What if I told you it IS possible to have blood sugars that are:
- More predictable
- More reliable
- More consistent
- Able to reduce diabetic complications risk & are
- Healthy for overall diabetic longevity
Wishful thinking, right?
Maybe not.
The blood glucose levels all type 1 diabetics (T1Ds) seek may be summed up in two words:
Insulin sensitivity.
Read on to learn how attaining and maintaining insulin sensitivity typically influences the results listed above.
Ready?
Let’s do this!
What is Insulin Sensitivity?
It’s likely whenever you see your diabetic physician, the first (and sometimes only) suggestions of getting better blood glucose levels is to focus solely on your diet and exercise.
Although these will generally support healthier blood sugars and improve your quality of life, they is far from the only ways to manage your blood glucose levels with more reliability and consistency.
Those who have changed their diet with minimal, if any, beneficial blood sugar results know what I’m talking about!
But before I go into more detail about what may improve blood sugars beyond just diet and exercise, I think it’s important for all type 1 diabetics struggling with their blood sugars to wrap their heads around insulin sensitivity.
Insulin sensitivity is a condition that can benefit both diabetics and non-diabetics.
It refers to how responsive the body’s cells are to insulin, the primary hormone that regulates your blood glucose levels (1).
In other words, assuming you have an appropriate insulin dosing method, the quicker your body can respond to insulin, the more predictable and reliable your blood glucose readings will tend to be.
In addition, type 1 diabetics who are insulin sensitive also commonly share these benefits:
- Less insulin demand for food and between meals
- Insulin medication is more affordable due to the decreased amount needed
- Increased blood sugar stability and predictability
- Healthier weight
- Reduced stress with their diabetic management
We see the exact opposite of this among those with insulin resistance, where the body does not respond to insulin reliably and in a timely manner.
This can lead to unpredictable blood sugars!
Let’s now go over what supports insulin sensitivity.
What Increases Insulin Sensitivity?
In my T1D’s Definitive Guide to Insulin Resistance post, you learn that the more insulin demand increases, the more likely insulin resistance will either begin or worsen.
Insulin resistance is commonly associated with type 2 diabetes. However, type 1 diabetics who have insulin resistance are known to have “double diabetes” (2).
The main focus for achieving better blood sugars should be to attain as much insulin sensitivity as safely as possible.
It’s common for many diabetics to be laser-focused solely on dietary changes in an attempt to acquire more stable blood glucose levels.
Although diet can play a significant role in blood glucose stability, it’s far from the only factor diabetics should focus on.
This becomes more evident for those who did not experience any positive blood sugar changes after changing their diet and still require more insulin with their diabetic management.
This is not to say that increased insulin won’t help bring down stubborn blood sugars, but I strongly discourage you from believing this is the only way to accomplish this goal.
Attacking from multiple angles normally helps to reinforce a particular outcome.
The biggest reason for this is that multiple lifestyle factors have been shown to influence insulin sensitivity, resulting in better blood sugars with more reliable consistency.
The most common ones I’ll be going over in this series of posts are:
- diet
- sleep
- physical activity
- effective stress management
- gut health
The more repetitive these intentions are, the greater the likelihood of becoming more insulin sensitive (3).
While improving insulin sensitivity is widely promoted for type 2 diabetes, it’s not talked about as often among type 1 diabetic therapies who suffer from chronic hyperglycemia (high blood sugar).
A big reason for this is that becoming more insulin sensitive may also lead to more hypoglycemic (low blood sugar) reactions if one isn’t prepared for this negative side effect.
However, with the help of a diabetic physician, being more insulin sensitive can be done safely.
For those extremely frustrated with A1Cs consistently above 6.85% (150 mg/dL; 8.32 mmol/L), this insulin sensitivity support may help you with your sanity and diabetic livelihood.
Let’s briefly examine the primary drivers behind increased insulin sensitivity.
Diet
Diet is the most routine behavior that can negatively impact blood glucose levels.
However, it can also have a positive effect once a type 1 diabetic understands how these dietary-blood-sugar strings are being pulled.
I’m sure many of you who have had type 1 diabetes for over five years have either already read or at least know of Dr. Bernstein’s Diabetic Solutions book (4).
If you don’t, I strongly encourage you to read it!
A low-carb diet normally improves blood glucose levels among prediabetics, type 1, and type 2 diabetics (5, 6, 7).
But how?
There are multiple reasons for this.
Here’s a short list for those who have been medically cleared to partake in a low-carb diet:
- Reduced Carb Intake
Less glucose enters the bloodstream from digestion, leading to decreased blood sugar spikes, sustained hyperglycemia, or both.
- Lower Insulin Demands
The more carbs you eat, the more insulin you’ll need to stabilize blood sugars after meals.
Elevated insulin demand (hyperinsulinemia) is one of the main drivers behind insulin resistance (8).
Fewer carbs mean less insulin demand, typically yielding less stress on the pancreas and insulin function. More importantly, less mistakes with insulin dosing!
- Improved Insulin Sensitivity
Over time, the lowered demand for insulin can enable the body to become better at using insulin to lower blood glucose levels.
- Decreased Rollercoaster Blood Sugars (Glycemic Variability)
By avoiding carb-rich foods, which can cause sharp blood sugar spikes, a low-carb diet may help to minimize unstable blood glucose levels by up to 45% (9).
- Weight Loss
In carb-rich meals, leftover glucose that is not digested is shuttled to be stored as fat once these glucose stores are filled.
This also promotes insulin resistance.
Weight loss is commonly seen when less glucose is available for fat storage (10).
- Altered Fat Metabolism
More extreme measures of a low-carb diet, commonly known as a ketogenic diet, force the body to use fat as energy instead of carbs.
Ketosis involves using fat as the primary macronutrient, whereas a low-carb diet should focus on protein.
Don’t be confused! Eating the right kinds of fats doesn’t normally make you fat!
Leftover glucose stored in fat tissues and cells is typically the culprit.
Ketosis reduces carb intake more than a standard low-carb diet.
This is why blood glucose stability and weight loss are commonly seen on a ketogenic diet (11).
Overall, consuming a low-carb diet strongly encourages the reduction of insulin demand, which is a prerequisite for insulin sensitivity and stable blood glucose levels.
Sleep
Sleep is a powerful lifestyle factor capable of being a diabetic’s best friend or worst enemy!
You see, poor sleep has been suggested to be both a cause and effect of autoimmunity and type 1 diabetes (12, 13).
On the other end, those who sleep a restful and uninterrupted 7 – 9 hours per night typically have benefits ranging from (14, 15):
- A stronger immune system
- A healthier weight
- Reduced stress and better mood
- Better focus and concentration
- Increased insulin sensitivity
I go over the hormonal domino effects and their impact on insulin resistance with poor sleep here.
All these hormones directly and indirectly influence blood sugars; however, when restful sleep is a normal routine, the benefits of blood sugar and overall health can’t be ignored.
Physical Activity
In my How Physical Inactivity Influences Unstable Blood Glucose Levels post, I review how insufficient exercise impacts insulin resistance.
Though all type 1 diabetics will respond differently, from my personal experience, I’ve never seen a quicker and more convenient answer to lowering blood sugar spikes than when I exert some intentional physical activity or exercise.
Admittedly, my 9 – 5 work days are more reliable when managing my blood sugars due to my predictable routine.
However, with my family and two boys (ages 9 and 3 at the time of this writing), there are a lot of volatile and unexpected turns the weekends can take us.
Sometimes, hyperglycemic episodes wish to join me on these days!
If I can move around comfortably, I’ll ride my bike, pull some weeds, take a 10 – 20-minute walk, or do a short workout.
My blood sugars typically stop spiking within 10 – 20 minutes and drop to more stable levels afterward.
And the best part?
Because I’m not injecting insulin, I don’t need to worry about the 3 – 5 hours it will stay in my body with the blood sugar lowering effects.
And even if I can’t physically move around because my insulin sensitivity has improved, my insulin injections are:
- quicker and more powerful to respond
- in lesser amounts as I don’t need as much to manage my blood sugars
- more reliable and predictable
Again, my experience with physical activity is not universal to every type 1 diabetic, but the more routine one is with exercise, the more insulin sensitive they usually become!
A big reason is that physical activity stimulates the muscles to use glucose for energy, causing blood sugars to drop (16).
During exercise, muscles contract to use more glucose, reducing the amount circulating in the blood.
This increased glucose uptake by the muscles can even occur during insulin resistance.
This is why physical activity benefits almost anyone with insulin resistance and blood sugar problems, as many commonly see weight loss and blood sugar improvements (17).
It’s important to note that some research suggests that exercise alone is not the most reliable for weight loss, which makes sense to me as I also don’t advocate just one way to become more insulin sensitive (18).
Positive lifestyle factors overlap, making the benefits more predictable and with greater certainty over time.
Combating Stress
Gif source: https://tenor.com/uwXm.gif
Stress management can significantly enhance insulin sensitivity through various biological and behavioral mechanisms.
Stress can trigger a domino effect, altering hormonal, inflammatory, physiological, behavioral, and gut functions. All of which influence insulin resistance.
Managing stress effectively minimizes these dysfunctions, aiding in more stable blood glucose levels.
Moreover, effective stress management often involves adopting healthier lifestyle habits, such as regular physical activity, balanced nutrition, and adequate sleep, directly contributing to improved insulin sensitivity (19).
Physical activity, in particular, successfully addresses stress while helping the muscles use glucose more efficiently (20).
As a result, both elevate insulin sensitivity.
Additionally, stress management techniques like mindfulness, meditation, or yoga may also reduce inflammation and oxidative stress in the body, further enhancing insulin sensitivity and overall metabolic health (21).
A Healthy Gut is One of Insulin’s Best Friends!
A healthy gut improves insulin sensitivity by influencing the body’s metabolism and immune system (22, 23).
The gut microbiome, made up of trillions of gut microbes (bacteria, archaea, fungi, and viruses), affects how the body processes and stores glucose and fat.
A diverse and balanced microbiome improves gut barrier function, reducing inflammation, a known factor of insulin resistance (24).
Beneficial gut bacteria also produce short-chain fatty acids (SCFAs) during the fermentation of dietary fibers.
Remember that fat storage enables insulin resistance (25).
SCFAs have been shown to enhance insulin sensitivity by regulating fat metabolism and reducing fat storage in the liver and other tissues.
Moreover, a healthy gut helps regulate appetite and body weight, both crucial for maintaining insulin sensitivity.
The gut also influences hormones like leptin and ghrelin, which control hunger and satiety (26).
When these hormones are compromised, overeating is a common response.
Also, don’t forget how widespread it is for those with autoimmunity to experience some level of gut dysfunction, typically gut dysbiosis at a minimum (27).
I discuss this at length in my T1D/gut posts.
If an altered gut is confirmed, it then needs to be treated.
Once proper gut microbiome balance has been restored, regular consumption of probiotics and prebiotics, which support healthy gut flora, usually plays a significant role in managing blood glucose levels and improving insulin sensitivity under the guidance of a knowledgeable physician (28).
The goal is to have as many of these insulin sensitive drivers become as routine as possible!
If you read any of my insulin resistance posts, you’ll see a snowball effect of one bad habit rolling into many others with negative blood sugar results.
Conversely, positive lifestyle factors can have the same impact with better blood glucose levels!
There’s rarely a “silver bullet” regarding longevity and sustainability for optimal health, especially with type 1 diabetes.
But consistency is key!
Is There a Link Between Insulin Sensitivity and Living Longer?
Gif source: https://getyarn.io/yarn-clip/f9c87937-2cc6-4d3a-a144-4c96ee30e8d5
Type 1 Diabetics
Elevated insulin sensitivity doesn’t just benefit more stable blood glucose levels.
In my Definitive Guide to Insulin Resistance post, you’ll see the complications that may arise when chronic insulin resistance and hyperglycemia occur.
As a result, these increase the rate of diabetic complications and mortality risk (29, 30).
When insulin sensitivity is present, it can assist with more manageable and healthier blood sugars that reduce these diabetic complications and overall death risks.
In my attempt to emphasize how vital blood sugar stability is, I’m now going to show you that even nondiabetics can benefit from insulin sensitivity.
Nondiabetics
You don’t have to be a diabetic to suffer the consequences of insulin resistance, either.
There’s a study that strongly suggests insulin resistance may predict mortality among nondiabetics (31).
Although the focus of this study was on cardiovascular and cancer-related deaths, this notion shouldn’t be ignored.
Metabolic disorders may also be seen among nondiabetics with insulin resistance (32).
These disorders range from:
- Increased body mass index (BMI)
- Bigger waist
- Elevated fasting blood glucose
- High blood pressure
- Higher A1C, triglycerides, and cholesterol
Incidentally, this group of conditions are major precursors to cardiovascular diseases, which are among the leading causes of death worldwide (33).
Now, if these complications can be seen among nondiabetics, I’m sure you can imagine how much worse it likely is among the diabetic population who struggle with their blood sugar management!
Gif source: https://tenor.com/1yvl.gif
Chronic insulin resistance and hyperglycemia may also contribute to the development of eye disorders, kidney disease, and even certain types of cancer, all of which have high mortality rates (34, 35, 36).
In addition to these direct effects, insulin resistance is often associated with other unhealthy lifestyle factors like physical inactivity, poor diet, and obesity, compounding its negative impact on blood sugars and health.
Therefore, improving insulin sensitivity through positive lifestyle changes is crucial for reducing the risk of these chronic conditions and lowering overall mortality rates in the general population, especially among diabetics.
Is There Any Relationship Between Insulin Sensitivity & Eliminating Diabetic Symptoms?
This is a touchy subject, as there’s no definitive answer.
However, there have been instances where hopeful promises may be seen.
The honeymoon phase in type 1 diabetes refers to a phase shortly after diagnosis where diabetic symptoms may improve for an unspecified period.
This honeymoon phase is suggested to occur in approximately 60% of type 1 diabetic adults, with one particular adult able to attain complete T1D remission for six years (37)!
The average range for partial remission is approximately nine months, with the longest noted at 13 years (38).
The honeymoon period occurs as the partially damaged pancreas can still produce some insulin and is not entirely devoid of this function yet!
However, the underlying autoimmune process and/or pancreatic stress (due to diet or other negative lifestyle factors) are ongoing and will eventually disable the pancreas from producing any more insulin.
Knowing this information, do you think stressing out an already dysfunctional pancreas is a good idea? Especially immediately after the initial diagnosis?
Gif source: https://tenor.com/bJMkF.gif
I don’t either.
However, not addressing any insulin sensitivity boundaries appears to be what may be cementing type 1 diabetes to stick around with nothing to fight it off during its early stages.
Increasing insulin sensitivity during this phase may prolong the honeymoon period and continue this partial diabetic remission.
Maybe even more! 🤷🏾♂️ Though, this has yet to be seen.
If you wish to read about other factors associated with type 1 diabetes development, I suggest you look at my T1D-Gut series.
I also review how some type 1 diabetics were able to go through partial remission during their honeymoon period by removing gluten from their diet.
Managing the Transition Into Insulin Sensitivity
Gif source: https://tenor.com/dIyo9MbvEbo.gif
Managing insulin sensitivity in a type 1 diabetic primarily involves lifestyle modifications and careful monitoring of blood glucose levels.
Here are some strategies to focus on.
Regular Physical Activity
Exercise is one of the most effective ways to increase insulin sensitivity.
For many, this has been the most effective and quickest way to help stabilize my blood sugars.
It helps muscles absorb glucose more efficiently, even without insulin.
A combination of aerobic exercises (like walking and cycling), resistance training (like weight lifting), and/or anaerobic training (sprinting and CrossFit) may get this ball rolling.
The catch, however, is to be on high alert for blood glucose levels dropping too low depending on your activity.
The two main factors that influence how quickly and drastically your blood sugar may drop are:
- Duration of exercise
- Intensity
Another warning you must be aware of is that some T1Ds may experience blood sugar spikes during or after exercise.
Again, there’s no 1-size-fits-all, but once exercise becomes routine, it’s common for blood sugars to adapt accordingly with more predictable outcomes.
So, make sure you have some glucose ready to consume just in case it drops too low during your activities.
Healthy Diet
If you’re cleared by your medical provider, a diet rich in fiber, low in carbohydrates, and high in animal protein typically enhances insulin sensitivity and supports gut health.
In addition, the higher protein intake commonly keeps you full quicker and longer, which helps stop frequent snacking.
Foods with a low glycemic index may be beneficial as they may cause a slower, more controlled rise in blood sugar.
Remember, the goal is to minimize the work insulin has to do since it’s already compromised!
Weight Management
An estimated 62% of T1D adults are overweight (39).
For those slugging around more weight than they would like, losing even a small amount of weight can improve insulin sensitivity (40).
This should be achieved through diet, exercise, and better sleep.
Adequate Sleep
Ensuring enough quality sleep is crucial, as poor sleep patterns can decrease insulin sensitivity.
The goal is the standard recommendation of 7 – 9 hours of uninterrupted sleep (41).
Remember that if your diet and exercise are perfect, but your sleep is off, you likely won’t get the results you seek.
This is how important proper sleep can be!
Stress Reduction
Chronic stress can negatively impact insulin sensitivity.
Mindfulness, meditation, and other stress-reduction techniques can be beneficial.
A simple walk or bike ride out in nature or by the water may be enough to get this ball rolling for you!
Regular Monitoring
Frequent blood glucose monitoring helps to see and understand how different activities and foods affect insulin sensitivity and blood sugar levels.
You want to catch the good and bad patterns!
Repeat the positive trends and stop the negative ones.
One factor that may help can be reviewed in my T1D’s Definitive Guide to Gluten.
In this post, I go over why all type 1 diabetics should strongly consider removing gluten from their diet, as it doesn’t appear to accommodate reliable blood sugar stability.
There’s a quote that I say at the end of almost every post that goes:
Predict what you can.
Control what you can.
Because the answers typically lie within the trends.
Patterns commonly reveal what’s working within a type 1 diabetic’s management protocol.
It also reveals what’s not working.
I encourage you not to be romantic about what’s not working.
For example, if you consistently notice blood sugar chaos after eating your beloved donuts, it’s probably a good idea to consider eliminating them.
Please know that I don’t care what you do.
As long as you see objective and subjective results, then keep rocking out your diabetic management as you are!
Examples of this notion include:
- Objective results: positive test results for blood, stool, gluten antibody, and other miscellaneous health panels
- Subjective results: how you look, feel, and perform with your daily and non-routine tasks
To me, results matter. Especially now that I have my family. I’ll do whatever I can to find the trends that produce the sustainable blood sugar results my body needs!
Medical Consultation
Regular consultation with your healthcare provider is essential.
They can provide personalized advice and adjust insulin therapy as needed, which will likely occur as your insulin demands decrease if you are intentional about becoming more insulin sensitive.
Combined with consistent medical supervision, these strategies can effectively manage and improve insulin sensitivity in type 1 diabetics, improving overall blood glucose control.
Blood Sugar Warnings When Becoming More Insulin Sensitive
As insulin sensitivity increases among type 1 diabetics, several cautions must be known to avoid bad health outcomes.
Risk of Hypoglycemia
This is the biggest warning every type 1 diabetic needs to be aware of!
Enhanced insulin sensitivity can lead to a greater risk of hypoglycemia.
As the body becomes more efficient in utilizing insulin, the same insulin doses might cause blood sugar to drop too low.
It’s crucial to monitor blood glucose levels closely and adjust insulin dosages as your healthcare provider recommends during this transition.
Dietary Adjustments
With increased insulin sensitivity, the body’s response to food changes.
This requires careful dietary management to ensure that carbohydrate and protein intake matches insulin dosages.
Wait? Protein increases blood glucose levels?
Yes, protein elevates blood sugars at a much slower and predictable rate (42).
This is why making protein your primary macronutrient of consumption while reducing carb intake is encouraged (as long as you’re medically cleared to do so).
Miscalculating your insulin dosing due to an overload of carbs eaten commonly leads to blood sugar imbalances.
We want to avoid this as much as possible!
Exercise Caution
Physical activity boosts insulin sensitivity but can also cause rapid blood sugar drops or spikes, especially if insulin doses aren’t adjusted accordingly.
It’s essential to monitor blood glucose before, during, and after exercise and to have fast-acting carbohydrates on hand just in case there’s an unexpected drop.
Alcohol Consumption
I bartended for almost ten years.
So, I get it.
Especially for you younger T1Ds reading this.
However, you need to know that alcohol can unpredictably affect blood sugar levels and insulin sensitivity.
It’s common for hypoglycemic reactions to occur.
Drinking excessive amounts of alcohol impairs the liver’s ability to release its stored glucose supply into the bloodstream (43).
This can lead to low blood sugar, especially if no food is consumed while drinking alcohol.
Alcohol consumption and blood sugars are a monstrous topic that I’ll be going over in depth soon.
Until then, I encourage type 1 diabetics to consume alcohol cautiously and always with food to prevent potential hypoglycemic reactions.
Sick Days
Illness can affect insulin sensitivity and glucose control as one commonly becomes more insulin resistant when sick.
This occurs as your hormones are one variable doing its part to fight off your particular illness.
While doing so, they can alter blood glucose levels unpredictably with hyperglycemic outcomes (44).
It’s important to have your doctor create a sick day plan that might include more frequent blood glucose monitoring and adjustments for insulin dosing.
Regular Medical Supervision
Gif source: https://tenor.com/whcw.gif
Regular check-ins with your healthcare provider are vital for adjusting your insulin dosing as insulin sensitivity finds its normalcy with your new routine.
Consistency with these lifestyle factors is the key!
However, you’ll likely have too much insulin already established based on previous recommendations and routines.
So, give your medical provider the heads-up well before embarking on your insulin sensitivity journey and ask them about their protocol for reaching out to them.
More importantly, confirm they have a 24-hour helpline to assist you in case an episode occurs during the weekend or at night.
Luck favors the prepared! Don’t learn this the hard way!
Education and Awareness
Staying informed about the signs of hypo- and hyperglycemia and understanding how to adjust insulin and diet accordingly are essential to safely managing increased insulin sensitivity.
I have 20+ years of blood sugar trial-and-error under my belt and am significantly more confident in my blood glucose awareness compared to my first five years of having type 1 diabetes.
And you know what?
I am still experimenting with things to ensure I have the best outcomes, especially now that I have a family to look after and care for.
And a heads-up:
Knowledge is power and I advise you to learn as much as you can in how your body and blood sugars respond to everything you do and want to do.
Dr. Mo’s Personal Experience with Insulin Sensitivity
Truthfully, this has been quite a journey I’ve been on with my type 1 diabetes.
I’m happy to shed some light for you in hopes of you not having to wait as long as I have to get the blood sugar results you hopefully seek!
The two suggestions I’d give (as long as your doctor medically clears you) to get the ball rolling with the quickest insulin sensitivity results are:
- A low-carb/high-protein diet with gut-boosting fibers (like soluble and fermentable fibers and foods)
- Routine exercise, even a simple walk after your meals, can help!
I also just learned a couple of years ago (at the time of this writing) that addressing my gut health was another boost with insulin sensitivity I have never experienced before!
When my diet, sleep, exercise, and gut health are in check, there have been times when I needed to suspend my insulin pump for hours at a time due to my insulin sensitivity reaching levels never explored!
And my blood sugars were still fine!
Again, there’s no 1-size-fits-all, but insulin sensitivity needs to be your focus to release your hyperglycemic shackles and chains!
Keep in mind, unless you’re sick and tired of being sick and tired, this won’t work if you don’t.
My type 1 diabetes and celiac disease are both my blessing and “curse.”
However, I see this “curse” more as my “opportunity” to not become just another negative diabetic statistic.
This is just another way I encourage you to think about this because negative thoughts can snowball you into an unhappy emotional and mental state!
Image source: https://yourstory.com/2023/09/tony-robbins-energy-attention-guide
You and your doctor got this!
Summary
- Insulin sensitivity is how quickly your body cells respond to insulin, which usually influences:
- Less insulin demand and cost (you don’t need as much insulin to take care of your blood sugars)
- Increased blood sugar stability and predictability
- Healthy weight
- Reduced blood sugar management stress
- Diet, sleep, physical activity, coping with stress, and gut health are the primary drivers behind successful insulin sensitivity.
- Acquiring insulin sensitivity has been suggested to provide a longer life among diabetics and nondiabetics.
- Upon initial type 1 diabetes diagnosis, acquiring better insulin sensitivity may allow partial remission of the disease for an unspecified period (as long as the driving lifestyle factors remain consistent).
- Managing and monitoring your blood sugars with your healthcare provider is crucial while transitioning your body into a more insulin sensitive state.
References
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671104/
3. https://www.cdc.gov/diabetes/basics/insulin-resistance.html
4. https://www.amazon.com/Dr-Bernsteins-Diabetes-Solution-audiobook/dp/B01N74YJUG/
5. https://www.health.harvard.edu/blog/low-carb-diet-helps-cut-blood-sugar-levels-in-people-with-prediabetes-202301032869
6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10335683/
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319397/
8. https://www.mayoclinic.org/diseases-conditions/type-2-diabetes/expert-answers/hyperinsulinemia/faq-20058488
9. https://pubmed.ncbi.nlm.nih.gov/32859328/
10. https://www.ncbi.nlm.nih.gov/books/NBK537084/
11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7705738/
12. https://research.uga.edu/news/study-explores-sleep-apnea-autoimmune-disease-link/
13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7023878/
14. https://health.gov/myhealthfinder/healthy-living/mental-health-and-relationships/get-enough-sleep
15. https://www.cdc.gov/diabetes/library/features/diabetes-sleep.html
16. https://diabetes.org/health-wellness/fitness/blood-glucose-and-exercise
17. https://www.health.harvard.edu/staying-healthy/the-importance-of-exercise-when-you-have-diabetes
18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5556592/
19. https://www.hsph.harvard.edu/nutritionsource/stress-and-health/
20. https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/exercise-and-stress/art-20044469
21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8798588/
22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847071/
23. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001875/
24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7589951/
25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725490/
26. https://microbiomejournal.biomedcentral.com/articles/10.1186/s40168-021-01093-y
27. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9632986/
28. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8481047/
29. https://www.jdrf.org/blog/2023/10/17/insulin-resistance-diabetes/
30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6965600/
31. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875420/
32. https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-022-01130-3
33. https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1
34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980426/
35. https://journals.physiology.org/doi/full/10.1152/ajprenal.00340.2016
36. https://pubmed.ncbi.nlm.nih.gov/37042166/
37. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9976506/
38. https://pubmed.ncbi.nlm.nih.gov/28329775/
39. https://publichealth.jhu.edu/2023/overweight-and-obesity-in-people-with-type-1-diabetes-nearly-same-as-general-population
40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519190/
41. https://www.cdc.gov/sleep/about_sleep/how_much_sleep.html
42. https://pubmed.ncbi.nlm.nih.gov/9416027/
43. https://academic.oup.com/alcalc/article-abstract/12/3/120/133387
44. https://www.cdc.gov/diabetes/managing/flu-sick-days.html