What You'll Learn:

• Blood sugar is primarily managed by the hormone insulin. When insulin is dysregulated (as in type 1 and type 2 diabetes), it can create blood sugar spikes and dips that disrupt your metabolic processes.
• Uncontrolled blood sugar can lead to a range of serious complications, including heart disease, stroke, and damage to vital organs. 
• A blood glucose monitor is a helpful way to track your blood sugar levels and ensure that your current treatment plan works. You'll also want to get your hemoglobin A1C checked at least once a year a the doctor (or at home) to track changes in insulin sensitivity and glucose clearance. 
• A diet rich in protein, fat, and fiber is the best option for blood-sugar control. Each of these macronutrients has a unique impact on blood sugar that helps to stabilize levels and keep you within a healthy range.
• As part of a well-rounded lifestyle, physical activity can significantly influence blood sugar regulation by improving insulin sensitivity and increasing glucose clearance from circulation.
• Low-carb, low-sugar snacks are a fail-safe for anyone trying to regulate blood sugar throughout the day. Having some healthy snacks on hand can help you avoid going for high-carb options while helping to keep your blood sugar levels stable.

This comprehensive guide will teach you all you need to know about the ins and outs of blood sugar regulation. We'll discuss what blood sugar is, why it's important to keep it regulated, how it can be managed, your ideal levels, and the key signs to look out for when blood sugar is off-balance.

We'll also go over the best ways to stay on top of your blood sugar, including glucose testing, foods that regulate blood glucose, and the importance of exercise for blood sugar maintenance.  

So without further ado, let's dive into the world of blood sugar. 

Introduction to Blood Sugar Levels

Before we jump into the nitty gritty of blood sugar, let's first review what blood sugar is and why maintaining healthy blood sugar levels is so crucial to overall health and physical balance. 

Your blood sugar naturally fluctuates throughout the day, depending on what foods you eat. While glucose from carbohydrates significantly impacts blood sugar, protein has a more moderate effect, and fat doesn't increase blood sugar at all. Therefore, carbohydrates are the most crucial to keep an eye on if you want to ensure that your blood sugar stays within a healthy range.

That said, your body does have a system for managing blood sugar as it rises, and that responsibility falls under the hormone insulin. As glucose (sugar) from your meal enters your circulation, insulin is released from your pancreas to help shuttle glucose into your cells, where it can be used as fuel, or stored for later. Therefore, maintaining steady blood sugar highly depends on your body's ability to release and respond to insulin which can become impaired if you are insulin resistant.

In the case of type 2 diabetes, your body may be making enough insulin to control blood sugar, but your cells have lost their ability to sense insulin signals. As a result, you'll end up with spikes in both blood sugar and insulin without any way to get the blood sugar out of circulation and into your cells. 

Small to moderate increases in blood sugar throughout the day is not a problem for most people, but for those with diabetes, blood sugar can accumulate rapidly and cause downstream issues such as[1]:

• Damage to blood vessels
• Vision problems
• Increased risk of heart disease and stroke
• Neuropathy (nerve damage) 
• Kidney damage
• Skin infections
• Bone and joint problems

Understanding Normal and Dangerous Blood Sugar Levels

So, what does normal blood sugar look like? While everyone's body is unique and will respond to glucose a little differently, there are parameters for the healthy range in which your blood sugar can fluctuate. 

In the fasted state, where you've had nothing to eat or drink in at least eight hours, blood sugar levels should be below 100 milligrams per deciliter. If your levels are above 100 milligrams per deciliter but below 126 milligrams per deciliter, you're in the prediabetes range. Anything above 126 milligrams per deciliter is considered diabetes[2]:

• Normal: less than 100 mg/dl
• Prediabetes: 100 mg/dl to 125 mg/dl
• Diabetes: 126 mg/dl or higher

But what about after your meal? What's a safe level of postprandial blood sugar?

According to the ADA (American Diabetes Association), postprandial blood glucose levels (post-meal) should stay at or below 180 milligrams per deciliter. If your pancreas produces insulin efficiently, and your cells are sensitized to insulin signals, then your blood sugar will likely never reach these numbers. However, in the case of diabetes, blood sugar may rise to 180 milligrams per deciliter or higher, which would put you into a state of hyperglycemia (high blood sugar).

Symptoms of hyperglycemia typically emerge slowly after several days or even weeks of elevated blood glucose. Early symptoms may include[3]:

• Frequent urination
• Increased thirst
• Blurred vision
• Feeling weak or unusually tired
• Headache

If hyperglycemia goes on for a while, you may begin to notice[1]:

• Fruity-smelling breath
• Dry mouth
• Abdominal pain
• Nausea and vomiting
• Shortness of breath
• Confusion
• Loss of consciousness

Over time if blood sugar levels are not normalized, it can lead to serious damage throughout your body. As mentioned previously, chronically high blood sugar due to untreated diabetes may lead to organ damage, damage to blood vessels and increases your risk for heart disease and stroke. 

Another complication of diabetes is hypoglycemia (low blood sugar). Although people without diabetes can experience low blood glucose, in most cases, hypoglycemia happens when your diabetes medication is not properly regulated, causing an imbalance in your insulin/glucose ratio. 

Some early signs of hypoglycemia include[4]: 

• Looking pale 
• Feeling shaky or off-balance
• Dizziness or lightheadedness
• Sweating
• Hunger or nausea
• An irregular or fast heartbeat
• Difficulty concentrating
• Feeling weak and fatigued 
• Irritability or anxiety
• Headache

In more severe hypoglycemia, you may experience:

• Confusion
• Loss of coordination
• Difficulty speaking or slurred speech
• Blurry or tunnel vision
• Muscle weakness
• Drowsiness

If left untreated, hypoglycemia could eventually lead to seizures or unconsciousness, although these symptoms are very rare. 

Monitoring Blood Sugar Levels: Glucometer, A1C Test, and Continuous Glucose Monitoring

Keeping an eye on your blood sugar levels is crucial for managing diabetes and avoiding potential complications. Your doctor will likely provide you with instructions on how often to test and which testing method is best for you, depending on the type of diabetes as well as any medications you may be taking. 

Generally speaking, if you're taking insulin, it's a good idea to test several times per day to ensure that you aren't taking too much or too little medication. This type of testing is usually recommended before meals or at bedtime. However, you can also use glucometers to check your postprandial blood sugar to see how well you're clearing glucose from your blood[5].

Blood Glucose Monitor

Blood glucose monitors (also known as glucometers) require a small blood sample (just a pinprick) to measure your current blood sugar levels. Blood glucose monitors are particularly useful for helping you understand how your body responds to carbohydrates and any glucose-lowering medications you may be taking. Ideally, your glucose monitor will be connected to an App that allows you to track your blood sugar over time and gain insight into your unique metabolic responses. 

If you're managing diabetes without medication, you may not need daily monitoring, but it's still good to have a blood glucose monitor around to keep an eye on things. Blood glucose monitors can also be helpful if you start to feel symptoms of hyper or hypoglycemia.

How to use a blood glucose monitor[5]: 

1. Begin by washing your hands with soap and water, and then dry your hands well.
2. Open the test strip container and take one strip out, handling carefully so as not to contaminate it. 
3. Gently massage whichever fingertip you plan to use for the blood draw to allow the blood to come to the surface.
4. Using a lancet, prick your finger and squeeze from the base of the finger to encourage blood flow. 
5. Place a small amount of blood onto your test strip, allowing it to absorb completely, and then immediately place the strip into the glucose meter.
6. After a few seconds, your meter will display your blood sugar levels. If you have an App connected to your meter, it will likely track this number for you. Otherwise, jot down your number in a journal. 

While your healthcare provider will assist you with your target ranges, below are generally accepted guidelines for people with diabetes:

• Blood sugar ranges before meals: 80 milligrams per deciliter to 130 milligrams per deciliter.
• One to two hours after meals: below 180 milligrams per deciliter.

Hemoglobin A1C Test

A Hemoglobin A1C (HgA1C) test measures your average blood sugar over the past three months. This type of blood test can help to diagnose diabetes and is recommended at least twice a year for people already diagnosed to get an idea of how well your body is managing blood sugar. 

HgA1C measures the percentage of hemoglobin (proteins) that are chemically linked to glucose (a process called glycation). The higher your HgA1C levels, the poorer your ability to manage blood sugar and the more susceptible you are to diabetes complications[6].

Hemoglobin is essential for helping your red blood cells carry around oxygen, but when glucose attaches to this protein, it can impair its function and reduce oxygenation to cells and tissues[7].

Checking your HgA1C can help you determine how well your current treatment plan is working and give you insight into what your glucose has been up to over the last several months. 

Since this test assesses the percentage of hemoglobin bound to glucose, your results will appear as a percentage:

• A reading below 5.7% is normal
• 5.7% to 6.4% is diagnosed as prediabetes
• 6.5% or higher on two separate tests indicates diabetes.

For people with diabetes, a target of less than 7% is associated with a lower risk of diabetes-related complications. 

Traditionally an HgA1C test would have to be carried out by your doctor. However, today there are at-home A1C tests that allow you to measure in the comfort of your own home.

Similar to a blood glucose monitor, at-home A1C tests require a simple finger prick for a small blood sample. At-home testing is a great option if you want to avoid a doctor's visit and a long wait for lab results. 

Continuous Glucose Monitor (CGM)

Continuous glucose monitors are typically used for people with type 1 diabetes that require insulin. These devices measure your blood sugar every few minutes using a sensor that's inserted under your skin (usually your stomach or arm). The sensor specifically measures the glucose found in the fluid between the cells, also known as interstitial fluid.

Your doctor will let you know if your treatment plan requires CGM[8]. 

Foods That Help Balance Blood Sugar: A Comprehensive Guide

Many people diagnosed with diabetes find that they don't need to take medication to manage blood sugar levels as long as they keep their diet in check. As you learned, each one of the three macronutrients has a different impact on blood glucose:

• Carbohydrates directly increase blood sugar most rapidly
• Protein has a moderate impact on blood sugar
• Fat does not influence blood sugar

Planning your diet to minimize blood sugar spikes can make or break your long-term prognosis with diabetes. 

Below are three food groups to focus on to help keep blood sugar levels stable throughout the day.

Protein

Of all the macronutrients, protein is well-known to be the most satiating due to its slow digestion and absorption. While carbohydrates can be broken down readily in your digestive tract, protein requires a concerted effort by your stomach acid and digestive enzymes. 

Due to the time and energy-intensive process of breaking down protein, its absorption into circulation happens slowly over several hours. This leads to prolonged satiety as your blood receives a slow and steady supply of nutrients[9]. 

Furthermore, in the case of protein, the end result of digestion is amino acids. Unlike glucose, which can directly spike blood sugar, amino acids have to go through a process known as gluconeogenesis (GNG) before they can be turned into glucose. And only a certain percentage of amino acids will even make it to the GNG pathway, as amino acids play a range of crucial roles in your body that often take precedence before their utilization as fuel. 

Some examples include renewing and repairing cells and tissues and synthesizing enzymes, DNA, and hormones[10][11]. 

When protein is combined with carbohydrates in your meal, it slows the entire digestive process as your enzymes have to tackle both protein and carb breakdown simultaneously. For this reason, it's a good idea to always include some protein in your meals – especially if you're eating carbs.  

When choosing protein sources, quality matters big time. 

Protein Quality

First, you want to ensure that your protein is highly digestible and that the amino acids in your protein form a complete amino acids profile. Without getting too into the weeds, a complete protein must contain a specific ratio of each essential amino acid. Luckily, any animal-sourced protein will naturally represent a complete protein which can make things easy if you're a meat eater. Animal-based proteins are also low in carbs, which is helpful when you want to keep your blood sugar low. 

Second, choosing high-quality animal proteins means that as often as possible, you're going for grass-fed, pasture-raised, organic, non-GMO, antibiotic-free, and hormone-free. It may sound like a tall order, but most farmers that raise their animals organic will already have the rest of the list covered. 

Some high-quality protein choices include:

• Red meat like beef, lamb, and pork
• White meat like chicken and turkey
• Eggs (all kinds)
• Seafood like fish, scallops, shrimp, and shellfish
• Dairy — particularly full-fat Greek yogurt and cottage cheese (low-fat versions often add more carbs, and you miss out on the healthy fats naturally contained in these foods)

Fiber

Another nutrient that's particularly helpful for blood glucose control is fiber. While fiber is technically considered a carbohydrate, it's not absorbed into circulation and, therefore, won't instigate an increase in blood glucose. 

In fact, studies in people with type 2 diabetes show that dietary fiber can help to control blood sugar and reduce insulin levels[12].

Similarly to protein, fiber helps to slow digestion and therefore reduces your uptake of nutrients into circulation. That said, fiber goes about this process in a very different way than protein. Instead of slowing digestion due to an intensive breakdown process, fiber can influence enzyme accessibility to your fat, protein, and carbs within your digestive tract.

When fiber is present, it creates a more complex food matrix, which means that your digestive enzymes must work harder to access and dismantle the other macronutrients present. As a result, digestion is slowed down, and glucose levels rise much more steadily[13]. 

In addition to its direct impact on digestion, fiber also acts as a food source for the beneficial bacteria in your gut. When your bacteria consume fiber, they produce short-chain fatty acids (SCFA), which studies show may improve hemoglobin A1c, glucose levels, and elevated levels of glucagon-like peptide-1, which regulates insulin[14].

While most foods that contain fiber tend to be higher in carbs than protein or fat, there are plenty of low-carb fiber options. For example:

• Seeds – flax seeds, chia seeds, pumpkin seeds
• Avocado
• Coconut (unsweetened)
• Berries – raspberries, blackberries
• Nuts – pistachios, almonds, 
• Vegetables – broccoli, asparagus, cabbage, spinach, collard greens, okra, artichoke, brussels sprouts 

Fat

Many people are adding more fat to their diets today for a variety of reasons; it's crucial for cellular health and function, it makes up around 60% of brain tissue, it insulates vital organs, and it adds a delicious mouthfeel to your meals[15][16]. 

For those with diabetes, however, fat has another significant benefit; it doesn't increase blood sugar. While protein may moderately raise blood glucose, fat won't directly influence blood sugar levels at all. What makes fat particularly helpful for people with blood sugar issues is that this macronutrient assists in the production of ketones which your body can use in place of glucose. This is one of the reasons that so many people with metabolic conditions are turning to a ketogenic diet that focuses primarily on fat and protein. 

Some high-quality sources of fat that you can add to your blood-sugar-regulating diet include:

• Butter
• Ghee
• Coconut oil
• Avocado oil
• Olive oil
• Nuts and seeds

The Importance of Exercise for Blood Sugar Management

While it goes without saying that exercise is an important aspect of overall health and well-being, regular activity can directly improve blood sugar management in a variety of ways, namely:

• Improved non-insulin-dependent glucose utilization
• Improved insulin sensitivity
• Improved glucose clearance 

Improved non-insulin-dependent glucose utilization

One of the fantastic benefits of exercise is that it improves your body's ability to use glucose, independent of the hormone insulin. During physical activity, glucose uptake into active muscles increases significantly as your hungry muscle cells need to maximize their fuel resources. 

To keep things running smoothly, research shows that when your muscles contract during exercise, it enhances your cells' ability to take up glucose from the blood, and this process takes place whether insulin is present or not[17][18]. 

Improved insulin sensitivity 

Studies show again and again that physical activity can improve insulin sensitivity. This is at least in part due to the role of a glucose transporter called GLUT-4. GLUT-4 is a protein that works with insulin to assist glucose uptake into your cells. Studies show that when you exercise, it increases GLUT-4 expression on your cell membrane, thereby amplifying your body's sensitivity to insulin signals and enhancing your ability to move glucose out of your blood[19][20][21]. 

Amazingly, studies show that just one bout of physical activity can increase insulin sensitivity up to 16 hours post-exercise[22].

Improved glucose clearance

Aside from its direct impact on insulin sensitivity, when you exercise, it draws on reserve glucose stored in your muscles and liver. As these stores become depleted, your body starts to pull glucose from your blood to rebuild its stores. The longer and more strenuous your exercise, the more your blood sugar will be affected[23].

Which Type Of Exercise Is Best?

Any regular movement should help to increase insulin sensitivity and glucose clearance. That said, the best exercise routine is one that you'll stick with. If you're new to working out, you may want to start with walking and then move up to more strenuous exercise like:

• Aerobics (jogging, hiking, cycling)
• Resistance training (weights, body weight, resistance bands)
• Interval training (HIIT, run-walk, or Tabata)
• Swimming
• Group classes
• Vinyasa or hatha yoga classes

Healthy Snacks for Diabetics: Low-Carb and Low-Sugar Options

Many people get tripped up when it comes to snacking for blood sugar regulation. Having low-carb and low-sugar options around can be a lifesaver if you're someone who tends to get hungry and snack mindlessly. A couple of intentional snack breaks throughout the day can also help you keep your blood sugar stable, so you don't feel inclined to grab the first thing you see to satisfy your hunger. 

Below is a list of low-carb and low-sugar snack options to have around as your fail-safe:

• Nuts and seeds (almonds, macadamia nuts, Brazil nuts, sunflower seeds, pumpkin seeds, etc.)
• ½ avocado with salt and lime
• Cottage cheese or Greek yogurt
• Turkey and cheese roll-ups
• Hard-boiled eggs
• Celery with nut butter
• Beef or salmon jerky
• Veggies and guacamole 
• Sardines
• Chia seed pudding

Conclusion: Maintaining Healthy Blood Sugar Levels for a Better Life

Maintaining healthy blood sugar levels is a cornerstone of metabolic health. Aside from conditions like prediabetes and diabetes, blood sugar regulation plays a role in overall nutrient utilization and physiologic homeostasis. 

When blood sugar becomes dysregulated, it can set the stage for serious complications, including heart disease, metabolic syndrome, and damage to vital organs. 

Furthermore, blood sugar control plays a direct role in weight management and maintenance, which itself can contribute to, or worsen, a wide range of health conditions. 

Once blood sugar is under control, you'll feel significant shifts in your daily energy levels, moods, cravings, and general well-being. By understanding what blood sugar is and how it works, you've armed yourself with the tools necessary to manage and maintain healthy levels for years to come.

References 

1. https://www.mayoclinic.org/diseases-conditions/hyperglycemia/symptoms-causes/syc-20373631
2. https://diabetes.org/diabetes/a1c/diagnosis
3. https://my.clevelandclinic.org/health/diseases/9815-hyperglycemia-high-blood-sugar#symptoms-and-causes
4. https://www.mayoclinic.org/diseases-conditions/diabetic-hypoglycemia/symptoms-causes/syc-20371525
5. https://www.cdc.gov/diabetes/managing/managing-blood-sugar/bloodglucosemonitoring.html
6. https://www.mayoclinic.org/tests-procedures/a1c-test/about/pac-20384643
7. Pu, Li Jin, et al. "Increased blood glycohemoglobin A1c levels lead to overestimation of arterial oxygen saturation by pulse oximetry in patients with type 2 diabetes." Cardiovascular diabetology 11.1 (2012): 1-6.
8. https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring#who
9. https://med.libretexts.org/Courses/American_Public_University/APUS%3A_An_Introduction_to_Nutrition_(Byerley)/APUS%3A_An_Introduction_to_Nutrition_1st_Edition/05%3A_Proteins/5.04%3A_Protein_Digestion_Absorption_and_Metabolism
10. Smith, Ann. "Nucleic acids to amino acids: DNA specifies protein." Nature Education 1.1 (2008): 126.
11. Walsh, Gary. Proteins: biochemistry and biotechnology. John Wiley & Sons, 2014.
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18. https://diabetes.org/healthy-living/fitness/getting-started-safely/blood-glucose-and-exercise 
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21. Leguisamo, Natalia M., et al. "GLUT4 content decreases along with insulin resistance and high levels of inflammatory markers in rats with metabolic syndrome." Cardiovascular diabetology 11.1 (2012): 1-10.
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23. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-and-exercise/art-20045697