The blood sugar levels are – just like the blood fats – part of the routine values in laboratory reports. They are mainly used for the diagnosis and therapy control of diabetes mellitus. But what do the different measurements indicate? Why do you need to be fasting for some values? And what does our blood sugar have to do with our life expectancy? In this part of the laboratory series, we will take a closer look at that.
Sugar in the blood – what do we actually need it for?
Our body needs energy – and a lot of it. The main mechanism through which our cells obtain energy is the glycolysis, the citric acid cycle and the respiratory chain.In this process, sugar molecules (glucose) are "burned" with the help of oxygen, thereby producing ATP. ATP is the abbreviation for Adenosinetriphosphate. One can also refer to ATP as the energy currency of the cell. For example, when we want to move our muscles, we need ATP for our muscle fibers to contract. At rest, our brain is the largest consumer of glucose in the entire body. About 20% of the total sugar is consumed by our brain – even at night.
Our cells therefore need "sugar" around the clock in order to function. For this reason, there are approximately 5g of glucose in our blood at all times.
To help you better understand what your body accomplishes daily, here are a few numbers: According to Mergenthaler et al., 2013 the human brain requires about 5.6mg of glucose per 100 grams of brain tissue per minute. With an average brain weight of 1400 grams, that amounts to 78.4mg per minute. Per hour, that is 4.7 grams and per day about 113 grams of glucose. And that's just for your brain!
Equally impressive is the fact, how much ATP your body consumes per day. It is on average about 65kg or as much as you weigh. Your ATP is recycled about 1000 to 1500 times a day, otherwise we would have to carry quite a bit of extra weight around with us.
In order for our cells to be supplied with glucose, we have sugar stores in the form of glycogen. Glycogen is a molecule that consists of many glucose molecules linked together.These can be separated if necessary and, for example, distributed from the liver into the blood.
Fasting blood sugar, long-term sugar – what types of measurements are there?
If you want to know your blood sugar level, there are different ways to measure it. The simplest method is a self-test with test strips and the corresponding measuring device. Both can usually be obtained at the pharmacy. For this type of test, you need a small drop of blood, which goes on the test strip, and just a few seconds later, the measuring device displays the blood sugar level. The advantage of this method is the simple execution. However, it only provides a snapshot insight into blood sugar metabolism.
A significantly more informative method is the use of glucose trackers, also known as Continuous Glucose Monitor (CGM).These devices measure, as the name suggests, your blood sugar continuously and send this information, for example, to your smartphone. This way, you can see "live" how your body reacts to different foods. Corresponding sensors are already available for about €100. The lifespan of a sensor is about two weeks – enough time to test the blood sugar reaction to different products!
In addition to these two methods, there are the following options to assess blood sugar metabolism. For this, a blood draw or a few drops of blood are usually required:
- Fasting blood sugar (NPG): Fasting blood sugar is referred to when you have not eaten anything for at least eight hours.This value is usually measured in the morning and should not exceed 100mg/dl in healthy individuals. HbA1c: This value is commonly known as "long-term sugar." It measures the concentration of red blood cells that are loaded with a sugar molecule. Since red blood cells have a lifespan of about three months, this allows for an estimation of the blood sugar situation over the last eight to twelve weeks. When making lifestyle changes or dietary adjustments, monitoring the HbA1c value makes sense only after about three months. High blood sugar levels lead to higher HbA1c values. Depending on age, there are different threshold values. The value should be below 5.7% in healthy adults.
- Occasional plasma glucose (OPG): This is the blood sugar level regardless of food intake. It varies greatly and is not particularly informative. The target value is below 200mg/dl.
A blood sugar measurement is easy to perform and provides a snapshot of the blood sugar level.
Too high blood sugar levels – what’s behind it?
If your blood sugar levels are too high, it may be a sign of the sugar metabolism disease, diabetes mellitus. Diabetes mellitus is one of the most common diseases worldwide. The most common variants or types of diabetes are Type 1 and Type 2. In Type 1 diabetes mellitus, the body's immune system destroys beta cells in our pancreas.The beta cells produce the hormone insulin. To simplify a bit, one can imagine insulin as a key that is needed to bring glucose from the blood into our cells. In type 1 diabetics, this key is missing, which is why the door to the cell interior remains locked and the sugar level in the blood becomes too high. Type 2 diabetics have a different problem. Their cells have become increasingly "resistant" to insulin. The key no longer works as well. Insulin resistance is the precursor to diabetes and, due to the significantly high number of undiagnosed cases, is a silent epidemic. The good news is that insulin resistance or prediabetes is still reversible.
Do you actually know where the name diabetes mellitus comes from? "Diabetes" comes from Greek and means something like "to flow through", while "mellitus" comes from Latin and means "honey-sweet".
The disease was already known in antiquity – with the main symptom of "sweet" urine. If blood sugar is significantly too high, the body excretes some of the excess glucose through urine. Since blood sugar levels could not be measured in the past, those affected were recognized by their sweet-tasting urine.
In the national guidelines for diabetes care in Germany, the diagnosis of type 2 diabetes mellitus is defined as follows:
At least two values of fasting blood sugar, HbA1c, or random blood sugar must be pathological.What does pathological mean exactly? Here, too, you can find corresponding threshold values in the guidelines:
| No diabetes | Increased risk for diabetes | Diabetes | |
| Fasting blood sugar | &< 100 mg/dl (&< 5.6 mmol/l) |
100 – 125 mg/dl (5.6 – 6.9 mmol/l) |
from 126 mg/dl (from 7.0 mmol/l) |
| HbA1c | &< 5.7% (&< 39 mmol/mol) |
5.7 to 6.4% (39 to 47 mmol/mol) |
from 6.5% (from 48 mmol/mol) |
| Random plasma glucose | from 200 mg/dl (from 11 mmol/l) |
If the values are not clear, an oral glucose tolerance test (OGTT) can be performed.
Sugar comes in many different forms. Basically, all of them promote insulin resistance to a similar extent.
OGTT – what does the oral glucose tolerance test say about my blood sugar metabolism?
In the oral glucose tolerance test, one drinks a sugar-water mixture, which consists of 75mg of glucose, thus significantly sweeter than soft drinks like cola. Blood sugar is measured once before consuming the drink and then every half hour after drinking. The last measurement takes place after two hours. The purpose of this admittedly somewhat elaborate test is the early detection of insulin resistance and thus impaired glucose tolerance.Typically, an OGTT is also performed during pregnancy to detect the occurrence of gestational diabetes as early as possible.The normal values for this test are defined in the National Care Guidelines for Type 2 Diabetics as follows:
| No diabetes (normal glucose tolerance) | Increased risk for diabetes | Diabetes mellitus | ||
| Abnormal fasting glucose | Impaired glucose tolerance | |||
| Plasma glucose fasting | &< 100 mg/dl (&< 5.6 mmol/l) |
100-125 mg/dl (5.6 – 6.9 mmol/l) |
&< 126 mg/dl (&< 7.0 mmol/l) |
from 126 mg/dl (from 7.0 mmol/l) |
| 2-h after oral glucose | &< 140 mg/dl (&< 7.8 mmol/l) |
– | 140 – 199 mg/dl (7.8 – 11.0 mmol/l) |
from 200 mg/dl (from 11.1 mmol/l) |
Why is blood sugar important for your longevity?
We looked at how to measure the different blood sugar levels, how to diagnose diabetes mellitus, and what insulin resistance is. But why is all of this so important for a long, healthy life?
Diabetes is a condition that often shows no symptoms for a long time. We do not necessarily notice when our blood sugar is too high. On the contrary – we quickly notice hypoglycemia. We become clammy, experience intense hunger, and cannot concentrate anymore.
According to data from the Robert Koch Institute, about 4.6 million (7.2%) of all Germans aged between 18 and 79 have a diagnosed diabetes, with the trend on the rise. This means that nearly one in ten is "diabetic". The number of insulin-resistant individuals is significantly larger but can only be estimated. Experts suspect a particularly high number of undiagnosed cases.
Injecting insulin is especially typical and necessary for type 1 diabetics.Type 2 diabetics only require insulin in the final stage of the disease.
Too high blood sugar levels and the risk of arteriosclerosis – a deadly combination
Too high sugar levels attack the vessels in our body. As a result, diabetes significantly contributes to the number one cause of death in the Western world: cardiovascular diseases. Our blood fats also play a role when they become unbalanced.
The death toll from diabetes is difficult to estimate. In the USA alone, according to this report there are more than 100,000 deaths per year. Probably even more when considering the role that high blood sugar levels play in the development of cardiovascular diseases.
Although the death toll from cardiovascular diseases is significantly higher, Dr. Peter Attia refers to insulin resistance as the foundation on which other life-shortening diseases, such as cancer, Alzheimer’s, and cardiovascular diseases can arise. From his perspective, it is important to address insulin resistance as early as possible.
Studies show that berberine, a naturally occurring dye derived from the bark of barberry plants, affects the body through the regulation of several signaling pathways and longevity pathways, including AMPK, NF-κB, sirtuins and some others, among other things on our sugar metabolism. Berberine (as well as the trace elements Chromium and Zinc) have been shown in several scientific studies to positively influence blood sugar levels (especially insulin sensitivity). All three substances are present in the Berberine Mineral Complex by MoleQlar .
Blood sugar levels – why don't we actually measure insulin?
Insulin resistance plays, as we have already seen, an important role in the development of Type 2 Diabetes Mellitus. Wouldn't it then be easier to measure insulin directly?
In principle, this is not a bad idea, however insulin does not stay very long in our bloodstream and that makes accurate measurement difficult. Much better suited for this is the C-peptide. This is produced during the creation of insulin. In the pancreas, C-peptide and insulin are still connected. For insulin to be effective, the C-peptide must now be cleaved off.
Medical professionals measure the C-peptide to gain insights into the type of diabetes.Type 1 diabetics produce little to no insulin, so simply put, their C-peptide levels are also low. Type 2 diabetics are insulin resistant. Here, the pancreas even produces more insulin, which is also reflected in a high C-peptide level.
