How Poor Sleep Can Raise Your Blood Sugar

We all know how it feels after a bad night’s sleep. You wake up groggy, foggy, maybe a little more irritable than usual. What you might not realize is that poor sleep can have a surprising effect on your blood sugar levels.

Even if you don’t have diabetes, your body’s ability to manage blood sugar can take a real hit when you’re not sleeping well. Let’s break down how this works and what you can do about it.

The Stress Response

When you miss out on sleep, your body sees it as a type of stress. In response, it raises levels of cortisol, your main stress hormone. Cortisol is designed to help you stay alert and ready for action. But it also tells your liver to release more sugar into the bloodstream to give you energy.

If this only happens once in a while, your body can handle it. But if poor sleep becomes a habit, your cortisol levels stay high too often, and your blood sugar can stay elevated.

Lower Insulin Sensitivity

Insulin is the hormone that helps your cells absorb sugar from the blood. Poor sleep can make your cells less responsive to insulin, a condition called insulin resistance. This means the sugar stays in your bloodstream longer instead of being used for energy.

Studies have shown that just one or two nights of poor sleep can start to reduce insulin sensitivity. Over time, if this keeps happening, it raises the risk of developing prediabetes or type 2 diabetes.

More Cravings, Less Control

When you’re sleep-deprived, your appetite hormones get out of balance. Ghrelin, the hormone that makes you feel hungry, goes up. Leptin, the hormone that signals fullness, goes down.

This explains why you’re more likely to reach for sugary or high-carb snacks when you’re tired. Unfortunately, those choices can send your blood sugar on a roller coaster, making things even harder on your system.

Your Brain Needs Sugar Too

The brain is a major user of glucose, but when you’re sleep-deprived, it becomes less efficient at using it. This means more sugar lingers in your blood, and at the same time, your brain keeps signaling that it wants a quick source of energy. That’s why sleep loss often comes with those nagging cravings for sweets or junk food.

Inflammation Makes It Worse

Chronic poor sleep increases inflammation in the body. This inflammation interferes with how insulin works, adding another layer of difficulty in managing blood sugar levels. It’s a bit like adding fuel to the fire.

What Can You Do?

Here’s the good news. You can take simple steps to protect your sleep and your blood sugar:

• Aim for seven to nine hours of sleep each night.

• Keep a consistent sleep schedule, even on weekends.

• Build a wind-down routine in the evening, avoiding screens and heavy meals before bed.

• If you snore or wake up gasping, consider getting checked for sleep apnea. Learn more about that here.

Sleep is often overlooked when it comes to managing blood sugar, but it plays a major role. While diet and exercise are essential, improving your sleep could be the missing piece that helps balance your system.

If you’ve been struggling with sleep and notice your energy, mood, or cravings shifting, don’t ignore it. Make sleep a priority, and your body will thank you.

Understanding GLP-1 Agonists: What They Are and How They Work

In the world of diabetes and obesity management, GLP-1 agonists have emerged as an innovative class of medications that help improve blood sugar control and, in some cases, assist with weight loss. But what exactly are GLP-1 agonists, and how do they work in the body? In this blog, we’ll explore the science behind GLP-1 agonists, their mechanism of action, and how they’re changing the landscape of treatment for conditions like Type 2 diabetes.

What are GLP-1 Agonists?

GLP-1 stands for Glucagon-Like Peptide 1, a hormone naturally produced in the intestines. Its primary role is in regulating glucose metabolism and promoting insulin secretion in response to food intake. GLP-1 agonists are synthetic medications that mimic the action of this natural hormone, and they are used primarily to treat Type 2 diabetes and obesity.

Commonly prescribed GLP-1 agonists include drugs like liraglutide (Victoza), semaglutide (Ozempic, Wegovy), exenatide (Byetta), and dulaglutide (Trulicity). These medications are typically injected, though oral formulations are also becoming available.

How Do GLP-1 Agonists Work?

GLP-1 agonists work in a variety of ways to help manage blood sugar levels and support weight loss:

1. Enhancing Insulin Secretion
   GLP-1 agonists stimulate the release of insulin from the pancreas when blood sugar levels are elevated. Insulin is the hormone that helps regulate blood sugar by promoting the uptake of glucose into cells. The key here is that GLP-1 agonists only enhance insulin secretion when glucose levels are high, helping prevent low blood sugar (hypoglycemia) – a common concern with other diabetes medications.
   

2. Suppressing Glucagon Release
   Glucagon is a hormone that has the opposite effect of insulin. It signals the liver to release stored glucose into the bloodstream. By suppressing the release of glucagon, GLP-1 agonists help prevent the liver from releasing excess glucose, which can be particularly useful in controlling blood sugar levels during fasting or between meals.
   

3. Slowing Gastric Emptying
   One of the reasons GLP-1 agonists are effective for weight loss is that they slow down the rate at which food leaves the stomach. This leads to a prolonged feeling of fullness and satiety, helping to reduce appetite and decrease overall calorie intake.
   

4. Promoting Weight Loss
   Through a combination of reduced appetite and slower gastric emptying, GLP-1 agonists help many people lose weight. They influence the brain’s hunger signals, leading to decreased food intake. This is particularly beneficial for those with Type 2 diabetes, as obesity is a major contributing factor to insulin resistance.
   

5. Improving Beta-Cell Function
   Beta cells in the pancreas are responsible for producing insulin. GLP-1 agonists have been shown to support the function of these beta cells, helping the pancreas better respond to glucose fluctuations. Over time, this can lead to improved overall insulin sensitivity and better long-term control of blood sugar.
   

Benefits of GLP-1 Agonists

• Better Blood Sugar Control: GLP-1 agonists are highly effective at lowering HbA1c, a long-term marker of blood sugar levels, making them an essential tool for managing Type 2 diabetes.
  

• Weight Loss: Many patients experience significant weight loss while on GLP-1 agonists, which can be an additional benefit, especially for those dealing with obesity-related diabetes.
  

• Cardiovascular Protection: Some GLP-1 agonists, such as semaglutide and liraglutide, have been shown to reduce the risk of heart attacks, strokes, and other cardiovascular events in people with Type 2 diabetes.
  

• Lower Risk of Hypoglycemia: Unlike some other diabetes medications, GLP-1 agonists don’t usually cause low blood sugar unless used in combination with insulin or sulfonylureas.
  

Side Effects of GLP-1 Agonists

Like any medication, GLP-1 agonists come with some potential side effects. The most common are gastrointestinal symptoms such as nausea, vomiting, diarrhea, and constipation. These effects often lessen over time as the body adjusts to the medication. However, in rare cases, more serious side effects like pancreatitis or thyroid cancer have been reported, though these are considered uncommon.

Other options to improve blood sugar regulation

There are lots of ways to improve blood sugar regulation and lose weight without the use of drugs. If you want a free PDF on 11 tips to improve blood sugar, get it here. There is also a stack of supplements you can take that include the ingredients to naturally produce GLP-1 without having to take an injection. We’ll be releasing the details on this soon in a podcast. Stay tuned and sign up for our email newsletter to be informed when it gets released.

What Happens if You Ignore Sleep Apnea?

If you wake up in the morning and you find your significant other sleeping in the next room, you probably have sleep apnea. Or, if like me, you think that your superpower is to be able to fall asleep instantly, you also likely have sleep apnea. That’s what is known as ‘sleep pressure’ and is a sign you are poorly rested.

Sleep apnea is estimated to affect 2-4% of the adult population, however many people are undiagnosed so the true numbers are likely much greater. It’s a very serious condition, and unfortunately many people ignore it. 

Perhaps it’s the annoyance of wearing a CPAP, or just not wanting to face your issues. Or perhaps most do not fully understand how devastating it can be for your health. It must be addressed because these are just some of the things sleep apnea can do you left untreated:

• Weight gain

• Diabetes

• Stress

• Alzheimer’s

• Chronic fatigue

• Metabolic dysfunction

• Heart attack

• Stroke

• Oxygen depletion

Fun list, right? There is one common thread amongst all of those complications; insulin resistance. If you feel like insulin resistance, aka diabetes, seems to cause every known chronic condition, well you’re right. Every cell in your body has insulin receptors. Insulin is a very potent hormone that instructs the cell to behave in certain ways. The way the body works is that hormones have certain roles. Once your body stops responding to the signal of the hormone, it has the opposite effect. For example, one role of insulin is vasodilation. So when your body stops responding to it, your blood vessels constrict. That’s just one way it affects the cardiovascular system. 

So what is the relationship between insulin resistance and sleep apnea? Breathing is directly tied to your nervous system. Breathing through your nose is parasympathetic, breathing through your mouth is sympathetic. When you snore, your mouth is open. So you’re in a sympathetic state all night. The sympathetic nervous system causes cortisol to be released. This is a hormone that instructs the liver and muscle to release glucose into the bloodstream for quick energy because the body thinks it’s in a flight or fight mode. 

Over years of sleeping this way you maintain chronic elevated blood sugars. The pancreas tries to balance the elevated blood sugar by secreting insulin which does the opposite of cortisol. The cells stop responding to insulin. Now you are developing metabolic problems and becoming diabetic. Next comes weight gain and fatty liver. Later in life it turns into Alzheimer’s which has become known as type 3 diabetes. This is when blood sugar starts to affect the brain. 

The body has 4 main homeostatic regulators, pH, O2/CO2, temperature, and blood sugar. All of these are tightly regulated and if they go off a bit, things go wrong. The good news is that blood sugar can relatively easily be influenced by diet and lifestyle choices. However, you can do all the right things with diet, exercise, cold exposure, etc; if you have sleep apnea, you’ll be fighting against the current. 

Get it checked out. There are now home sleep studies that can be ordered by a pulmonologist. Find out how severe you are and get it addressed. Your best bet is a CPAP. However, if you have mild sleep apnea, or until you get a CPAP, there are devices that may help.

We’ve had good results using a combination of this mouthpiece, and this mouth tape. The mouthpiece pushes your tongue forward, and the mouth tape forces you to breathe through your nose. 

Here is a quick quiz you can take which is a sensitive screening tool for sleep apnea.

The Link Between Excess Iron and Diabetes

Iron deficiency anemia affects more than 3 million people per year in the U.S. However, a lesser known problem is too much iron, or iron overload. Iron overload affects 200,000 people per year in the U.S. This can be much more devastating, and even deadly if it goes untreated because it “rusts” the organs. It affects men more than women because men accumulate iron over a lifetime, whereas women lose iron from menstruation. After menopause, iron overload can become a problem for women as well. Many women are anemic through their menstruating years and are told to take iron, but are rarely told to come off it after menopause which can induce iron overload. There is a line of evidence building that shows a correlation between the development of diabetes due to excess iron. 

We know there is a strong association between diabetes and cardiovascular disease. Iron overload may explain the uptick in heart attack of post menopausal women. The original theory was that estrogen had a protective effect on heart disease and replacement therapy was suggested. Researchers began to question the role of excess iron in heart disease. In 2002, a study was conducted that aimed to determine if phlebotomy (bloodletting) affected risk for heart disease. Iron depletion at near-deficiency levels were associated with a reduction of risk, and improvements in lipids were observed. Blood pressure reduced, triglycerides reduced, and there was also an increase in response to glucose and insulin. These are all metabolic markers, and these were completely revered with iron repletion. 

Iron can easily become oxidized, so it acts as an oxidant. That means it takes poorly reactive free radicals and converts them into highly reactive ones. As iron accumulates in the body, it affects the pancreas and interferes with insulin synthesis, the hormone that regulates blood sugar. This is a two way street meaning that insulin stimulates cellular uptake of iron creating a sort of vicious circle. 

There are some other clues that iron overload affects blood sugar negatively. Excess iron also deposits into muscle and damages it, inhibiting its ability to uptake glucose. Type 3 diabetes is a newer term for dementia due to diabetes. Excessive iron has been found in patients with Alzheimer's. Gout has been linked to insulin resistance, and phlebotomy (blood donation) leads to a decrease in gout flare ups. 

It’s important to note that iron is the least sensitive marker for iron, ironically. Only about 1% of the body’s iron is floating in the serum. Ferritin is the storage molecule for iron and is a much more reliable marker for iron stores. However, when the body is inflamed it will store more iron in ferritin because viruses and bacteria replicate with bacteria. It’s a protective mechanism but that can lead to a false positive if you are inflamed. So you have to look at other markers of inflammation and correlate it. 

Elevated ferritin levels have been linked to insulin resistance in even seemingly healthy people. In one study, ferritin was proportional to glucose concentration, blood pressure, and HDL. In epidemiological studies, the higher the ferritin levels, the higher the incidence of type 2 diabetes. 

Signs of iron overload are vague and overlap with many disease processes which makes it impossible to diagnose with symptoms alone. Fatigue, joint pain, impotence or loss of libido, skin bronzing, palpitations, depression, and abdominal pain. These are just some of the symptoms and because of its ability to damage all organs, the symptoms can vary wildly. 

So how do we accumulate iron? It can come from excess consumption, either from the diet or from supplementation. Or, we absorb too much of it. This is called hemochromatosis. Hemochromatosis is a genetic defect (one of the most common) causing the body to absorb more iron that it needs. Unfortunately, it’s often misdiagnosed or completely missed altogether. The average person will wait 9 years for a correct diagnosis. So what is hemochromatosis? The mutations C282Y and H63D are the genetic snips that can cause hemochromatosis. If you’ve had a DNA test and want to find out if you are at risk for hemochromatosis, you can download our worksheet here. 

Outside of hemochromatosis, there are some diet choices that may increase iron absorption. This includes food high in vitamin C, beta carotene, HCL supplements (digestive enzymes), red meat and liver, sugar, and alcohol. So these can be strategies if you are iron deficient, but should be avoided when your ferritin levels are high. 

Bloodletting, or blood donation is a reliable way to reduce iron stores. It also reduces blood viscosity, which is a risk for heart attack. Anecdotally, many have reported weight loss with frequent blood donation. This may be more evidence of the correlation between iron and diabetes. 

If you are worried about excess iron, let’s hop on a free functional medicine consult call:

References: 

Eugene D. Weinberg. (2008) Iron Out-of-Balance: A Risk Factor for Acute and Chronic Diseases. Hemoglobin 32:1-2, pages 117-122.

Facchini FS, Saylor KL. Effect of iron depletion on cardiovascular risk factors: studies in carbohydrate-intolerant patients. Ann N Y Acad Sci. 2002 Jun;967:342-51. doi: 10.1111/j.1749-6632.2002.tb04290.x. PMID: 12079862.

José Manuel Fernández-Real, Georgina Peñarroja, Antoni Castro, Fernando García-Bragado, Ildefonso Hernández-Aguado, Wifredo Ricart; Blood Letting in High-Ferritin Type 2 Diabetes : Effects on Insulin Sensitivity and β-Cell Function. Diabetes 1 April 2002; 51 (4): 1000–1004. https://doi.org/10.2337/diabetes.51.4.1000

Martinelli N, Traglia M, Campostrini N, Biino G, Corbella M, Sala C, Busti F, Masciullo C, Manna D, Previtali S, Castagna A, Pistis G, Olivieri O, Toniolo D, Camaschella C, Girelli D. Increased serum hepcidin levels in subjects with the metabolic syndrome: a population study. PLoS One. 2012;7(10):e48250. doi: 10.1371/journal.pone.0048250. Epub 2012 Oct 29. Erratum in: PLoS One. 2013 Jun 26;8(6):null. PMID: 23144745; PMCID: PMC3483177.

Why Stress is Giving You Diabetes

You may have heard there is a correlation between stress and diabetes (Type 2). Stress affects the autonomic nervous system in profound ways including secretion of hormones. In this blog we’ll explore the mechanism, and what to do about it. 

The autonomic nervous system is divided into 2; the sympathetic and parasympathetic systems. The sympathetic system is the fight or flight response. When it is triggered, it secretes cortisol, the stress hormone. 

Cortisol’s main function is to liberate sugar from the muscles and liver. Sugar (glucose) is a quicker energy source than fats. So this is a survival mechanism. The nervous system perceives threat and it is programmed to give you quick energy. And this is a good thing in an emergency. The problem occurs when we are chronically stressed and spiking this system. Insulin does the opposite of cortisol, it pushes the glucose back into cells. Over time, the body becomes insulin resistant and our blood sugar remains higher leading to diabetes.  

When we say stress, we don’t mean just perceived or emotional stress. Stress comes in many forms. There is hormetic stress which is a good type of stress but in the right doses. For example, exercise or an ice bath is a hormetic stressor. This is a stress that we rebound from and become more adaptable. It’s like sun exposure; some sun is good and you get a tan, making your skin more protected from the sun. This is something you build with time. Too much sun and you get burned which is not good. The problem is, we try to combat stress with more stress. So maybe work is tough, you got poor sleep, and you workout out, run on your lunch break, do an ice bath, or whatever your form of self inflicted torture is. It may be too much for you to handle and you won't recover. 

What is happening to you on a physiologic level is that you are constantly in a stimulated, fight or flight mode and you are maintaining high levels of blood sugar. Technically, blood sugar dysregulation is a form of stress so when this system is overactive, it’s a bit of a downward spiral. 

So what do we do about this? We have to seek more parasympathetic activity. This gives the nervous system a break and allows for recovery. It will also stop the pancreas from secreting so much insulin. It will also allow our bodies to burn fats rather than carbs for energy. There are lots of ways to do this, a walk in nature, massage, a relaxing book, breathwork, etc. Here is a video of some tips on the parasympathetic system: 

Life is about balance. You can’t fight fire with fire. It’s also important to note that prediabetes is reversible. However, when diabetes becomes too far gone, cells in the pancreas start to die and then you become dependent on medicine. Prioritize sleep, recovery, and the parasympathetic system, and you will thrive. You’ll also find that if you do this, the times you do want to exercise, you’ll perform better and get more out of it. 

Want to learn more about performance and the nervous system? Check out our new program:

Stress and Blood Sugar

We all know that stress is bad for you, but the consequences of chronic stress are perhaps more far-reaching than you may imagine. Some amount of stress can be good, such as hormetic stress. However, high levels or chronic stress can negatively impact your blood glucose levels, setting you up for diabetes. 

Stress, whether real or perceived, puts your nervous system in sympathetic mode. This is a protective mechanism as this is fight or flight mode. The body switches to a state that prioritizes everything you would need to fight or flee. 

The digestive system is turned off because you don’t need to digest while fighting. Cortisol and adrenaline start pumping, and the vascular system constricts to increase pressure and therefore more blood to the muscles. By the way, when your gaze is fixed, you are in a more sympathetic state which is why I think it’s a bad idea to watch TV while you eat. You will have poorer absorption of nutrients because the digestive system is inhibited. 

Muscles can use either fats or glucose for contraction. Glucose is an easier, and more readily available fuel source, so glucose is liberated into the bloodstream. This is why it raises your blood glucose levels. 

Here is the problem, it’s not like a light switch, either on or off. It’s more of a gradient or spectrum. You can be in a slight sympathetic state. Modern society in the developed world is very conducive to being in a sympathetic state. Most of us are rushing around, are in jobs that are stressful, and working longer hours. On breaks, we hit starbucks to keep up with the demands of work which just stimulates the sympathetic nervous more. All of this leads to chronically elevated blood glucose levels. 

Now the pancreas has to work overtime to constantly secrete insulin to mitigate the onslaught of glucose in the bloodstream. Over years, the cells of the body stop responding as well to insulin, and this is what type 2 diabetes is. Insulin has many roles, and one of them is to build stuff. One of the things it builds is fat cells. Many people think being obese causes diabetes, but it’s really the other way around. So, if you are slowly gaining weight over the years, I would strongly suggest you monitor your blood sugar levels. 

The best way to do this is with a continuous glucose monitor. Then you get to see in real time what causes blood sugar spikes. I have used nutrisense in the past and gained a lot of valuable insights. For instance, the simple act of driving to work consistently raised my blood sugar levels, even though I did not feel stressed, nor was I experiencing road rage. This is an important point, you do not have to feel stressed to be in a sympathetic state. 

I also learned that things like exercise, green tea, and ice baths reduced my blood glucose levels so now I use this as a strategy. For instance, I drink green tea while I drive to buffer the spike. 

I also recommend seeking the parasympathetic state. This can be achieved by any relaxing activity. It could be a walk in the woods, reading a book, laying in a hammock, getting a massage, breathwork, yoga, meditation, tai chi, etc. 

Type 3 Diabetes

Type 3 diabetes is a new (and not quite accepted yet) term to describe the effects that diabetes can have on the brain. It describes the progression of diabetes to Alzheimer’s disease. The correlation between diabetes and Alzheimer’s is well documented, and this blog will aim to describe the proposed mechanism.

Just a quick reminder; diabetes is directly affected by insulin. There is either not enough insulin (type 1), or too much production due to insulin resistance (type 2). Type 2 diabetes is the one that is implicated in Alzheimer’s disease. 

Alzheimer’s is complicated, and the current understanding of the disease process postulates that progression is due to a build up of a protein called amyloid beta peptide. These form plaques that affect brain function. Your brain cells have receptors of insulin, so when it is released from the pancreas, it has a direct effect on the brain. When the brain becomes insulin resistant, more insulin has to be released to have the intended response. The plaques in patients with Alzheimer’s are formed in the space between nerves of the brain, not inside the nerves. An overabundance of insulin causes the nerves to release the amyloid beta protein into the space between the nerves (Gasparini et al., 2001). 

Alzheimer’s accounts for about 80% of all dementia. Vascular dementia is another form where the blood vessels aren’t functioning normally. There is a cause and effect relationship between hyperinsulinemia and hypertension. Insulin increases blood pressure by increasing sodium absorption in the kidneys, activating the fight or flight nervous system, and causing the blood vessels to thicken. Conversely, high blood pressure causes decreased delivery of insulin and glucose to the muscle cells, resulting in impaired glucose uptake (Salvetti et al., 1993). 

These are just a few of the mechanisms of how insulin resistance may be causing dementia. The more you read on insulin resistance, the more you learn just how horrible it is. For example, too much insulin will make you gain weight. Fat cells are like endocrine organs, meaning they can secrete signaling molecules. One of the molecules they secrete is cytokines, which cause inflammation. Inflammation causes further insulin resistance, which causes more inflammation, and the cycle repeats. This chronic systemic inflammation eventually reaches the brain. 

Another problem is that many people are insulin resistant and have not been diagnosed. If you are overweight and have high blood pressure, you are very likely to have insulin resistance. A few other signs of insulin resistance are dark patches of skin around the armpits and neck, and also skin tags which are little growths of skin. By the way, you don’t have to be overweight to be insulin resistant. You can be T.O.F.I., which stands for “thin on the outside, fat on the inside”. Fat can form around your organs. 

If you have some of these symptoms, you may want to speak to your physician about adopting a low carb, high fat diet. Also, you can order a self test kit to check your A1C. Find the test here, and use the code DPT20 for 20% off. 

References: 

Gasparini, L., Gouras, G. K., Wang, R., Gross, R. S., Beal, M. F., Greengard, P., & Xu, H. (2001). Stimulation of β-Amyloid Precursor Protein Trafficking by Insulin Reduces Intraneuronal β-Amyloid and Requires Mitogen-Activated Protein Kinase Signaling. The Journal of Neuroscience, 21(8), 2561–2570. https://doi.org/10.1523/jneurosci.21-08-02561.2001 

Salvetti, A., Brogi, G., Di Legge, V., & Bernini, G. P. (1993). The Inter-Relationship between Insulin Resistance and Hypertension. Drugs, 46(Supplement 2), 149–159. https://doi.org/10.2165/00003495-199300462-00024