Blood sugar basics: Too high, too low—and how to stay “just right”

Q. I’ve read your explanations of diabetes, but can you explain how it relates to hypoglycemia? Do the natural remedies that balance blood sugar for diabetics work for people with hypoglycemia as well?

Dr. Micozzi:

Hypoglycemia is a condition of low blood sugar, which is essentially the opposite of the high blood sugar that occurs in diabetes. That’s the simple explanation. But since no doctor has probably ever taken the time to help you fully understand your condition, let me give you more details. Fair warning: It’s a bit complicated.

The simple and complex carbs we eat are digested and metabolized into sugars in the blood (glucose). Glycogen is a form of sugar stored in muscle and other tissues. This stored sugar is another source of blood sugar. When the body signals that blood sugar is low and you are not eating, or when you are burning sugar rapidly as during intense exercise, the tissues release glycogen into the blood.

The blood transports sugar to the tissue cells—where it’s used for metabolism. The cells essentially “burn” the sugars to make energy and water. This is the source of all the energy and most of the water in your cells. The blood also supplies sugar to the brain for energy.

When the tissues tell the body they need more sugar, the pancreas releases insulin (an endocrine hormone) into the blood. Insulin is like a key that opens the tissue cells and lets the sugar move from the blood into the tissues.

Type 1 diabetics are unable to produce insulin. That means they can’t get sugar from the blood into the tissues. Since the tissue cells cannot get the sugar to metabolize for energy, the body breaks down fats instead. Unfortunately, that causes byproducts that are toxic and can lead to coma and even death.

But if someone with type 1 diabetes is given too much insulin, it can drive all the sugar into the cells. That leaves too little sugar in the blood and causes low blood sugar, also known as hypoglycemia.

In type 2, or “insulin-resistant” diabetes, the pancreas is able to make insulin. There is insulin in the blood, but the tissues resist allowing the blood sugar into the tissue cells anyway. This can signal the pancreas to produce even more insulin. The result is even higher insulin levels in the blood.

Type 2 diabetics can also be given insulin and other drugs to “force” more sugar from the blood into the tissues. But too much insulin, or other drugs, can also lead to hypoglycemia.

Hypoglycemia is most immediately a problem for the brain, which needs a constant supply of both oxygen and sugar since it is very metabolically active and sensitive. Up to one-third of the blood and sugar in the body goes to the brain. If the brain lacks blood, oxygen, or sugar, it can become unconscious and go into a coma in just two to three minutes. Brain damage ensues just a few minutes after that.

Of course, most people with hypoglycemia are not in such dire straits. In fact, anyone who skips meals can suffer hypoglycemia because there is simply not enough sugar available to get into the blood. On the other hand, eating simple sugars and certain carbs (unlike the fructose in fruits) causes blood glucose to rise too rapidly. This rapid rise in turn can trigger the pancreas to release excess insulin into the blood, clearing out the blood sugar and causing reactive hypoglycemia.

I talk a lot about herbs that lower blood sugar because that’s the problem that concerns most people. But the same herbs may help people with hypoglycemia as well. That’s because, unlike most drugs, natural remedies generally help the body balance itself. And the whole point of normal metabolism is to keep blood sugar in proper balance.

So herbs that affect blood sugar are unlikely to have the potential side effects of insulin or drugs that can potentially drive blood sugar too low and cause hypoglycemia. Unfortunately, we don’t know more because the people who should be studying these remedies (and who are paid with our tax dollars to do so) stubbornly refuse.