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The Dose Transcript for November 2, 2023

Host: Brian Goldman

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BRIAN GOLDMAN: Hi, I'm Dr. Brian Goldman. Welcome to The Dose. Do you know your blood sugar? You should because blood sugar that's too high for too long leads to all kinds of serious yet preventable health problems. And low blood sugar can be just as hazardous to your health. Whether you know you have type 2 diabetes or not, you need to know your blood sugar. So this week, we're asking, why should I care about my blood sugar and what are some fixes that I can do? Welcome back, Anar.

ANAR ALLIDINA: Hi. Thanks so much for having me.

BRIAN GOLDMAN: So how many of your clients actually know their blood sugar?

ANAR ALLIDINA: Okay, so I work with clients who specifically have prediabetes, insulin resistance or type 2. But having said that, a lot of them are not exactly aware of their blood sugar, you know, for the past few months. So they typically go to a doctor to get their blood panel done. And, you know, their doctor may say everything's okay or things are a little bit high. You need to work on your lifestyle. So then when I talk to them and I ask them specifically, you know, what is your fasting blood sugar, What is your A1C, which is a three month marker? So the A1C measures the amount of sugar that's stuck around your red blood cells. So it's a percentage. So, you know, surprisingly, a lot of people don't know what their A1C is, even though they've been told they have, you know, elevated blood sugar levels. So, you know, to answer your question, yeah, a lot of people, it's kind of hit or miss. Some people do know what their blood sugars are, but a lot of them still don't.

BRIAN GOLDMAN: Before we begin our conversation, can you give us a Hi, my name is? Tell us what you do and where you do it. Just adlib.

ANAR ALLIDINA: Yeah, sure. So my name is Anar Allidina. I'm a registered dietitian. I specialize in blood sugar management. So I work with clients who have polycystic ovarian syndrome, PCOS, Prediabetes and type 2 diabetes, and I have a virtual practice. I'm based in the Greater Toronto area.

BRIAN GOLDMAN: What is the ideal blood sugar range for the average adult?

ANAR ALLIDINA: Okay. So for the average adult, you know, you want to have a fasting blood sugar of 5.6 millimoles or less. So for those of you, for those people who have their blood sugar reading higher than that could indicate some imbalances with your blood sugar. For people who have already been diagnosed with type 2 diabetes, you really want to have a fasting blood sugar less than seven millimoles per litre.

BRIAN GOLDMAN: Okay. How does that change as we age?

ANAR ALLIDINA: Yeah. So as we age, so type 2 diabetes, one of the risk factor is being over the age of 40 or 45. So as we get older, you know, our body also ages, same with our organs, like our pancreas, which is responsible for producing insulin. So as our body is ageing, it's not as efficient, you know, in kind of regulating everything. So as we get older, yes, our chances of some of these metabolic conditions do increase. And that's why it's so important at a younger age to really take care of your health and really be proactive on that.

BRIAN GOLDMAN: Now, you know, it strikes me that we're not just talking, having this conversation before a group of people who know they have type 2 diabetes or prediabetes. We're talking to people who have no idea what their blood sugar is. So how often should they be checking their blood sugar to see if they're creeping into the prediabetes, prediabetic range?

ANAR ALLIDINA: Yes, so that's an excellent question. So first of all, getting, you know, meeting with your doctor annually to get a blood panel done is a great way to stay on top of your health. And it's so wonderful now, you know, because we can log in and check our, you know, our bloodwork. We can see everything. We have a record of it. So I really encourage people to, you know, look at that and look at the trends of what's happening. You know, so if your A1C, which is, you know, a really good robust measure of your blood sugar, and it's typically done in a routine exam, you don't need to be fasting for that. You just want to look at it year on year to see is it trending upwards? Is it relatively stable? And that will give you a really good indication on how things are progressing. And, you know, if you had, you know, recent weight gain in the past year, you know, if there was like a really stressful event in your life that has happened, you really want to make sure, you know, you do stay on top of your bloodwork at least once a year to check how things are working out for you.

BRIAN GOLDMAN: You know, it's interesting that you said that the haemoglobin A1C, I guess my first thought would have been people who have diabetes should be following that very closely. But it kind of makes sense that rather than checking random blood sugars here and there, which can be very misleading, that haemoglobin A1C would be a far more robust measure of whether or not you're moving into the range where you're prediabetic, if not a diabetic.

ANAR ALLIDINA: Exactly. So the A1C, like you said, it is very robust. It looks over the past three months and how your body is utilizing everything. So it is a really good indication. You know, like you said, just taking a random blood sugar is missing a lot of other things, right? Like it could be so dependent on other factors, but the A1C is a really good measure. And that's something that, you know, I highly recommend everyone once a year to get done.

BRIAN GOLDMAN: But certainly, if you do have prediabetes or diabetes, you're following your sugar a lot more closely. How closely?

ANAR ALLIDINA: Yeah. So if you have been diagnosed with prediabetes or type 2, I would highly recommend getting a blood sugar monitor. You know, nowadays, they have these fancy wearables like the CGM, which are really expensive, but you don't necessarily need to get that. Even just getting from the drugstore a glucometer that you can kind of, you know, pick a few days a week to see how things are working for you, that would be a wonderful thing to have to stay proactive. But in terms of getting your A1C measured, it depends. You know, if you are someone who, you know, has an A1C above seven, you want to be getting that done every three or four months. Someone with prediabetes, I would say at least twice a year, getting your A1C checked would be a good idea.

BRIAN GOLDMAN: There is a question that I'm going to be sneaking into a lot of episodes of The Dose, and that is the fact that 6.5 million Canadians, that's the estimate, don't have primary care, don't have a family doctor or nurse practitioner. So have you ever recommended that somebody go out and buy, somebody who doesn't have a family doctor go out and buy a glucometer and just check it for themselves?

ANAR ALLIDINA: Yeah, 100%, especially, you know, if they already know that they have prediabetes. If they're having, you know, a lot of, you know, issues in terms of like low energy, just not feeling the best, then I would say, yeah, absolutely. You can go to the drugstore to get a glucometer and see for yourself how things are working out for you.

BRIAN GOLDMAN: You know, I think of, you know, certainly, when it comes to high blood pressure, it's a silent disease. You know, people don't have symptoms. You can get some symptoms with an elevated blood sugar, depending on how high it is. What are some of those? Remind us what some of those are.

ANAR ALLIDINA: Yeah, exactly. So if your sugar levels are elevated, some symptoms you may be experiencing are just being really tired, having a lot of anxiety. That could definitely cause because you're having such fluctuations. You know, being thirsty, that's another sign that maybe your blood sugars are off, you know. So having, really having a lot of thirst. Again, this is just your body is trying to dilute that blood sugar because it has nowhere to go. So, you know, drinking water can help dilute that. So a lot of people do have… do feel very thirsty. Again, increased urination. This is, again, your body's defence mechanism to help kind of flush things out. So those are some examples of having elevated blood sugars.

BRIAN GOLDMAN: And I think it's probably fair to say that the symptoms don't always correlate precisely to the severity of the blood sugar elevation. So some people are going to have… are going to be more sensitive and, you know, their bodies are going to react more, more, more quickly to a low… to a modestly elevated blood sugar. And some people won't have the symptoms that you've just described, you know, the classic polyuria, polydipsia, like excessive thirst and excessive urination, unless they have a very, very high blood sugar.

ANAR ALLIDINA: That's true. That's very true.

BRIAN GOLDMAN: You know, I'm an emergency physician. I've lost count of the number of patients I've treated in the ER for low blood sugar, hypoglycaemia. The symptoms include shakiness, sweats, nervousness, irritability, confusion, hunger. When blood sugar gets really low, it can cause coma and seizures and can be lethal. And there is a very strong correlation to the foods that people eat. And as a registered dietitian, like when you see somebody who is having crashes, having lots of low blood sugar episodes, what's behind that diet wise and what are the fixes?

ANAR ALLIDINA: Yeah. So usually, when people do have a lot of, you want to think of it like a rollercoaster, right? So their blood sugars are elevated and then they dip down because whatever goes up needs to come back down, and then they eat something and then again it spikes up. So, you know, throughout the day, they're experiencing highs and lows of blood sugar fluctuation. And taking a look at your diet, you know, can really give a lot of insight. So for people who have a diet that's high in refined carbohydrates, a lot of sugars like white flour, a lot of packaged foods, sweet foods like juices, pop, you know, those specialty coffee drinks that tend to have a lot of sugar in them, muffins, you know, those kinds of foods that really break down very quickly in our body. Yes, it does give us energy, but it really increases our blood sugars and then we experience a dip. And that dip is a hypoglycaemia. So when we're experiencing a dip, like you said, you know, we just feel tired, shaky, irritable, hungry even, you know, and our body signalling to us that we need something for energy. And then sometimes, we typically gravitate to easy, you know, grab and go foods which tend to be high in carbohydrates and sugar. So really taking a look at your diet to make sure you're getting enough nutrients in there, enough, you know, specifically protein and fibre, because these two nutrients really help slow down how those sugars are released in your body. You know, they kind of act like a buffer. So really working to make sure you're getting enough protein and fibre with your meals or every single time you eat can really help you stabilize those blood sugar readings.

BRIAN GOLDMAN: And as somebody who from time to time reaches for the wrong foods and experiences those crashes, that's good information to know. And what role do cravings play in choosing the wrong foods?

ANAR ALLIDINA: Yes. So typically, when our blood sugar does drop, that's when we, you know, feel hungry, we have cravings, like sugar cravings specifically. And, you know, typically, you know, many people experience cravings in the afternoon around 3 p.m. and again in the evening. And this is just, again, goes with our circadian rhythm as well. So we all naturally have a dip in our energy levels in the afternoon. So one way, if you are someone who has a lot of cravings in the afternoon, one of the best things you can do is really focus on your midday meal, so around lunchtime, to make sure you're getting enough protein and fibre with that. Additionally, you don't want to be cutting out carbs drastically. That's not a good long term solution. So you want to make sure you are including carbohydrates that give you fibre. So, you know, I'm talking about whole grains. So if you are having a sandwich, you know, opting for, you know, a whole grain, a rye, a sour dough, that's going to give you that fibre that's going to slow down how your… the way that your food is digested. So really paying attention to your midday meal when you… if you do experience cravings in the afternoon can really help for sure in terms of keeping your blood sugar a little bit more balanced and stable so that you, you know, feel better as well because our blood sugar is a direct reflection of our energy level.

BRIAN GOLDMAN: And you've said it already. I'm going to underscore this. Nobody's saying cut out sugar altogether because you… there are parts of the body, your brain, for instance, that requires sugar. It requires sugar. It requires glucose to be able to run, to operate optimally. So we don't… we're not saying avoid sugar, but just modify the kinds of sugar that you consume to avoid some of the rollercoasters that, you know, the dips and the highs followed by the dips that can mess with your energy level during the day. That said, some people do consume too much sugar. And so how do you, as a registered dietitian, how do you go about getting people to change their diet, what could be decades of eating habits? How do you change those?

ANAR ALLIDINA: Okay. So the first thing that I like to talk to my clients about is figure out what you can add to your diet, okay? So adding in more nutrient dense foods to help replace some of those foods that really don't have much in them. So looking at each meal specifically, you know, for breakfast, for example, and educating on, you know, getting more protein in. So if you are someone who, you know, really enjoys, let's say, you know, like sugar in your coffee, you know, just working to… it doesn't mean you have to completely cut out the sugars, but maybe you can decrease how much of that you're adding in. Or maybe you can have your beverage, your coffee drink after you have some protein. That's going to help kind of stabilize your blood sugars. You know, anything that's liquid and sweet is going to hit your bloodstream right away. And so, you know, looking at your first meal of the day, this is going to be the best thing anyone can do for their health. You know, you really want to be strategic with the sugars that you're getting in at your first meal. So if you're someone who drinks orange juice, for example, you know, I would say, okay, first have your breakfast and then maybe have a little bit of orange juice. Or better yet, have an actual orange because the fibre is still there. Whereas in orange juice, the fibre is not there. You're just getting the liquid. And making sure you're getting protein in. So, you know, for example, if someone is used to having, you know, toast with butter, so why not make that toast with some avocado or an egg, which is going to give you healthy fats, fibre, and the egg is going to give you that protein. So it's going to be a more balanced breakfast, you know? And then if you wanted to have something sweet, you know, fruit or a little bit of juice after that, then, you know, your body is going to be able to slowly digest those sugars. So it's not necessarily cutting, like you mentioned, cutting all the sugar out. It's just being strategic and figuring out what you can add to whatever you enjoy that's going to give you, you know, the nutrients like healthy fats, fibre and protein, which is going to slow down the way those sugars are absorbed in your body.

BRIAN GOLDMAN: What about water consumption? What do you recommend? What's the relationship between water consumption and blood sugar?

ANAR ALLIDINA: Yes. So again, the more hydrated you are, the better your body's able to kind of do its thing. Especially with blood sugar, you know, sometimes, it can get concentrated in our body. So having enough water can help dilute that. So that's really important. So staying hydrated is key.

BRIAN GOLDMAN: Got it. Now, to what extent do you incorporate non dietary measures that are important for lifestyle, like sleep, exercise, into your pitch, into the kind of global advice that you're giving your clients?

ANAR ALLIDINA: Yes. So definitely, when it comes to blood sugars, obviously, our diet plays a huge role. But then there's other factors as well, which you mentioned, right? So our exercise can really help. You know, getting movement in in our bodies. And the way we are living now, you know, a lot of us have computer jobs. We're sitting, we're sedentary, we're not moving as much. And this doesn't help our body at all. So getting in at least 30 minutes of physical activity, you know, every day is going to be beneficial. And it doesn't have to be anything crazy. It could be, you know, going for a walk. You could even be strategic about it. After you have your meals, going for a 10-minute walk. You know, studies have shown this really helps with your post-meal blood sugars. So that could be a really great thing to implement. You know, just moving your body for 10 to 15 minutes after you eat, instead of if you don't have the time to structure in exercise during the day. So that works as well. Again, sleep. Making sure we're getting enough sleep is so critical for our blood sugars. And, you know, again, when we sleep, that's when our body can reset. This is when our hormones can rebalance. You know, and studies have shown that if we get… like a one night of bad sleep can really impact our insulin levels. So, you know, we wake up, you know, we're not rested, we tend to crave more coverage foods because our body is deprived of like energy, and that's definitely not going to help our blood sugars.

BRIAN GOLDMAN: Now, we've been talking a lot about type 2 diabetes, a little less about prediabetes. What are the signs that someone may be developing insulin resistance or frankly in the prediabetes stage, which would be, I guess, an ideal opportunity to try to nip it in the bud?

ANAR ALLIDINA: Yes, exactly. So, you know, if you've been diagnosed with prediabetes, you know, don't take this lightly. You know, this is an opportunity for you. It's kind of like a warning sign that you have control to bring that back to normal levels. And, you know, so it is a blessing to be, in disguise, right, to be diagnosed with prediabetes because you can actually fix that. So insulin resistance is a curse, you know, And some symptoms of that include, you know, even just taking a look at your bloodwork again, right? If you're someone who has high triglyceride levels, it's a type of cholesterol. These typically follow in line with our blood sugar. So if our triglycerides are elevated, then that can show some. Signs with our blood sugars. If we have a waist circumference, for women, if it's greater than 35 inches, for men, if it's greater than 40 inches, these are signs of insulin resistance. When we're carrying more weight around our midsection, when our blood pressure is elevated. If it's over 130 or over 80, that's signs of insulin resistance. If you are someone who has PCOS, polycystic ovarian syndrome, chances are that there is some insulin resistance going on. And so, you know, you could get a fasting insulin done. But typically, you know, not all doctors do request that. And if you're not able to, just taking a look at your cholesterol panel, taking a look at your waist circumference, taking a look at your blood pressure, you know, these are some signs. You know, if you've been diagnosed with fatty liver, that's another indication of insulin resistance. Additionally, if you have skin tags on your body, if you have dark, velvety patches around the folds of your skin, so under your arms, around your neck, those are also signs of insulin resistance as well, that your body is not as efficient at utilizing the sugar in your body, right? So your blood sugar could still be at a normal level, but you have these other symptoms that are coming up. And, you know, changing your lifestyle can really help with managing those conditions.

BRIAN GOLDMAN: You see clients who have polycystic ovarian syndrome, you see clients who have prediabetes, who have type 2 diabetes. At what point are you nudging your clients who you try to help with your best advice back to their family doctor or nurse practitioner for more intensive management and maybe starting medications?

ANAR ALLIDINA: Yes. So definitely, you know, medication is a great… it's another tool in the toolbox. So, you know, if someone is in the prediabetes PCOS range, we really look at their lifestyle first. But yes, you know, sometimes, you know, having a strong family history of type 2 diabetes, you know, being in a certain ethnic group just puts us at a higher risk. And sometimes, yes, things are out of our control. You know, we could be doing the best we can and medication can definitely be a great source. And, you know, you know, a lot of my clients don't want to start medication, but some of them actually have because there's only so much that they can do, right? They need that extra support. And so, you know, if blood sugars are not, you know, if their A1C is coming back and it's, you know, going up or, you know, they're just not feeling the best or they're having a really hard time, yeah, so that's when I would definitely suggest that, you know, why don't we have a conversation about medication? Talk to your doctor and see what will be the best way to go about that. But definitely, medication, I don't want you to think if you're someone who has type 2 diabetes, if you're on medication, that you don't need to worry about your lifestyle. Not at all. Medication is another tool. And, you know, using that in conjunction with a healthy lifestyle is absolutely amazing. And it can really help with keeping things in check and preventing further complications later on. So yes, medication is definitely a great tool. And I don't want you to think of it as kind of like, okay, it's, you know, I cannot be on medication or I have to be… you know, like I want you to kind of combine the lifestyle and the medication piece as well.

BRIAN GOLDMAN: Well, Anar Allidina, thank you so much for providing us some advice. And, you know, to those people who maybe don't have a family doctor or nurse practitioner, you've provided some good advice that could at least get you started on the road to regulating your blood sugar and maybe not becoming a prediabetic or having diabetes. So thanks very much for speaking with us.

ANAR ALLIDINA: Yes, thank you so much for having me.

BRIAN GOLDMAN: Anar Allidina is a registered dietitian and certified diabetes educator. Here's your dose of smart advice. Type 2 diabetes is very common. Prediabetes means blood sugar levels are higher than normal, but not high enough to be called type 2 diabetes. Many people with prediabetes develop type 2 diabetes eventually. The health complications of diabetes include heart attack and stroke, poor circulation, kidney disease, vision problems and nerve damage. Long term complications of diabetes such as heart disease may begin during prediabetes. Regulating blood sugar levels helps prevent complications. Blood sugar levels vary throughout the day. Before meals, the suggested target blood glucose range is 4.0 to 8.0 millimoles per litre. Two hours after meals, the range is 5.0 to 10.0 millimoles per litre. The target blood sugar may vary. Talk to your health care provider about the ideal blood sugar range for you, and get your A1C once a year if you don't have diabetes and more often if you do. A1C measures your diabetes control over a three-month period. An A1C of 7.0% or less is recommended for most adults. Type 2 diabetes can often be managed with weight loss, healthy eating and regular exercise. Diet affects blood sugar. Fatigue and craving sweets and caffeine after meals usually means that the blood sugar has cratered. Consuming less carbs overall, more complex carbs and more fibre can help address those cravings and help regulate blood glucose. If you consume lots of sugar, reduce it gradually at first, beginning with breakfast. A good first meal of the day is key to better blood sugar control. Have a bit of protein first, which makes it more palatable to begin gradually decreasing sugar at breakfast. Instead of toast and butter, try toast an avocado or egg. The healthier your breakfast, the less your energy will crash and the less you'll crave snacks. Diabetes medications are usually needed when targets for blood sugar and A1C cannot be met by other means. If you have topics you'd like discussed or questions answered, our email address is thedose@cbc.ca. If you like this episode, please give us a rating and review wherever you listen. This edition of The Dose was produced by Stephanie Dubois. Our senior producer is Colleen Ross. The Dose wants you to be better informed about your health. If you're looking for medical advice, see your health care provider. I'm Dr. Brian Goldman. Until your next dose.

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Why should I care about blood sugar? - Transcript

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