Some people walking amongst us are driven in their pursuit of perfection. They strive continuously for more, for better. If you've met a professional sportsperson, this is a typical trait (definitely not me).
They cannot bear to lose. They struggle so much to be the best that it consumes them. It is extreme - but in the case of sport, it works. We place these people on pedestals and rightly so, they dedicate their entire lives to being better than any other person on this planet at one particular thing.
People with diabetes are charged with this very same perfection. Not to be better than others, but to be faultless in our ability to manage our blood sugars. We didn't ask for it, and in many cases, we don't want it - but we don't have a choice.
We are responsible for maintaining strict glycemic control. So much so, that if we falter too much and too often, it could devastate our health. The risks are high.
But this pressure is massive, and for children, it's arguably too much - too soon. So how do we strive for perfect blood sugars whilst also living what we consider a normal life, eating normal food, doing normal activities?
The answer to this is that we cannot. Insulin saves our lives and helps us live longer, but it doesn't do or act the same as the insulin secreted in a non-diabetic.
What is is a perfect blood sugar?
Depending on who you ask, you’ll likely get a different response. But what we need to be thinking about is “what are the perfect blood sugars of a healthy non-diabetic”. To further define this, I am referring to a person that has optimum metabolic health. Not your average Joe eating a highly refined western diet. We need to have the glucose levels of the best, not the normal.
Our most current estimates are between 3.5 - 6.7 mmol (65 - 120 mg/dl).
The reason why it’s important to look at what some may consider less achievable numbers is that they provide us a benchmark; the pinnacle of health, and that’s what we need. We don’t need the blood sugars of someone who’s just consumed 400 grams of carbs in one day and has seen peaks and troughs just like an actual diabetic. They are doing very real damage to their body, so why are we kidding ourselves into thinking that’s normal?
That being said, now that we know what we’re aiming for, is that even achievable? And is the whole process of trying to achieve these numbers more detrimental than actually achieving them?
The answer to this charged question is of course subjective. So let’s look at The positives and negatives of being extra vigilant on your pursuit of flawless blood glucose levels.
Note: Through mountains of research, the only lifestyle choice I am aware of that sufficiently allows a diabetic to achieve non-diabetic blood sugars and optimum metabolic health is via a very low carbohydrate / ketogenic diet. With this in mind;
Positives of perfect blood sugars
1) Less stress - combination of all of the below.
2) Less hypos - decreased insulin requirement = less risk of going too low.
3) Less hypers - Low carb or keto = decreased risk of high blood sugars.
4) Decreased chance of complications - diabetic complications are primarily a result of hyperglycemia, which is dramatically decreased.
5) Less money spent on Insulin - decreased insulin requirements due to change in diet and exercise.
5) Less money spent on food - low carb high fat converts your body into efficiently burning fat for energy. Your appetite decreases and your shopping bill does too. Cheap and nasty food might taste nice but you eat more of it.
6) More and better sleep - better blood sugars results in better sleep, and less interrupted sleep, either by CGM alarms or checking BS overnight. This also greatly impacts stress and general health.
7) Less chance of DKA (Diabetic ketoacidosis) - blood sugars in range result in your body using dietary ketones for energy and decreasing the chance of DKA with sufficient insulin on board.
8) Weight loss and/or stabilisation - using fat for energy converts your natural fat stores for energy rather than glucose metabolised from carbohydrates. You naturally slim down and your weight stabilises.
Negatives of pursuing perfect blood sugars
1) Difficult to manage - many people find it extremely difficult to remain disciplined enough to not eat and drink highly refined carbohydrates due to their addictive nature.
2) Access - Good, wholefood is hard to access easily as most retailers stock cheap, high carb foods as they last longer on the shelf and due to the very cheap manufacturing process, they provide the greatest profit margin.
3) Research and health guidance - the food industry is heavily influenced by lobbyists and thus provide confusing and contradictory information on what constitutes healthy food.
4) Marketing - many food manufacturers are still able to get away with shameless and unethical marketing tactics declaring their food ‘healthy’, when in fact it shares a similar nutritional profile to cardboard (i.e. cereal, fruit juice, soft drinks, yoghurt).
5) Cultural significance - many people correlate certain foods with their culture and thus find it very difficult to part ways with it (Pasta, pizza, curry).
6) Insulin is a cure - we all know insulin is not a cure, but many people still want to believe that they can eat or drink anything and insulin will keep their blood sugars in the same range as a healthy non-diabetic. It is near-impossible to achieve perfect blood sugars eating 100/200/300 grams of refined or processed carbs per day.
7) Control - to admit you have to change your diet and lifestyle due to illness is to admit you don’t have full control over your life (and that you have the illness). This is, of course, not true. But many people will continue to eat and drink what they want as they believe they are the ones in control. The irony is it’s actually the opposite.
8) Medical profession - it’s likely that your doctor or endocrinologist would have played down the severity of diabetes upon diagnosis to lessen the impact on you. This unfortunately can set a dangerous precedent whereby the patient believes they can still live the same life and eat and drink what they want without repercussion. In particular the target blood sugars - I was told between 4 and 8 mmol. (72 - 145 mg/dl).
9) Increased risk of burn out - Modern life is difficult enough without having to constantly evaluate every meal and drink. This onslaught of meticulous diligence is hard to keep on track, and could lead some toward burning out.
You may read this and say “well, this is heavily biased in favour of completely changing my life and removing all the things I enjoy”. And you’d be right. However, you don’t have to become a monk to start honing your skills in blood glucose management.
We now have a plethora of low sugar, low carb food and beverage alternatives to replace the old high carb ones. This makes life easier and still sweet.
The reality is though, even if we didn’t have sweet alternatives, I would still encourage a significant diet and lifestyle change, because the risks are too high and without our health we have nothing.
Achieving perfect blood sugars is another step up though and takes real discipline, but more importantly, education.
I am sat here right now in a restaurant eating a flank steak and Brussel sprouts. Would I love fries? Definitely. Would I love a dessert? 100% yes, but the risks for me outweigh the benefits.
Why am trying to kid myself and say “oh I can eat what I want and just cover it with insulin“, when the reality is that I know those foods aren’t doing me any good anyway. That’s IF I get the calculations right and don’t see a significant rise or fall in blood sugars. If I get it wrong, I’m potentially going high, increasing the glucose in my blood, damaging my nerves and organs. Or maybe going low and being forced to eat food that I, nor my body wants or needs to get out of a hypo.
All of this his can be avoided, by simply choosing food that is more healthy,
Having an HbA1c of 4.5 would take enormous planning, precision, discipline, vigilance, education and constant testing.
You would have to incorporate daily exercise and eat a very specific diet. Your insulin regimen would need to be extremely accurate as well.
It is achievable though. It just depends on whether you want to spend the rest of your life learning and pushing yourself to achieve better.
Many people still achieve great numbers with HbA1c’s in the 5’s and 6’s and this is commendable. They are still dramatically decreasing their chances of complications but still having the occasional treat. Many of us would naturally gravitate toward this outcome.
No-one is ever allowed to tell you how to live your life. Managing diabetes is hard enough without someone preaching to you about cinnamon curing you or ditching insulin on keto, but the harsh reality is without controlled effort and motivation to achieve better, we face some big risks.
Hopefully, you’ll never have to deal with diabetic complications, and your life won’t be anymore eventful than just dealing with this disease. But we know for sure, if you want less stress brought on by unpredictable blood sugars and the fear of what the future may hold for your health, it’s time to get serious about your lifestyle choices.
Oh, and be happy that most alcohol doesn’t impact your blood sugars too much.
Believe the hypo