Is there Really A Connection?

In my many years of practice in pain management, it has been quite common for people diagnosed with diabetes to report chronic pain. And I have also noticed that many of those who suffer from pain in their hands and feet are either pre-diabetic, are bordering on overweight or have some issues with their blood sugar balance.

Seeing it in practice might be anecdotal, but as a certified nutritionist, I knew I had to talk about the relationship between blood sugar, inflammation, and chronic pain. I decided to start a series of blog posts on it, in hopes of helping more people understand better.

What is dysglycemia?

Dysglycemia broadly describes the abnormality in the stability of blood sugar levels. Dysglycemia includes both low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia).

Because blood sugar is related to insulin, the hormone that helps our tissues take in and process glucose, blood sugar balance is important to keep our bodies functioning well, have energy and get the most out of nutrients. Dysglycemia can affect different systems in our body. Some would even say it can affect every cell.

According to Klingman (2007), dysglycemia is an “unavoidable intrinsic aging process” that contributes to chronic conditions such as connective tissue disorders, vascular dementia, atherosclerosis and certain autoimmune diseases.

Several conditions can cause dysglycemia such as diabetes (type 1 & 2, gestational diabetes, and prediabetes), adrenal gland deficiency and other endocrine disorders, liver or kidney issues, malnutrition, eating disorders, tumors that increase insulin production and certain medications.

Although these might sound frightening, it is important to emphasize that blood sugar imbalances can be addressed, especially through lifestyle changes and the way we approach nutrition.

But before we go there, let’s talk about the symptoms and some research on dysglycemia and inflammation.

Symptoms of dysglycemia

There are different symptoms of dysglycemia, depending on whether the blood sugar levels are too low or too high. Feeling tired and sleepy after eating, especially a high carbohydrate meal is one of the most common symptoms but here’s a quick list of several others:

Years ago, I used to have dysglycemia, I remember at one point my blood Glucose level was 38 (very low) and if I missed a meal or went longer than 2-3 hours without eating, I would become very irritated, snap on people, especially on family members. Not nice

Does dysglycemia really contribute to inflammation?

The short answer is YES. The number of preclinical and clinical studies on this topic continues to increase through the years. Many of them support the idea that regulating blood sugar levels and inflammation contributes to improvement in metabolic state and management of different kinds of cardiovascular diseases.

In a 2006 study published in the Diabetes Care Journal of the American Diabetes Association, Rekeneire et. al., concluded that dysglycemia is indeed associated with inflammation, particularly in older individuals with diabetes and those with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT).

A review done in 2012 by Goldfine and Shoelson looked into the different therapeutic approaches to diabetes management and they highlight that clinical trials suggest that understanding biological processes that underlie dysglycemia and inflammation can help in creating therapies for metabolic and cardiovascular diseases.

How to control or manage dysglycemia

Because the symptoms are different for hyperglycemia and hypoglycemia, the management and treatment for each also varies.

1. Immediate treatment may be necessary if the blood sugar drops too low or increases to an alarming level. Some of the immediate treatments are:
   • Having fast-acting carbohydrates such as candy, glucose tablets or fruit to raise low blood sugar
   • For severe cases, a glucagon injection may be necessary
   • Replacing fluids and electrolytes orally or through an IV
   • Insulin therapy for high blood sugar
2. Exercise – regular physical activity helps in treating the instability of blood sugar levels by helping cells manage glucose levels and become more sensitive to insulin. It is also a plus that physical activity helps decrease weight and presentations of obesity.
3. Changes in medication – for those with dysglycemia due to diabetes, a change in dosage or timing of medication might help to better regulate blood sugar levels
4. In the past few years Metformin gained a huge popularity as the drug of choice for blood sugar control and even as an anti-aging medication.
5. Diet and nutrition – plays a crucial role in avoiding inflammation, and fluctuations in blood sugar levels. Some of the most helpful dietary changes are:

• Avoiding the following as much as possible:
  • Processed foods
  • High-sugar food (especially refined sugars)
  • Simple carbohydrates
  • Too much alcoholic beverages
  • Foods high in saturated fats
  • Foods high in trans fats
  • Mixing alcohol with sugar-filled mixers

• Choosing the following:
  • Diet rich in protein and vegetables
  • Food with high soluble fiber
  • Whole grains and other complex carbohydrates
  • Snacking on nuts (preferably low-salt or salt-free–read more of the why in this blog post
  • Low-fat cheeses
  • Supplements like Berberine, acts very much like Metformin drug.
  • Food with low glycemic index and glycemic load score (e.g. green leafy vegetables, most fruits, chickpeas, kidney beans, raw carrots, lentils)
  • Lean protein
• Eating small frequent meals every 3 to 4 hours instead of three large meals per day if you have low blood sugar.
• Exercise lowers blood sugar levels so eat a small meal and drink at least a glass of water before exercising. A high-protein snack is advisable before a workout.

Inflammation is just one of the conditions associated with blood sugar imbalance and there is a tendency for this to be a vicious cycle–more issues with dysglycemia can lead to more inflammation and more inflammation can up the chances of more blood sugar level issues. But as we’ve discussed here, there are lifestyle changes, particularly in nutrition that can be made to alleviate the problems associated with these two.

As I have mentioned at the top of this blog post, this is just the first installment in a series on blood sugar.

Stay tuned for the next one on blood sugar imbalance and muscle & joint pain.

Get in touch with me today if you want to learn more or if you are interested in getting a consultation for nutrition or pain management (virtual sessions available.)