Author: Amy Cottrell (DipCNM, mBANT, rCNHC, mANP)

In the first article in this series, we discussed how our bodies manage our blood glucose levels, how they are measured, the symptoms that might indicate that yours are out of whack and how genes might play a role in your blood glucose management and your metabolic health.

Many different factors can impact our blood sugar levels, whether they rise too high (also known as hyperglycaemia) or go the other way and dip too low (also known as hypoglycaemia) (a).

What can result in high blood sugar (hyperglycaemia)?

• Refined Carbohydrates: Carbohydrates are an essential energy source for the body and are present in an array of healthy food. However, carbohydrates that form a large part of the Western diet are usually refined and found in processed foods such as cereals, white sliced bread, and soft drinks. Refined carbohydrates are particularly problematic for our blood sugar because they no longer contain fibre, vitamins or minerals. They are digested very quickly, causing rapid spikes in our blood sugar levels (and, therefore, insulin levels). Over time, these uncontrolled blood sugar and insulin peaks can lead to weight gain, insulin resistance, metabolic issues and chronic health conditions (b). Some specific genes can make us more sensitive to carbs in terms of blood sugar spikes and putting on weight, particularly the TCF7L2 gene. 
• Stress and Cortisol: Cortisol is a hormone commonly referred to as the “stress hormone”. The truth is that we need cortisol to survive as human beings as it contributes to reducing inflammation as well as the metabolism of glucose. It’s also linked with our “fight or flight” response when our body perceives danger and releases cortisol to ensure that we can quickly escape from danger. However, chronic activation of this fight or flight response can raise cortisol levels, which can be detrimental to our health. In terms of glucose and blood sugar management, higher cortisol levels can increase the risk of insulin resistance and might reduce insulin excretion and (c). Our genes can also play a role in contributing to higher cortisol levels, including FKBP5 and HSD11B1. 
• Excess caffeine: How many of us reach for coffee first thing in the morning to help us to wake up and get through our busy days? Unfortunately, caffeine might increase blood sugar levels (d). Caffeine also causes peaks in cortisol, which, as we’ve just mentioned, can negatively impact our blood sugar levels. One way to counteract this is to reduce your caffeine intake or have your first cup of coffee after breakfast instead of before to minimise an unwanted peak in blood sugar. Our genes also determine how fast or slowly we process caffeine. People with the “slow” version of the CYP1A2 gene tend to be more negatively impacted and more addicted to caffeine!
• Poor/insufficient sleep: We all know that excess caffeine can result in disturbed sleep or difficulty sleeping. There are many other reasons why we don’t get enough sleep in today’s busy world, such as stress, anxiety and not making enough time to rest. The truth is that lack of sleep negatively impacts our blood sugar management (e) and our longer-term health. It’s also worth mentioning that we screen for the genes LEPR (“leptin receptor”. Leptin is a hormone that plays a role in satiety) and FTO (also known as the “fat gene”), both of which review how likely you are to feel satiated after meals and if you’re more susceptible to overeating, being overweight and therefore more vulnerable to insulin resistance and chronic conditions like diabetes type 2. 
• Inactivity or lack of exercise: Many of us work in front of a computer for 8+ hours a day, sometimes going several hours without getting up or moving around. Inactivity and our sedentary lifestyles are contributing to poorer health outcomes. In terms of blood sugar, it might reduce insulin sensitivity and increase the risk of developing insulin resistance (f).
• Dehydration: The body is made up of about 60% water, it’s vital for survival, yet a lot of us do not drink sufficient water on a day-to-day basis, and even if mildly, we are often dehydrated. The impact of hydration levels on our metabolic health has been studied extensively. Although evidence is conflicting, adequate hydration might positively affect our metabolic health (g) and drinking more water will always benefit our health. 
• Artificial sweeteners: There are many different artificial sweeteners out there, marketed as a great alternative to sugar. However, studies have shown that some artificial sweeteners can still negatively impact our blood sugar management (h, i) and might be best avoided.
• Certain medications: Interestingly, illness and some medications such as steroids or antipsychotic medications might also cause a rise in our blood sugar.

What can cause low blood sugar (hypoglycaemia)?

The most well-known reason for low blood sugar levels is not eating enough or leaving too long between meals. Hypoglycaemia occurs because the amount of glucose in the blood drops too low, and your body sends out warning signs such as feeling shaky, sweating, dizziness and an increased heartbeat. Certain medications can result in high blood sugar, but others can result in low blood sugar, such as insulin and beta blockers.

Alcohol also lowers our blood sugar levels as it can inhibit both the synthesis of glucose and the breakdown of glycogen into glucose (gluconeogenesis and glycogenolysis) (j).

As you may have noticed, there might be a number of different reasons why our everyday habits might be impacting negatively on your blood sugar levels, where they peak too high or dip too low. In the following article in this series, we’ll take you through some simple strategies to get your blood sugar levels back in check. 

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