated with diabetes. (11)
The American Heart Association (AHA) recommends incorporating aerobic and anaerobic forms of exercise into your physical routine to promote cardiovascular health and prevent insulin resistance. It is recommended to gradually work up to at least 150 minutes of moderate-intensity or 75 minutes of high-intensity aerobic activity, with at least two sessions of muscle-strengthening exercise, every week.
Beginning a new exercise routine can feel overwhelming. The good news is that research shows even small amounts of physical activity are better than none. For example, walking 15 minutes after meals significantly helps 24-hour glucose control.
Stress Management and Quality Sleep for Hyperglycemia
As discussed earlier, chronic stress and lack of sleep contribute to sustained elevations in cortisol and poorer blood sugar control. Research has shown that diabetic patients who feel stressed also report greater insulin use, poorer glycemic control, and a general sense of less empowerment. Therefore, ensuring patients can implement effective stress management techniques and get adequate good-quality sleep is a very important aspect of a hyperglycemia treatment protocol.
In addition to eating a healthy, well-balanced diet and exercising regularly, mindfulness-based stress reduction practices (discussed in more detail below) and adaptogenic herbs can modulate the "fight-or-flight" division of the nervous system and cortisol levels to help the body better adapt to stress.
Establishing healthy sleep hygiene habits can promote restorative sleep. The following tips are often recommended to facilitate deep sleep. Aim to wake up and go to bed at the same time each day of the week. Avoid intense activity and other stimulants (e.g., caffeine) later in the afternoon and evening. Create a calming wind-down routine before bed that includes dimming lights and avoiding blue light. Ensure your bedroom is dark, cool, and quiet.
Mind-Body Approaches for Hyperglycemia Management
Mind-body therapies, including yoga, mindfulness-based stress reduction therapy, and acupuncture, effectively manage stress. Interestingly, research demonstrates that each of these modalities supports healthier blood sugar control, indicated by improvements in fasting blood glucose and hemoglobin A1c levels.
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Summary
Hyperglycemia is a medical condition that cannot go unrecognized and untreated. An integrative approach to prevent and treat high blood sugar, incorporating functional medicine labs and a combination of complementary therapeutic modalities, offers promising possibilities for achieving optimal glycemic control.
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