At high altitudes, where the air is thin, people often experience low blood sugar levels — a phenomenon long observed in Tibet, Peru, and Nepal, but remaining unexplained.
A new study from the Gladstone Institute has uncovered the mechanism: red blood cells, primarily known for transporting oxygen, transform into powerful glucose absorbers under hypoxic conditions. In experiments on mice, low oxygen levels caused a sharp decrease in blood sugar regardless of insulin. It was found that erythrocytes not only increase in number under hypoxia, but each cell absorbs three times more glucose due to an increased amount of transporters GLUT1 and GLUT4. The absorbed glucose is directed towards the production of 2,3-DPG — a molecule that helps hemoglobin release oxygen to tissues. A key role is played by an oxygen-dependent switch: at low oxygen levels, hemoglobin releases the enzyme GAPDH, and glycolysis accelerates without the involvement of genes. In diabetic mice, both hypoxia and blood transfusions reduced blood sugar levels. This discovery transforms erythrocytes from passive carriers into active regulators of metabolism and opens the way for a fundamentally new treatment for diabetes — through the management of glucose consumption by blood cells.
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