From bruises to blood donation, menstruation to mozzies, the first season of It Can’t Hurt To Ask focuses on blood.
Gaurav Puri is an endocrinologist and clinical director of Logan Endocrine and Diabetes Services. In this episode, he’s helping us bust some myths about blood sugar. He takes us through how blood sugar works, how what you eat and how you move your body can affect your blood sugar levels, and how insulin works. He also walks us through the two types of diabetes, and how Queenslanders can reduce their risk of developing diabetes at all stages of life.
Featured in this episode
Dr Gaurav Puri
Dr Gaurav Puri is an endocrinologist. He’s the clinical director of Logan Endocrine and Diabetes Services.
Episode resources
Diabetes
In this episode, Dr Puri discusses the symptoms and treatments of diabetes. An estimated 1.9 million Australians live with diabetes.
There are three types of diabetes: type 1 diabetes, type 2 diabetes and gestational diabetes, or diabetes that develops during pregnancy. You can learn more about all three types of diabetes, how to reduce your risk and where to get support if you or a loved one has been diagnosed with diabetes, from Diabetes Australia.
Transcript
Vox pops: Why does my blood sugar matter?
What are the signs of hypoglycaemia?
How do you manage living with diabetes?
Can sunburn affect your blood sugar?
Narrator: Welcome to It Can’t Hurt To Ask, the podcast from Queensland Health exploring all your health questions, concerns and curiosities.
This season is all things ‘In My Blood’, with today’s episode focusing on blood sugar.
Hi, I’m Lauren and this episode was recorded on the lands of the Jagera and Turrbal people. We acknowledge the Traditional Custodians and pay our respects to the Elders past, present and emerging.
As always, whatever you hear in our episodes is general information. Always speak to your doctor about your individual circumstances.
Let’s get into it...
Have you measured your blood sugar level today?
This could be a regular part of your day or maybe it’s something that’s never even crossed your mind.
Either way, understanding what your blood sugar, or blood glucose level, is doing, is important to your health.
And it changes constantly throughout the day, depending on what you’re eating, drinking or doing.
Was that my stomach rumbling or yours?
Dr Puri: My name is Gaurav Puri. I'm an endocrinologist. And I'm the clinical director of Logan Endocrine and Diabetes Services. And I'm also the current chair of Queensland Diabetes Clinical Network.
Narrator: That’s Dr Puri, who as an endocrinologist, is a specialist in conditions related to the endocrine system. This system is made up of a number of organs called glands.
Glands are the things that produce and release different hormones in your body. They control all sorts of functions, like your mood, hunger, sleep patterns, metabolism, blood pressure, blood sugar and sexual development.
Said almost as an aside: Oh, and if you want to learn more about your adrenal glands, you can listen to a dedicated episode in our previous series, My Amazing Body. We’ll pop a link in the show notes.
But back to the glands at hand! The pancreas is the gland that plays a significant role in your digestive system. It produces a hormone called insulin that controls the level of sugar in your blood. That’s the gland that’s most important to what we’re discussing today.
When we say ‘blood sugar’ what are we actually talking about?
Dr Puri: Blood sugar is the concentration of sugar in the blood. Or another way of saying is the amount of sugar dissolved in blood. Sugar is substrate or sugar is fuel for almost every single cell in the body and just like petrol or diesel for engine of your car.
The engines inside human body or the cells generally being called mitochondria, they need fuel to make energy and sugar is the fuel and sugar circulates through the blood to
various organs in the body and gets stored in cells like liver and muscles, but get utilised by almost every single cell in the body.
When we say blood sugar, we're referring to that dissolved or the concentration of sugar in the blood.
Narrator: Sugar in the body is a little bit different to the stuff we might have in our pantries. And you may hear the terms ‘sugar’ and ‘glucose’ used to mean the same thing. Here’s why.
Dr Puri: I think for common terms, sugar being called sugar is glucose that we are looking at in the blood. And it's important to understand that the sugar is present in the body in mainly two forms, either the one that is circulating, which is glucose, or in its stored form, called glycogen. Slightly different to the sugar or different types of sugar that we eat. But what we're essentially measuring is the concentration of glucose in the blood. And doesn't matter what we eat, the food or the nutrients get converted into glucose for utilization.
Narrator: Sugar or glucose is essential to have in your blood otherwise the human body wouldn’t able to function. As we heard before, sugar is the fuel for the energy which runs everything.
Depending on what is happening in the body, our blood sugar levels can either decrease or increase. And there are several different hormones with the power to cause the processes that send it in either direction.
Some of the hormones that increase the blood sugar are called glucagon, cortisol and catecholamines or adrenaline as some people might know them. The only hormone in the human body that can lower the blood sugar is called insulin.
Blood glucose levels are recorded using a scale that measures the number of millimoles of glucose per litre of blood.
Your ideal or target blood glucose levels, also known as BGLs, will vary, particularly if you are living with diabetes. We’ll talk about that more very soon. Other medication, treatment or inherited blood conditions may also impact your BGLs.
Generally speaking, a healthy recording sits between four and seven. An average blood sugar of around 5.5 is considered healthy.
If we use that as our baseline, then what happens to the body if levels get significantly lower or higher than this?
Dr Puri: Low blood sugars have got issues and so does the high blood sugar level because of complications. So, diabetes is the term that is coined when the blood sugar is above what we expect or what we deem as normal blood sugar levels. And then that could be defined on the basis of either a fasting sugar, i.e. the blood sugar measured in fasting state, or after a load of glucose, that where the body is able to keep the homeostasis maintained under balance. And above that, we classify that as diabetes.
Narrator: What are the signs that you or someone you know may be experiencing high blood sugar, also known as hyperglycaemia.
Dr Puri: Patients who present with newly diagnosed diabetes, for example, they present with symptoms of what we call polyuria, polydipsia. The polyuria as in you're peeing a lot and polydipsia as in feeling thirsty all the time and feeling tired all the time and thin.
Thin, thirsty, tired… and going to toilet. So, four T's sometimes referred in the paediatric world for education for patients and their relative and mum and dad. That's the symptoms of high blood sugar.
So if you see any member in your family or friend circle, they're going to toilet too many times, they're thirsty, they're peeing a lot, so thirsty, tired, toilet and thin as in loss of weight. So they are the signs of hyperglycaemia or potentially could suggest that a person has developed diabetes.
Narrator: Those are the acute or immediate signs of high blood sugar. There are also long-term effects which are defined as either microvascular complications – that means they involve small vessels such as capillaries. Or macrovascular complications, involving large vessels such as arteries and veins.
What do those look like, though? Let’s go back to Dr Puri.
Dr Puri: These are the complications that happen to people or patients who have had suboptimally controlled blood sugars or diabetes. And that represents as retinopathy, so problems with the eyes, they lose the vision, they may develop stroke, they may start developing plaques within their heart. It leads to ischemic heart disease.
And then the poor circulation in their feet, it affects the nervous system that they develop what we call neuropathy, where they lose the sensation of feeling in their hands and feet, mainly in feet to start with. And the complication of that is sometimes they step onto sharp objects unknowingly, which then develops into an ulcer. But because at the same time, the circulation has been affected due to vacuoles or development of plaques, the poor hitting of the ulcers then leads to further infection into the muscle, the soft tissue, the bones, like colostrum myelitis, and unfortunately at times leads to amputation.
So, diabetes is a slow killer, so poorly controlled or sub optimally controlled blood sugars offer some silent insult to human body and almost every organ gets affected.
Narrator: While this is a more extreme example, it’s an important reminder about how dangerous diabetes can be if left untreated or unmanaged.
We’ll come back to talking about diabetes, because there’s lots more to cover. But it makes sense to look at the flipside here as well. Having dramatically low blood sugar for a short or extended period is also very dangerous.
This is called hypoglycaemia, as opposed to hyperglycaemia when blood sugar is too high.
Low blood sugar can occur in otherwise healthy individuals. For example, if you haven’t eaten for a long time. Or you’ve used your glucose reserve way too rapidly during intense exercising like running or climbing and you're left feeling very, very tired.
Dr Puri: If a low blood sugar or what we call the hypoglycaemia as opposed to hyperglycaemia, which represents high blood sugar, it takes away your ability to be able to function at a normal state. But it can also happen due to the treatment that we offer to our patients. And the most common treatment is insulin. Insulin is the most potent medication that lowers blood sugar, but it can also have detrimental effect. So if not regulated appropriately, it can cause hypoglycaemia.
Narrator: Low blood sugar reduces your capacity to be able to function normally. And the most impacted organ? Your brain.
As the most sensitive organ in the human body, the brain consumes almost 50% of your blood sugar per day.
Dr Puri: The brain is very, very sensitive and very active organ, and therefore it's the brain that will sense hypoglycaemia first. And it's the brain that sends the signals and then tells the individual that you're not able to function well.
And if that continues to happen on a daily basis for, let's say, for individuals who are taking insulin therapy and they haven't been regulating or managing their diabetes very well, and if they continue to have what we call recurrent hypoglycaemia, that takes away that effect, or what we call the blunted effect. So they don't get the awareness of hypoglycaemia just like other individuals.
Narrator: If low blood sugar occurs regularly your brain starts to believe this is a normal phenomenon, and you won’t get the signals you have low blood sugar. And if that happens, your body cannot function well.
Dr Puri: That's what when you start walking in oncoming traffic or you don't know what you're doing. And at times, you may be asked by your loved ones or people who know you well that, hang on a second, you're not behaving normally, is everything all right? Because you may not recognize that you're having a hypo, but that is what we call the blunted hypoglycaemic awareness.
Narrator: If you’re prone to high or low blood sugar it may help to let your colleagues or relatives know so they can look out for some of the signs: if you’re a bit confused, acting out of character or suddenly appear weaker.
There’s also medical black bracelets you can buy and wear to signal that you’re on insulin or certain treatments.
Dr Puri: So, you can be confused, you can lose consciousness and in severe form, you can have a fit or what we call the neuroglycopenic symptoms. The neuro as in related to your nervous system, glyco is in relation to the sugar, penia means low, the neuroglycopenic symptoms. So, loss of consciousness or even a convulsion or fit. So, they are the more severe form.
Narrator: In these circumstances, where someone is unconscious, it is an emergency and you should call an ambulance on 000 and state ‘diabetic emergency’.
There are many types of diabetes. Some are genetic, some are autoimmune, some are lifestyle- or weight-related and others arise as a result of medication, such as immunosuppressants post-transplant or cancer treatment.
The two you’ve most likely heard of are type one and type two diabetes.
To understand the difference, let’s remind ourselves of how insulin works.
As we said earlier, insulin is the only hormone that lowers blood sugar. It works by pushing the sugar inside the cells from the blood.
Dr Puri: How does that do that? Well, if you consider this room is a cell and the corridor outside is a blood vessel. So, every individual walking in the corridor represents a glucose molecule. Insulin will help to open the knob to push the door open and let the glucose come inside the room as in the cell.
Right? Now, two things that can be affected or that can affect that glucose entry is if you're not able to open the door. So, insulin coming, trying to push the door open. So that's what we call insulin resistance. And that is governed generally by the weight of the body. So the heavier you are, more insulin resistance you have, which means the insulin is not able to push the door open. So, there is higher amount of glucose. There are more people in the corridor.
Narrator: This can also happen if there’s no insulin, which is the case for type 1 diabetes. In this type of diabetes, the pancreas can’t make insulin because the body’s immune system attacks the cells in the pancreas, called islet cells that normally make it.
Dr Puri: Type 1 diabetes is an autoimmune disease where there is destruction of what we call the pancreatic beta cells or islet cells. It's an autoimmune disease. Remember autoimmune - auto means yourself, immune is the immune system, so your immune system working against yourself and destroying your pancreatic cells and reducing the ability to produce insulin. If you do not have insulin, you can't get the glucose inside the cell or there is inability of insulin to be able to push the door open or get the sugar inside the cell.
Type one is where there is autoimmune destruction of the pancreas, type two is mainly governed by the insulin resistance there for the weight of the body.
Narrator: The numbers of case of both types of diabetes is on the rise, with 90% of newly diagnosed patients with diabetes having type two diabetes.
Dr Puri: The biggest risk factor for development of type two diabetes is obesity or high body weight. And we know that two thirds of Queenslanders now are either obese or overweight and the prevalence of type 2 diabetes soon arrives.
Narrator: Lifestyle intervention, for example weight loss, is key to management of type two diabetes. It can also help reduce the risk of disease before type two diabetes has developed.
Dr Puri: So, someone who gets diagnosed with type 2 diabetes within the first five years, if they were to lose significant amount of weight, whether through diet, lifestyle intervention, medications or through surgery, the chances of their diabetes going into remission is close to 80%. So, eight out of 10, which is fantastic. Which means that whoever has got type two diabetes, the weight loss lifestyle intervention, they should form the key sort of baseline underpinning principle.
Narrator: While weight is a significant factor in type two diabetes, it’s also important to acknowledge that some factors around weight loss are outside an individual’s control or might make it more difficult to achieve.
These could be environmental, socioeconomic or genetic. So, if you have a family member with diabetes, you have a genetic disposition to the condition.
In Australia, Aboriginal and Torres Strait Islander people have a higher rate of diabetes. They are currently 3.6 times more likely to have diabetes than non-Indigenous Australians.
Dr Puri: I think one thing that is quite a big myth that we tell our patients and then our patients feel bad that weight gain is all their fault. Look, weight is something that is out of your control as a matter of fact. It's a lot of it is genetically driven. So we are in an environment where there is a lot of the food availability or the food security has been at its best. And we have been talking about the environment and the behavioural change for almost three to four decades. We've been telling people to eat healthy and move. See where we are. Two thirds of Queenslanders are either obese or overweight. Now that is not due to the colossal collapse of willpower.
So for clinicians, we need to stop saying that to patients because that hasn't led us anywhere and that will not get us anywhere. So, we need to really start putting in some interventions and interventions because it is driven genetically.
Narrator: This is because there are some genes that predispose us to put on extra weight. So the typical recommendations won’t work by themselves.
As part of his work, Dr Puri runs clinical trials of these interventions at the Logan Endocrine and Diabetes Services. We’ll add a link to where you can find out more information about his work in the episode description.
Intervention is important because the complications start long before diagnoses. In fact, by the time people who have developed type 2 diabetes are diagnosed, they often only have around 50% of their blood sugar level function left.
Narrator: What else can you do to manage the impact of this type of diabetes?
You can follow a good diet plan, take your medication as prescribed and check your blood sugar regularly.
This may be through a finger prick test that gives you instant results or a three-monthly blood sugar test called HBA1C that’s done at your GP or a specialist centre and processed in a lab.
The finger prick test is quick, easy and can be done at home. You use a small needle called a lancet to prick your fingertip and get a blood drop. The drop is then pressed onto the test strip in the glucose meter, which shows your blood sugar level within seconds.
Looking after other areas of your health can also help manage or prevent further complications with your eyes and feet, including going to the podiatrist and optometrist regularly.
Dr Puri: And it's always a multidisciplinary approach, management of all types of diabetes. So you've got your doctors, your nurses, your dieticians, cardiologists, psychologists, they play a fantastic role in that. And also, let's not forget the role of pharmacists as well. Nowadays, the pharmacists are also, they can access the Medicare scheme where they can offer medication reconciliation plans. So there are a lot of opportunities out there.
Narrator: Another form of diabetes is called gestational diabetes.
Dr Puri: Gestational diabetes is diabetes in a pregnant woman. Now that pregnant person could have had type one diabetes even prior to pregnancy. That person could have had type two diabetes and then fell pregnant. or they just develop what we call gestational diabetes, which is slightly high blood sugar, just in that sort of temporary phase of pregnancy.
Narrator: Doesthe food you eat matter when your diabetic or looking to reduce your risk of diabetes?
The answer is a resounding yes.
Whole foods, like vegetables and fruit, are better than processed foods. But if you have diabetes, it’s less about eating a lot of fruit and instead eating a fruit to avoid accidentally spiking your blood sugar.
Dr Puri: A cheek of mango, an apple a day, an orange a day maximum. Stay away from fruit juices because to make a glass of orange juice, you may need to squeeze six oranges into that.
Narrator: It’s also recommended to stay away from alcohol, either completely or to only drink in moderation. This is because it can impact your blood sugar levels.
Regularly exercising is also really important.
Dr Puri: Look, I prescribe all my patients that one should try to exercise for 60 minutes every day.
And try to keep yourself active, but also mental health is quite important. Whatever you can do to keep yourself happy. Spending time with the family, that seems to keep people happy and engaged. And then more on the diet front, look, also you can get your primary care physicians to do a chronic disease management plan. And through that, you would be able to access up to five visits of allied health support out in the community, dietetics, podiatrists, et cetera.
Narrator: How long or how well we sleep can also impact our blood sugar levels.
Dr Puri: People who've got good sleep hygiene or sleeping habits, they tend to be healthier and happier because then you have less insulin resistance, less stress levels, you tend to take your treatment regularly, you go for walks, you attend your appointments regularly, so all that can affect it.
Narrator: Ok. Now that we know all factors of our lifestyle – diet, movement and even sleep – impact our health and blood sugar, what about those who work shifts, on the road, or outside the nine to five where it may be more challenging?
Luckily, Dr Puri has some realistic and practical advice.
Dr Puri: Look, do whatever you can do. So, we don't need to all turn into, you know, aim for the ideal. So, I do see patients and as the clinician, we also need to offer tangible advice. So, if you're a truck driver, you rely upon the food that's available wherever you drive. Well, then try to take out, you know, if you were to have burgers and chips all the time, then try to take out the chips out of the whole situation. So, make some tangible changes there. Add some fruits. Add some fresh vegetables to your diet. Try to rely less on processed food. Take your medications regularly. Try to fit in 60 minutes of exercise.
When I say exercise, you don't need to really go to gym. Believe it or not, I do tell my patients and I do ask them that do you have an outdoor dining table? And when they say yes, and I said, could you start going around it 50 times a day? Just for me, do it for a week, because once you've done it for the whole week, then by second week, your body will ask for it.
Narrator: We couldn’t let Dr Puri leave without asking the truth about a, erm, slightly wackier myth: Can sunburn really spike your blood sugar? After all… it can’t hurt to ask.
Dr Puri: Physiologically, the hormones that are catabolic hormones, catabolic hormones like glucagon, cortisol and catecholamines, so adrenaline level. So, let's say you're standing in front of a lion cage in a zoo. and suddenly the cage breaks open. Now, what should be your response? You need to run away. You run away. Now for you to run away, your body or the cells in the body should be able to perform. And for them to be able to perform, you need the fuel and the fuel is glucose. So, your body will make those stress hormones that will convert the stored form glycogen into glucose. and a spike of glucose so that you can utilize and safely run away.
The same thing happens when we are sick or when we're going through sunburn or whatever analogy or example we use. When the body's under stress, the cells in the body or the body needs to be able to cope and fight, for example, infection. So, the blood sugars can get affected due to all those reasons.
Narrator: From why our blood sugar matters to the Four T’s of a hyperglycaemia attack, we hope you’ve enjoyed this introduction to why blood sugar matters.
As the fuel for everything we do, it’s always good to know a bit more about how it works.
For the rest of the season, we’ll keep exploring a range of blood-related health topics, including antibodies, organ donation, mosquito-borne viruses and more.
New episodes drop every Wednesday.
If you enjoyed this episode, please rate or review. Even better, tell or share with a friend, family member or colleague who you think would also enjoy it.
Until next time, bye bye!