Fueling Hunger Despite High Blood Sugar?

January 9, 2024by Dr. S. F. Czar0

The Ghrelin Enigma in Diabetes Mellitus:

Diabetes mellitus is a chronic illness characterized by elevated blood sugar levels. Despite this, many diabetics experience persistent hunger, a phenomenon known as the ghrelin enigma. Ghrelin, often referred to as the “hunger hormone,” is a peptide hormone produced by the stomach that stimulates appetite. In healthy individuals, ghrelin levels rise before meals and decrease afterward. However, in diabetics, ghrelin levels often remain elevated, even after eating, contributing to persistent hunger and difficulty with glycemic control.

Ghrelin and its role in appetite regulation

Ghrelin is produced by P/D endocrine cells in the fundus of the stomach. Its release is stimulated by an empty stomach and inhibited by leptin, a satiety hormone produced by adipose tissue. When ghrelin enters the bloodstream, it binds to receptors in the hypothalamus, the brain’s appetite control center. This binding triggers a cascade of signaling events that stimulate appetite and food intake.

Ghrelin in diabetes mellitus

Several factors contribute to the ghrelin enigma in diabetes mellitus:

  • Insulin resistance: In diabetes, the body becomes resistant to the effects of insulin, a hormone that regulates blood sugar levels. Insulin also suppresses ghrelin production. Therefore, insulin resistance leads to increased ghrelin secretion, contributing to persistent hunger.
  • Chronic inflammation: Diabetes is often associated with chronic low-grade inflammation. This inflammation can stimulate ghrelin production and further exacerbate the ghrelin enigma.
  • Changes in gut hormones: Diabetes can also affect the production of other gut hormones, such as GLP-1 and peptide YY, which promote satiety. A decrease in these hormones, along with elevated ghrelin levels, can contribute to persistent hunger.
  • Psychological factors: Some diabetics may experience increased hunger due to psychological factors, such as stress, anxiety, and depression. These factors can activate the reward system in the brain, leading to cravings and overeating.

Consequences of the ghrelin enigma

The ghrelin enigma can have significant consequences for diabetics. Persistent hunger can lead to:

  • Overeating and weight gain: This can worsen insulin resistance and make glycemic control more challenging.
  • Poor dietary choices: Diabetics who are constantly hungry may be more likely to make unhealthy food choices, such as sugary or processed foods.
  • Increased risk of complications: Poor glycemic control and unhealthy eating habits can increase the risk of diabetes complications, such as neuropathy, retinopathy, and nephropathy.

Management of the ghrelin enigma

There are several strategies that can help diabetics manage the ghrelin enigma:

  • Dietary modifications: Eating a balanced diet that includes plenty of fiber and protein can help regulate blood sugar levels and promote satiety. Smaller, more frequent meals may also be helpful in managing hunger.
  • Medications: Several medications can help regulate ghrelin levels and reduce hunger. These medications include GLP-1 receptor agonists, DPP-4 inhibitors, and ghrelin receptor antagonists.
  • Lifestyle changes: Regular exercise and stress management techniques can help improve insulin sensitivity and reduce chronic inflammation, both of which can contribute to the ghrelin enigma.
  • Psychological support: Diabetics who are struggling with persistent hunger may benefit from psychological support to help them develop healthy coping mechanisms and prevent emotional eating.

Ghrelin, the “Hunger Hormone”: Produced by the stomach, ghrelin revs up appetite before meals and dips afterward. In healthy folks, this dance keeps hunger in check.

The Diabetic Twist: In diabetes, insulin resistance throws the dance off. Ghrelin stays high, even after eating, fueling persistent hunger and making glycemic control challenging.

Why the High Ghrelin?

  • Insulin Resistance: Insulin normally suppresses ghrelin. With resistance, ghrelin production goes rogue.
  • Chronic Inflammation: Diabetes-linked inflammation can boost ghrelin too.
  • Gut Hormone Imbalance: Other gut hormones like GLP-1, which promote satiety, might be low in diabetes, further complicating things.
  • Psychological Factors: Stress and anxiety can activate the brain’s reward system, leading to cravings and overeating.

Consequences of the Enigma:

  • Overeating and Weight Gain: Constant hunger can lead to uncontrolled food intake, worsening insulin resistance and glycemic control.
  • Poor Dietary Choices: Hunger pangs often translate to unhealthy food choices, further impacting blood sugar levels.
  • Increased Complication Risk: Poor glycemic control and unhealthy eating habits raise the risk of diabetes complications like neuropathy and retinopathy.

Managing the Enigma:

  • Dietary Changes: Prioritize a balanced diet rich in fiber and protein for satiety. Consider smaller, frequent meals to manage hunger.
  • Medications: GLP-1 receptor agonists, DPP-4 inhibitors, and ghrelin receptor antagonists can help regulate ghrelin and reduce hunger.
  • Lifestyle Tweaks: Regular exercise and stress management techniques can improve insulin sensitivity and reduce inflammation.
  • Psychological Support: If emotional eating is a struggle, consider seeking psychological support to develop healthy coping mechanisms.

The Takeaway: The ghrelin enigma adds complexity to diabetes management. However, by understanding the underlying mechanisms and employing effective strategies, diabetics can gain control over hunger, improve blood sugar levels, and ultimately, enhance their well-being.


The ghrelin enigma is a complex phenomenon that can significantly impact the lives of diabetics. By understanding the factors that contribute to persistent hunger and implementing effective management strategies, diabetics can better control their blood sugar levels and improve their overall health and well-being.

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