Integrative Approaches to Managing High Blood Sugar: Specialty Testing, Lifestyle Modifications, and Natural Remedies

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 management of high blood sugar to support overall health and well-being. This article will explore the potential benefits of various integrative approaches to support healthy blood sugar levels.

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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 important for supporting long-term health. Persistent hyperglycemia that goes unmanaged may contribute to diabetes and other long-term health challenges such as cardiovascular issues, kidney concerns, nerve discomfort, and vision changes (4). Timely identification and appropriate management of hyperglycemia can support overall health and minimize the risk of associated health challenges.

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 often associated with lifestyle factors such as insulin resistance influenced by dietary habits and physical activity levels. (2)

There are other secondary factors that may contribute to hyperglycemia. Conditions affecting the pancreas, such as pancreatitis, hemochromatosis, pancreatic cancer, and cystic fibrosis, can influence blood sugar levels. Endocrine disorders like Cushing's syndrome, acromegaly, pheochromocytoma, and hyperthyroidism, can also affect insulin sensitivity. (1, 2)

Physiologic stress results in the release of cortisol, the body's stress hormone, which can influence blood sugar levels. Reactive hyperglycemia may 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 changes in blood sugar levels (1).

Symptoms of Hyperglycemia

Early symptoms of hyperglycemia may include (5, 6):

Increased thirst and hunger
Frequent urination (especially at night)
Headache
Blurred vision
Fatigue

Later signs and symptoms that may develop in cases of chronic, unmanaged elevated blood sugar include (5, 6):

Unintentional weight changes
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 Considerations Associated With Prolonged High Blood Sugar Levels

Diabetic ketoacidosis (DKA) is a potentially serious condition that can occur when insulin levels are insufficient, leading to the production of acidic compounds called ketones for energy. As ketone levels rise, the blood becomes acidic, which can affect the normal function of vital organs. Signs and symptoms of DKA may include fruity-smelling breath, abdominal discomfort, nausea and vomiting, labored breathing, rapid heartbeat, confusion, and loss of consciousness. Without management, DKA can lead to serious health outcomes.

Prolonged hyperglycemia in the absence of ketoacidosis may also pose health considerations. High blood sugar can affect blood vessels over time, potentially increasing the risk of cardiovascular issues such as heart attack, stroke, and peripheral artery concerns. Additionally, changes to capillaries within the kidneys and eyes can contribute to kidney health challenges (diabetic nephropathy) and eye health (diabetic retinopathy). These may increase the risk of kidney function changes and vision concerns, respectively. (7)

Nerve health, known as diabetic neuropathy, is another common consideration with hyperglycemia, potentially resulting in numbness, tingling, and discomfort in the extremities. Nerve changes to the enteric nervous system, which governs the function of the gastrointestinal tract, may lead to digestive challenges, most commonly related to slow intestinal transit (gastroparesis).

Finally, hyperglycemia may influence the immune system. In conjunction with circulation changes due to endothelial changes within the blood vessels, immune function may be affected, making individuals more susceptible to infection and slower wound healing. (7)

Functional Medicine Labs to Explore Root Causes of Hyperglycemia

Patients with hyperglycemia are often identified 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 explore underlying factors and monitor overall health.

Additional functional labs can help to better understand the root causes of hyperglycemia and diabetes, potentially making management strategies more effective. Functional doctors commonly consider the following labs for patients with hyperglycemia and diabetes.

Diabetes Panel

A diabetes panel offers a more comprehensive 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 can provide insights into 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 often used by functional doctors to evaluate functional disorders related to the stress axis.

Genetic Panel

Genetic factors may influence glucose homeostasis. A genetic panel assesses for genetic variations that may affect 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 Management Options for Patients With Hyperglycemia

Functional labs can help doctors personalize dietary, lifestyle, and supplemental management options. The following labs could be considered on an individual basis for patients managing hyperglycemia.

Micronutrient Panel

Nutritional factors associated with high blood sugar and insulin resistance may include inositol, vitamin D, magnesium, zinc, and chromium (2). A micronutrient panel can identify levels of these (and other) essential nutrients that may contribute to 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 may affect the mechanisms underlying the development of type 2 diabetes and that intestinal dysbiosis may contribute to blood sugar dysregulation and hyperglycemia. Additionally, intestinal hyperpermeability and digestive function may contribute to immune regulation, systemic inflammation, and nutrient levels associated with type 1 diabetes, glucose metabolism, and 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 may impact sleep by influencing the body's circadian rhythm. Poor sleep, in turn, may sustain cortisol levels and the 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 management strategies, 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 management 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 Management for Hyperglycemia

The goals of managing hyperglycemia involve supporting healthy blood sugar levels, addressing symptoms related to high blood sugar, and minimizing long-term health considerations. Depending on the factors contributing to hyperglycemia, different conventional approaches may be considered. 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 help maintain healthy blood sugar levels and support the body's return to a balanced state after eating. Processed foods rich in simple carbohydrates, added sugars, and unhealthy fats may contribute to insulin resistance and rapid changes in blood sugar. Alternatively, well-balanced meals composed of healthy ratios of complex carbohydrates, fiber, lean proteins, and unsaturated fats may lead to steadier blood sugars, improved insulin sensitivity, and increased satiety (helping to manage sugar cravings and overeating). Evidence-based, anti-inflammatory, and low-glycemic dietary patterns that may 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 studied for their potential to support healthy blood sugar levels and may be considered as part of a comprehensive management plan alongside lifestyle and dietary modifications.

Berberine

Berberine is a naturally occurring plant compound with properties that may support microbial balance, inflammation management, lipid levels, and blood sugar levels. A meta-analysis of 27 randomized controlled trials and over 2,500 patients found that supplemental berberine may enhance the effects of lifestyle modifications, dietary changes, and oral diabetes medications. Positive outcomes noted in this meta-analysis included changes in fasting glucose, post-prandial glucose, and hemoglobin A1c.

Cinnamon

Cinnamon is a common household pantry spice that has been studied for its potential health benefits. The active component of cinnamon, cinnamaldehyde, has been attributed to potential glucose-managing effects. It is believed that cinnamaldehyde may support insulin release and enhance insulin sensitivity, promoting cellular uptake by cells. Studies have shown that therapeutic doses of cinnamon may influence fasting blood sugar levels. (9)

Chromium

Chromium has been studied for its potential to enhance insulin's metabolic effect; chromium levels have been linked to type 2 diabetes. A meta-analysis of 28 studies revealed that oral chromium supplementation may influence fasting blood sugar, insulin levels, hemoglobin A1c, and HOMA-IR (a marker of insulin resistance).

Gymnema

Gymnema is an herb thought to act by multiple mechanisms to support healthy blood sugar levels. Perhaps the most interesting characteristic of this herb is its potential to interfere with perceiving the sweet taste; by influencing the sweet taste of foods, people may naturally limit their intake of sweet foods. Additionally, gymnema may influence gastrointestinal absorption of sugar, stimulate pancreatic insulin production, and improve signaling for peripheral uptake of blood glucose. Research has shown that these properties may influence 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 an important aspect of diabetes management. Regular physical activity may help improve insulin sensitivity, allowing the body to utilize glucose for energy effectively. It also supports weight management, which may reduce the risk of insulin resistance. Engaging in exercise can support healthy 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 support cardiovascular health and manage insulin resistance. It is suggested 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 may support 24-hour glucose control.

Stress Management and Quality Sleep for Hyperglycemia

As discussed earlier, chronic stress and lack of sleep may contribute to sustained elevations in cortisol and affect 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 management plan.

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 may help 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, may help manage stress. Interestingly, research demonstrates that each of these modalities may support healthier blood sugar control, indicated by changes in fasting blood glucose and hemoglobin A1c levels.