Can Hypothyroidism Cause High Blood Sugar?
The answer is yes!
But what I find in most patients is that the primary cause of high blood sugar is typically not the thyroid (although it certainly can contribute).
Instead, there are several other conditions such as the amount of stress that you are under, what type and how much thyroid medication you are taking, the foods that you are eating, and more.
In this article, we are going to discuss the nuances of managing high blood sugar if you have hypothyroidism and include some takeaway therapies as well.
High Blood Sugar Stems from Insulin Resistance (& Sugar Consumption)
Treating high blood sugar is incredibly important from an overall health perspective but also from a weight loss perspective.
Because the fact that you have high blood sugar is usually a sign of something known as insulin resistance.
You've probably heard of insulin in the past but perhaps you didn't really understand its significance.
It's important to understand these basics so you can understand how your thyroid impacts both insulin and blood sugar.
So what exactly is insulin?
Insulin is a hormone secreted by your pancreas typically in response to food (1) (but stress can also stimulate it).
Your body produces insulin after you eat a carbohydrate-rich meal because it wants to utilize the energy you just consumed.
Insulin directs your blood sugar INTO your cells.
And this is a good thing (typically).
But there is a difference between insulin the hormone and insulin resistance.
Insulin resistance is a state of cellular resistance to insulin which occurs in response to repetitive and repeated carbohydrate (sugar) intake.
And that's when things start to become a problem.
As your body becomes resistant to insulin, your blood sugar will rise because your body has a harder time putting inside of your cells.
This leaves it floating around in your bloodstream instead of inside of your cells where you want it.
So how does your thyroid fit in?
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Hypothyroidism and Blood Sugar
What does that mean?
It means that if there is something wrong with your thyroid function then it will almost always affect your blood sugar in some way.
And, by the way, this is separate from other issues which can ALSO cause insulin resistance.
It's certainly possible that you have high blood sugar from a diet rich in carbohydrates (sugar) which is ALSO made worse by the fact that you have hypothyroidism.
Thyroid hormone, under normal conditions, is supposed to act to help your body get rid of excess sugar inside of your cells.
In this way, it opposes the action of insulin.
The interplay of thyroid hormone and insulin/blood sugar is actually more complex than that (3), but this serves to drive home the point.
If there is an issue in thyroid status (meaning that your thyroid levels are abnormal) then it will always affect your blood sugar and insulin receptor sensitivity in some way.
It's best to think of the connection between thyroid function and blood sugar as a balance.
If thyroid hormone is too low then it will result in high blood sugar and insulin resistance.
On the flip side, if thyroid hormone is too high then it will also result in insulin resistance and high blood sugar.
You want your thyroid status to be just right in order to balance blood sugar.
This also means that patients with hypothyroidism (which is incredibly common, by the way) are at a distinct disadvantage when compared to other healthy people.
Because the current treatment paradigm for hypothyroidism may leave up to 20% of thyroid patients 'undertreated'.
Does Thyroid Medication Worsen or Treat Insulin Resistance?
One question that I am asked frequently has to do with thyroid medication and whether or not it helps or hurts blood sugar.
The answer is that thyroid medication only impacts blood sugar insofar as it impacts thyroid function in your body.
What do I mean?
It means that it depends on how much you are taking and how much your body actually needs.
It's possible for thyroid medication to make insulin resistance (and blood sugar) worse but it's also possible for thyroid medication to improve your blood sugar.
It depends on how much you are using.
Thyroid medication is always taken to treat a deficiency of thyroid hormone in your body.
But taking thyroid medication is NOT the same as allowing your body to produce thyroid hormone on its own and we are never quite as good as your own body is at that.
If you take too much thyroid medication (T4 or T3) and you become hyperthyroid based on certain lab tests, then you may raise your blood sugar,
I don't find this to be common for most people because most people are not taking enough thyroid medication.
The situation I see in most patients is that they are not taking ENOUGH thyroid medication or the right type of thyroid medication.
This generally leads to persistently high blood sugar (and insulin resistance (4)) and the inability to lose weight.
If you take the right type of thyroid medication (usually a medication which contains a combination of both T4 and T3) it's usually much easier to lose weight and it has to do with thyroid status in your body (not the medication itself).
Cortisol, Blood Sugar & Thyroid Function
The connection between your thyroid and blood sugar goes even deeper than what I've already explained so far.
There is a further connection between your thyroid function and your stress levels that we also need to address.
A quick recap first, though:
We know that hypothyroidism (or hyperthyroidism) can lead to high blood sugar.
This blood sugar issue can be treated with the use of thyroid medication.
But what about stress and cortisol?
There is another deeper connection between cortisol and your TSH (another way to describe the fact that cortisol impacts thyroid function).
For those unaccustomed to understanding the nuances of TSH, a rising TSH is an indication of HYPO (slowing) thyroid function.
So, what does that mean for you?
It means that stress can cause a decline in thyroid function by itself.
So now we have a system that looks like this:
Stress = decreases thyroid function = increases insulin resistance = increases blood sugar = increases your weight
And it doesn't stop there.
In this way, it's probably more important for you to manage stress (if you are suffering from it) than it is to focus on your thyroid to directly impact both your thyroid and your blood sugar.
A high amount of untreated and repeated stress can lead to weight gain from insulin resistance which usually manifests as an increase in belly fat (not ideal for most people!).
The bottom line?
If you have high blood sugar and hypothyroidism, you should also make sure to consider testing your cortisol and managing your stress.
By addressing both your stress and cortisol you may be able to indirectly impact your thyroid function.
The Impact of your Diet on Blood Sugar
Another area which is worth going into some more detail is that of your diet and its impact on your blood sugar.
I touched on this in the very beginning but not for long.
When most people think about high blood sugar they often think immediately of the food that they put in their mouth (7).
It just makes logical sense that if you eat a meal high in sugar that it will then increase your blood levels of sugar and this is largely true.
Imagine consuming a 44-ounce big gulp (or whatever they are called near you) of Coke or Pepsi loaded with high fructose corn syrup.
All of that sugar is going to be rapidly absorbed into your body and trigger the release of insulin as we've discussed previously.
But other foods are also high in blood sugar and more than just carbohydrates can stimulate the same response.
Starchy foods, potatoes, fruits, etc. can all be absorbed and stimulate the insulin response as well.
The main difference between these foods and the big gulp example is the rate of absorption and how this rate impacts the rise of insulin levels from the pancreas (8).
Because of this, healthy whole foods are nowhere near as hard on insulin levels as foods with rapidly absorbed sugar.
In addition to this, high sugar foods which are consumed with high fat also exacerbate and contribute to insulin resistance.
I've found that it's generally safe for most people (not all) to consume whole foods which are high in 'sugar' if they don't consume them with high fat (even healthy fats (9)).
Beyond this relationship, it's also important to note that even foods high in protein can also stimulate the insulin response.
The only macromolecule which has the smallest impact on insulin by itself is fat.
Because of this, many doctors and providers have started recommending diets which are very high in fat as a treatment for high blood sugar and insulin resistance.
But there is a problem with this approach... it doesn't always work!
*Note though, that it does at least a majority of patients but it's often insufficient to completely reverse insulin resistance by itself.
There are plenty of people who go on ketogenic diets and high fat & low carbohydrate diets but yet they still experience high blood sugar and weight gain.
This just highlights the fact that we need to better understand the relationship between blood sugar and insulin.
My opinion is that there are other factors outside of just your diet that contribute such as subclinical thyroid dysfunction and cortisol dysregulation (as we've discussed above).
Treating Insulin Resistance if you have Hypothyroidism
So, what are you supposed to do if you have high blood sugar and hypothyroidism and you want to treat it?
What if you want to treat insulin resistance to help you lose weight?
There are several strategies that you can take and I've listed several below:
- Optimize your thyroid medication - What I mean here is that you need to make sure that your thyroid medication is optimized for your body. For most of you, that means you will probably need to take more than you are currently taking. For some that may mean lowering your dose. When optimizing your medication for blood sugar, you'll want to focus less on the TSH and more on your free thyroid hormones (free T3 and free t4). As you optimize both of these numbers you will probably find that your blood sugar will drop naturally. Avoid increasing these numbers outside of the reference range while trying to optimize them in the top percentile of the "normal" range. You can learn more about this concept here.
- Take insulin sensitizing supplements - There are several supplements (which are available over the counter) which you can take in conjunction with all of the therapies I've listed here, which can help improve your blood sugar. Some of my favorites include Berberine, fish oil, Alpha lipoic acid, and chromium. These supplements all have scientific studies which show that they are effective at reducing both blood sugar and insulin resistance. And the best part is that they can be taken or used in conjunction with medications and other lifestyle modifications.
- Take insulin-sensitizing medications - If you really want to kick things up a notch you can also try the use of insulin-sensitizing medications. These medications are particularly useful if you are struggling with weight loss resistance which you believe is secondary to insulin resistance/high blood sugar. These medications can be used temporarily (to reverse the condition) and don't necessarily have to be taken long-term for you to realize their benefits. Medications which fit into this category include Victoza, Saxenda, and Metformin. There are others, but these should serve as a good basic framework for you to look at. Victoza and Saxenda are quite expensive if insurance doesn't cover them while metformin is incredibly cheap at around $4.00 per month. The downside to using Metformin is that it's not quite as effective as the others, but it's a great medication to use in many people. Metformin (and the others) can also be used in conjunction with supplements with may enhance their potency and effects!
- Exercise correctly - We didn't talk much about exercise in this post, but it's certainly an important aspect if you are trying to lower your blood sugar. Exercises which put a temporary high strain on the body over a short period of time tend to be best at improving insulin sensitivity. Exercises that fit into the high-intensity interval training spectrum are often ideal. The good news is that you don't need to spend hours on a treadmill but the bad news is you will need to push yourself to get results.
- Clean up your diet - Another thing you'll want to do no matter which therapies you use is adjusting your diet. Taking all the supplements, medications, and thyroid hormone in the world will not be enough to counteract the negative effects of a bad diet. Most people know what 'healthy' foods are, but even if you aren't sure then look to a diet such as Whole-30 as a guide. Diets which are high in real, whole foods are your best bet.
- Consider other medications such as LDN - Lastly, some other medications can also be used to help sensitive your body to insulin. Medications like LDN (low dose naltrexone) can also potentially help autoimmune disease states such as Hashimoto's thyroiditis (a major cause of hypothyroidism). These medications are often prescribed off-label though, so you may need a willing physician to help you out.
As you consider these therapies just keep in mind that the more therapies you add on top of each other the more likely you are to see your desired results.
That means you'll want to simultaneously change your diet, take the right supplements, adjust your thyroid medication, exercise sufficiently, and consider other medications to normalize your weight and blood sugar.
While it is true that hypothyroidism can lead to high blood sugar, the connection between the two is not just that simple.
There is a range of competing factors which can also contribute to high blood sugar in hypothyroid patients which should also be evaluated.
The good news is that you can lower your blood sugar by taking several steps such as adjusting your thyroid medication, taking supplements, and improving your lifestyle.
Lastly, never forget the connection between stress, your thyroid, and your blood sugar.
Many people out there right now are probably suffering from a combination of all 3 while not even realizing it.
If you haven't already, I would encourage you to look at therapies (supplements) which can help your body tolerate more stress than it would be able to otherwise.
These therapies have the potential to help improve your energy levels and may also improve other hormone systems in your body.
But now I want to hear from you:
Do you have hypothyroidism?
Do you also have high blood sugar?
What have you done to try and treat your blood sugar?
Do you feel that stress is contributing to your situation?
Leave your comments or questions below!
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