The Most Common Type 1 Diabetic Frustrations and the Answers to Them – Part 1

The Problems

Most certainly after initial diagnosis, almost all type 1 diabetics quickly realize our condition isn’t a simple disease to manage and can be quite a nightmare for many who struggle with their blood sugar management.

But why is this struggle so real and ongoing for so many?!

In part 1 of this series of posts, I’m going to review the most common type 1 diabetic annoyances many of us have struggled with and why they occur.

The rest of these posts will cover templates to start implementing and the medical research behind why they may work with the help of your diabetic physician to address these frustrations with better blood sugar results.

Ready?

Let’s go!

The Most Common Diabetic Annoyances

Diabetic Frustration #1: Why are My Blood Sugars High in the Morning When I Haven’t Eaten Anything?

Many type 1 diabetics assume that diet and insulin are the only sources of blood sugar changes.

This is not the case as there are other factors that may influence early morning high blood sugars (aka hyperglycemia).

Answers:

1. The Dawn Phenomenon

The dawn phenomenon results from high blood sugars typically seen in the morning due to the body’s overproduction of glucose sent to the blood (1).

The human body is built to regulate many physiological mechanisms for checks and balances to support survival.

Anytime we eat proteins and carbohydrates, some of the protein and all of the carbs are broken down into glucose.

One of the many functions of glucose is to be stored away in the liver for when blood sugars drop and there’s an immediate need for glucose to raise it back up.

There are fasting periods in which we will spend a fair amount of time without consuming any form of glucose.

During this time, blood sugars typically start to drop, which triggers the body to activate gluconeogenesis.

Gluconeogenesis is the response of bringing back up blood sugars by releasing glucose stored in the liver back into the blood.

Healthy, non-diabetics have insulin released to balance out gluconeogenesis.

Unfortunately, type 1 diabetics need to have an appropriate dosing of insulin calculated in response to this blood glucose increase if the dawn phenomenon is present in the mornings.

It’s estimated that over 50% of type 1 and type 2 diabetics are affected by this dawn phenomenon (2).

If the dawn phenomenon is active, blood sugars will typically rise higher in the early morning.

Sometimes blood sugars are worsened when breakfast also needs to be accounted for.

This doesn’t mean you need to skip breakfast but I’ll be going over dietary suggestions for this in part 2.

2. Inaccurate Insulin Dosing

Another factor to consider, by itself or with the dawn phenomenon, is not enough insulin is being administered while a type 1 diabetic is asleep.

This will obviously lead to higher blood glucose levels either while asleep or upon waking up or both.

And if the dawn phenomenon is active, blood sugars will likely be even worse in the morning as a result.

3. What Happens if Meals are Consumed Just Before Bedtime?

It’s not uncommon for blood sugars to spike the next morning if a meal is consumed shortly before falling asleep from the previous night.

The two main components to consider with this effect are:

increased melatonin production in the evening leading to
impaired insulin function

Melatonin is a hormone that the brain produces in response to darkness and helps with sleep (3).

Levels of melatonin typically rise at night and peak in the early hours of the morning.

It has been observed that melatonin may impair insulin function in both non-diabetics and diabetics, which results in disrupted blood sugars throughout the night and the next morning (4).

Meals just before bedtime may worsen these results further (5).

With insulin function already impaired among type 1 diabetics, dosing accurate amounts for meals just before bedtime may be complicated leading to higher blood sugars throughout the night and the next morning.

And if the dawn phenomenon is present, this may lead to a perfect storm of more blood sugar chaos!

4. The Somogyi Effect

In the 1930s, a chemist PhD named Michael Somogyi (so-MOH-guy-ee) discovered if there is too much insulin injected before falling asleep, the body may activate gluconeogenesis in order to compensate, leading to higher blood sugars in the morning (6).

This may also be known as “rebound hyperglycemia.”

Again, type 1 diabetics don’t have the ability to naturally secrete the right amounts of insulin in response to gluconeogenesis, leading to high blood sugars.

However, if too much insulin is injected prior to sleep, a low blood sugar (aka hypoglycemic) episode may occur, which will override gluconeogenesis and any form of hyperglycemic response.

Diabetic Frustration #2: Why am I Depressed or Anxious About My Blood Sugar Management?

Thinking like a pancreas 24 hours a day, 7 days a week, and 365 days a year is typically not something a type 1 diabetic does with ease right away after learning of their diagnosis.

Knowing the pancreas can literally affect every cell, tissue, organ, and function in the body may also lead to overwhelming feelings of doubt.

Striking out on blood sugar management day in and out, and for some year in and out, can easily lead one to believe there is no hope with their blood sugar goals.

Being a type 1 diabetic for over 20 years I can relate to these damper thoughts. Especially with my earlier lifestyle choices and the poor blood sugar results I received as a result.

As much as I wish I could just say one’s downward-spiral mood is only because a type 1 diabetic isn’t meeting their blood sugar goals, there’s commonly a bit more going on to influence these depressive or anxious conditions.

Answers:

One typical response is that yes, playing a broken record with minimal results can often lead to these hopeless thoughts and moods.

However, a condition known as gut dysbiosis may be adding fuel to this frustrating fire.

Intestinal dysbiosis is a gut disorder that occurs when there’s an imbalance of beneficial gut microbes (aka good gut bugs) compared to bad ones.

This gut complication appears to be extremely common among those with autoimmunity and type 1 diabetes (7, 8).

As a result, gut dysbiosis almost always disrupts the gut’s main 2 functions, which are to:

absorb nutrients
protect the body from pathogens

Interestingly, gut dysbiosis appears to have a bidirectional relationship with many illnesses, meaning that they both are capable of influencing each other.

Examples include intestinal dysbiosis commonly observed with imbalanced blood sugars (9).

Disrupted insulin signaling, as seen in insulin resistance, may also contribute to gut dysbiosis (10).

(I’ll be going over insulin resistance in more detail shortly.)

Many of you may be thinking, “Great, Dr. Mo but what does any of this have to do with a type 1 diabetic’s depressive or anxious state?!”

The gut is considered the “2nd Brain” of the body due to how many complications that may occur if it’s impaired, depression and anxiety being a couple of examples (11).

If:

your diet is poor and/or you have a long track record of unsuccessful blood sugar results

This increases the risk of:

chronically high blood sugars
higher demand for insulin
increased insulin resistance
gut dysbiosis or worsening of the condition, which may lead to increased levels of
depression and anxiety

Trying to figure out which condition caused the other is similar to which came first? The chicken or the egg?

You can find more in-depth info on the gut-brain connection and its influence on type 1 diabetes here.

Diabetic Frustration #3: Why Do Blood Sugar Roller Coasters (Glycemic Variability) Exist?

This is an extremely common occurrence among type 1 diabetics, especially after meals:

This roller coaster of up and down of blood sugars is known as glycemic variability, which studies suggest increases the risk of the most common diabetic complications such as cardiovascular, retinopathy, kidney, and nerve diseases (12, 13, 14, 15).

Even among non-diabetics, these fluctuating blood sugars appear to not only increase insulin resistance and type 2 diabetes risk but also overall declining metabolic health (16, 17, 18).

So, what’s going on with these roller coaster blood sugars?

Answers:

The quick answer most physicians and educators go to is diet but there’s a bit more going on beyond this.

There are 3 likely factors when it comes to glycemic variability frequency:

inaccurate insulin dosing due to
the constant guesswork behind certain foods eaten and their suspected effects on post-meal blood glucose levels
insulin resistance making it more complicated to predict the first 2 factors more accurately

Let’s go over each in more detail, shall we?

1. Inaccurate Insulin Dosing

I won’t spend too much time on this topic because I feel this reason is not only particularly common but obvious.

Namely because on the surface this is the whole intention behind blood sugar management, at least how it was initially presented to many of us!

However, for those of us type 1 diabetics who are obsessed with thriving with our condition(s) and not just surviving, we already know this is not just “fine” for our longevity!

One meta-analysis even suggests simple carb counting is not even that useful among type 1 diabetics (19)!

Image source: https://www.mdedge.com/endocrinology/article/59374/diabetes/counting-carbs-comes-short-type-1-diabetes

Let’s take a look at what complicates inaccurate insulin dosing further.

2. The Guesswork Between Food Consumed and the Right Amount of Insulin to Inject or Bolus With

If my pancreas is already dysfunctional, does it sound like a good idea to continue to stress it out further, especially at the expense of my own health and longevity if I keep coming up with unsuccessful blood sugar results?

Expectantly, many type 1 diabetics agree to not cause our bodies any continued distress.

However, the biochemistry behind many foods we want to eat doesn’t typically lead to the desired blood sugars we all seek due to triggering sensations in our brains that push our palatable “wants” ahead of our blood sugar “needs”.

Most of us will gladly take the pizza but why is this a no-brainer intention to want to consume compared to a healthier salad?

Turns out that the regulation system of appetite has been observed to be altered with the frequent consumption of more flavorful (aka hyperpalatable) foods (20).

Unfortunately, many of these tasty meals are highly processed, refined, high in energy/calories, and low in nutrients and fiber (21, 22).

Most of these foods also contain gluten and I’ve gone over how this sneaky protein may impact gut and type 1 diabetic health here.

In fact, if these hyperpalatable junk foods are part of your standard diet, they may lead to drug-addiction-like behavior of overconsumption as observed in both human and animal studies (23, 24).

This addiction-like response is typically why “willpower” is not enough to stop consuming these foods despite knowing these red flags.

You’re not going to drink alcohol in front of an alcoholic, right?

Why, then, would a type 1 diabetic allow someone in their circle who doesn’t appreciate the severity of this notion, then?

For non-diabetics, this overeating can lead to an increased risk of insulin resistance, diabetes, liver disease, and obesity (25).

Diabetics, on the other hand, may not only see some or all of the previously mentioned conditions but these may be diagnosed earlier due to chronic hyperglycemia.

These hyperpalatable foods consistently increase the risk of insulin resistance and obesity (26). Both of which typically lead to more blood sugar instability.

In addition, there is no food that has a greater impact on blood sugar spikes than processed and refined carbs (27, 28)!

This is exactly the reason why accurate insulin dosing may be as burdensome as it is or non-effective.

3. Insulin Resistance

I briefly mentioned that insulin resistance may play a role in gut dysbiosis.

In most cases, too much of anything can be a problem. And our bodies are constantly responding to maintain some sort of “balance” with many things we expose ourselves to.

This physiological process of balance is known as homeostasis.

Homeostasis examples include when humans get too cold, our physiological response is to shiver to warm us up a little.

If we get too hot, we start to sweat to cool our bodies off.

Too much of anything in our bodies will normally cause a physiological response in order to maintain balance.

Too much insulin is no exception!

More insulin is typically needed to accommodate many of the carb-rich foods being consumed today.

A long duration of high insulin demand typically leads the body to resist its effects, leading to insulin resistance (29).

Insulin resistance will make blood sugar management even worse as the insulin dose previously used to balance blood glucose levels will now increase.

As a result, insulin resistance will now rise, again, in response to this new insulin load.

But why?

Beyond the attempt to maintain homeostasis, insulin resistance is a protective mechanism for the body as it realizes this increased insulin demand could easily lead to low blood sugar/hypoglycemic reactions and in severe cases, death!

Even though we’re attempting to give our bodies enough insulin to cover all these foods, unfortunately, our bodies were never made to consume these large amounts of glucose on a routine basis, especially with the typical loads of insulin to cover it.

Why is This Insulin Rat-Race Problematic for Type 1 Diabetics?

Although insulin resistance is largely talked about among type 2 diabetics, medical research provides no question it is possible to be present among type 1 diabetics, as well (30, 31).

I do believe insulin resistance is the foundation of many blood sugar annoyances among those with type 1 diabetes.

Insulin is produced by our pancreatic beta (β) cells.

Among type 1 diabetics, these cells are impaired and no longer capable of producing and releasing insulin normally.

When insulin resistance is added to β-cell dysfunction, blood sugars are likely to skyrocket and typically lead to a consistent average of high blood glucose levels or glycemic variability (32).

These results do not typically favor healthy, long-term diabetic health.

As you can see, there isn’t just one cause to fluctuating blood sugars but many of these influencing factors collaborate to form a disaster of negative blood glucose results!

Summary

Why are BGs high in the morning?

the Dawn Phenomenon – affects approximately 50% of diabetics; active morning gluconeogenesis
inaccurate insulin dosing
ate just before sleep – melatonin may respond by impairing insulin function
the Somogyi Effect – gluconeogenesis triggered due to excess insulin, aka “rebound hyperglycemia”

How are BGs linked to depression/anxiety?

constant communication between the gut & brain is disrupted due to either or both:

gut dysbiosis – can influence unstable BGs
unstable blood glucose levels – can influence gut dysbiosis

Why do blood sugar roller coasters exist?

inaccurate insulin dosing due to:

the constant insulin guesswork behind certain foods consumed & their suspected effects on post-meal blood sugars
insulin resistance makes it harder to predict the first 2 factors mentioned accurately

Hopefully, this information was able to address the cause for many of these common type 1 diabetic frustrations.

In part 2, I’ll be going over two commonly successful dietary protocols to begin to address some of these issues with the help of your physician.

References