Good Old Blood Sugar Again

Blood sugar problems can sometimes hinder the proper action thyroid hormone.

On of insulin's roles is to act on the membranes that surrounded each of our cells. Insulin enables the cell membranes to allow blood sugar to enter the cells.

If blood sugar is rising too high at times then this may mean one of two things:

1) Insulin is too low and therefore this stops enough glucose from entering the cells - and the blood levels of glucose are high at times. Diabetes is the extreme case of this but pre-diabetes (early beginnings of diabetes can also do this).

2) Insulin levels are fine but the insulin isn't acting on the cell membranes properly - which means in turn that glucose isn't getting into the cells. This is called insulin resistance.

In both 1 and 2 above in some cases by restricting carbs the patient may be able to avoid high levels of blood sugar BUT this may have the consequence that not enough glucose enters the cells.

If glucose doesn't enter the cells in sufficient quantity then the mitochondria won't make enough Adenosine Triphosphate (ATP), and this will starve the cell nuclei of chemical energy. The consequence of this is that thyroid hormone won't be able to help the cells work faster and better - regardless of how much thyroid hormone or what type you take.

The other consequence is that when you take more thyroid hormone (of any type), the cells say: "Hey! I need more ATP - why haven't you given me more glucose? Hey! You had better ask the adrenaline guys to make some more glucose fast because we've run out down here!" So, we can sometimes see the symptoms of excess adrenaline in people that do not have enough ATP for some reason. Even good cortisol levels won't fix this if it is pre-diabetes or insulin resistance.

Fixing blood sugar levels by keeping them low by diet is NO solution either, as I have already mentioned. We need to eat food and see blood sugar go up and down naturally, i.e. insulin needs to be made and it needs to work. This is red flag for all those people who have been told to manage their rising blood sugar by going on calorie or carb restricted diets. Completely restricting our carbs isn't the right way for many people because our cells need glucose. Some doctors put people on a very low carb diet and say that is good enough - sometimes it isn't and the person just feels tired all the time. That just keeps the sugar levels down and doesn't fix the underlying issue. For those on a great diet with plenty of good quality fats, protein and enough other vitamins and minerals, yes, they can do well by limiting cards. This is what a Ketogenic diet is all about and it is quite healthy. A ketogenic diet can provide good, stable blood sugar levels without having to use lots of carbohydrates. In fact, ketogenic diets are known to burn excess fat and in doing so release plenty of energy and necessary blood sugar.  But simply going from a normal diet and just chopping the carbs out is not necessarily going to be healthy and may be quite the reverse.

So, the way forward when blood sugar issues are suspected is proper lab testing.

One excellent test is a glucose tolerance test (GTT) with insulin being measured also. A GTT usually is done on a morning before someone has eaten anything. Insulin and glucose may be measured at the start of the test. A fixed amount of glucose is then given to the patient and then glucose and insulin may be measured every 30-60 minutes over the period of a few hours.

If glucose and insulin both go high after the glucose is given then this may suggest insulin resistance. If glucose is high and insulin is low then it is pre-diabetes. Metformin or other medications may be needed if it is insulin resistance or a very early form of diabetes. A doctor experienced with the GTT can interpret the results easily - but often a patient will have to ask for insulin to be tested as well as glucose.

Some problems may be rooted in the gut and a proper approach to gut healing and the removal of aggravating foods (gluten or lactose containing foods are often a problem) may be a vital step in managing blood sugar. Finding a good doctor, naturopath or specialist who can support someone in healing their gut and enabling good digestion may be relevant for some people. 

None of the above is specific to the use of T3, NDT or CT3M. Having good blood sugar control is simply essential for correct thyroid hormone action.

Of course if a patient has low cortisol, this will often result in low levels of blood sugar, as maintaining healthy glucose levels in the blood is one of the main roles of cortisol in the body.
So, CT3M may be appropriate for some patients with low cortisol problems, and that may be enough in some cases to correct any low blood sugar issue (hypoglycaemia).

It is definitely best to work on whatever is causing the blood sugar issue - be it high or low. Usually this does not mean that starting thyroid treatment or changing thyroid treatment has to be delayed. If someone needs T3 for instance (perhaps due to extremely poor conversion) they should just get on with this and work on the blood sugar issues in parallel. If someone has low cortisol which responds to CT3M, they should continue to work on this. Any issue with blood sugar can usually be handled in parallel. In fact, it is now thought that insulin resistance actually responds to T3 therapy:

I Hope that you found this helpful.

Best wishes,


(Updated in February 2019)