Phase 1 insulin response

[jonathan183]

To answer the topic question, when I go low I have a racing heart and my body mimics a panic attack, which leaves me shaky for over an hour. I can even faint.

I stress that I am not a typical type 2 diabetic, I take no meds, and my blood sugar levels can drop to 2. My medical team are puzzled, but have witnessed this and know it happens.

See Dr Bernstein's diabetes solution - page 95 & 96 diminished phase I insulin response ... you are not the only type 2 with this issue

 

[lucylocket61]

See Dr Bernstein's diabetes solution - page 95 & 96 diminished phase I insulin response ... you are not the only type 2 with this issue

i dont have that book.

 

[zand]

i dont have that book.

...Sounds like your medical team don't have it either...

 

[lucylocket61]

...Sounds like your medical team don't have it either...

well, a fuller explanation, rather than a book reference, would have been helpful. Looking at the first phase insulin response on google indicates that it is a common initial indicator of insulin resistance, not something unusual in type 2 diabetics, which my dropping down to 2 and fainting is.

 

[zand]

well, a fuller explanation, rather than a book reference, would have been helpful. Looking at the first phase insulin response on google indicates that it is a common initial indicator of insulin resistance, not something unusual in type 2 diabetics, which my dropping down to 2 and fainting is.

Yes I agree. Your dropping down to 2 is unusual.
I definitely have insulin resistance and a diminished phase one insulin response , but have never dropped to 2

 

[Oldvatr]

well, a fuller explanation, rather than a book reference, would have been helpful. Looking at the first phase insulin response on google indicates that it is a common initial indicator of insulin resistance, not something unusual in type 2 diabetics, which my dropping down to 2 and fainting is.

An explanation I have seen may explain why I too get a short period of feeling faint after eating a high protein or high-fat meal. It is that the digestion of these macronutrients places a high demand for water, which causes temporary dehydration. This may be affecting how the bgl meter is reading since they are susceptible to being affected by dehydration altering the blood chemistry.

My symptoms have gotten worse since my last stay in hospital, and it follows a change in medication where I am now on a water tablet and dapagliflozin for my heart, which is designed to dehydrate me. I was taking these meds just before my breakfast, which is a high protein meal, and in the morning following the nightly micturition that elderly men tend to suffer from, so this may be worth investigating. I will try moving these tabs to the midday slot, which in my lifestyle is a fasting period.

 

[jonathan183]

well, a fuller explanation, rather than a book reference, would have been helpful. Looking at the first phase insulin response on google indicates that it is a common initial indicator of insulin resistance, not something unusual in type 2 diabetics, which my dropping down to 2 and fainting is.

OK the way I understand it is for a non-diabetic there are 2 phases to insulin release, the first uses insulin which has been produced in the past and is stored in crystal form, and the second is a secretion at the rate it can be produced by beta cells. This means production and storage of insulin can occur without release into the bloodstream.

I believe the idea is a type 2 diabetic can loose control of the phase 1 release so insulin is released into the bloodstream as it is produced rather than stored until needed. This has two effects:-
a) the phase 1 concentrated release does not occur when needed so blood glucose rise is not controlled when carbohydrates are consumed
b) insulin is released when not needed, leading to low blood glucose even though no blood lowering medication is used.

I am not sure if this can also result in crystal release at the wrong time (I'm not a doctor), if it can then the concentrated release will also have a significant impact lowering blood glucose levels.

Hopefully that makes sense ...

Ed: Bernstein refers to granule not crystal ... sorry I misquoted

 

[lucylocket61]

OK the way I understand it is for a non-diabetic there are 2 phases to insulin release, the first uses insulin which has been produced in the past and is stored in crystal form, and the second is a secretion at the rate it can be produced by beta cells. This means production and storage of insulin can occur without release into the bloodstream.

I believe the idea is a type 2 diabetic can loose control of the phase 1 release so insulin is released into the bloodstream as it is produced rather than stored until needed. This has two effects:-
a) the phase 1 concentrated release does not occur when needed so blood glucose rise is not controlled when carbohydrates are consumed
b) insulin is released when not needed, leading to low blood glucose even though no blood lowering medication is used.

I am not sure if this can also result in crystal release at the wrong time (I'm not a doctor), if it can then the concentrated release will also have a significant impact lowering blood glucose levels.

Hopefully that makes sense ...

this is true, but doesnt explain why my blood sugar levels go down so far, enough to make me pass out. Nearly all type 2's have their liver kick in long before that point. Perhaps its because my liver was damaged, rather than as a progression of failure.

I notice you are new, so welcome to our happy band. What type of diabetic are you? It is helpful if you can fill in your profile and information, as responses you get to questions you may have vary, depending on the type of diabetes, and the meds taken for it, or if you are on no meds. Best wishes.

 

[Jaylee]

well, a fuller explanation, rather than a book reference, would have been helpful. Looking at the first phase insulin response on google indicates that it is a common initial indicator of insulin resistance, not something unusual in type 2 diabetics, which my dropping down to 2 and fainting is.

Hi,

Could the drop & passing out not be due to a possible lowered or lack of response from the liver producing glycogen?

 

[Antje77]

the first uses insulin which has been produced in the past and is stored in crystal form

I've never heard of this storing in crystal form, except when it's about injected insulin, especially Lantus (glargine). Can you tell us more about it or share a link?

 

[jonathan183]

I've never heard of this storing in crystal form, except when it's about injected insulin, especially Lantus (glargine). Can you tell us more about it or share a link?

Bernstein explains this in the section on Blood sugars: the nondiabetic versus the diabetic (page 45 to 47). I have not searched elsewhere so can't provide another link at the moment ... I'll add one when I come across something.
This might help https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324607/

 

[lucylocket61]

Hi,

Could the drop & passing out not be due to a possible lowered or lack of response from the liver producing glycogen?

Yes. My question is why, as an unmedicated type 2 diabetic, my body does this.

 

[Oldvatr]

OK the way I understand it is for a non-diabetic there are 2 phases to insulin release, the first uses insulin which has been produced in the past and is stored in crystal form, and the second is a secretion at the rate it can be produced by beta cells. This means production and storage of insulin can occur without release into the bloodstream.

I believe the idea is a type 2 diabetic can loose control of the phase 1 release so insulin is released into the bloodstream as it is produced rather than stored until needed. This has two effects:-
a) the phase 1 concentrated release does not occur when needed so blood glucose rise is not controlled when carbohydrates are consumed
b) insulin is released when not needed, leading to low blood glucose even though no blood lowering medication is used.

I am not sure if this can also result in crystal release at the wrong time (I'm not a doctor), if it can then the concentrated release will also have a significant impact lowering blood glucose levels.

Hopefully that makes sense ...

Nowhere in my investigstions into insulin have I ever seen mention of it being stored in the body on crystalline form for later use. Do you have a reference for this claim?

My understanding of Stage 1 insulin response is that amylase in the saliva starts to breakdown the simple sugars into smaller molecules before they get to the stomach and that the pancreas secretes some insulin to kick off digestion of these simple glucose sugars, thus mitigating the sharp spike,
https://diabetes.diabetesjournals.org/content/51/suppl_1/S117

The main insulin surge follows to tackle the more complex carbs, but also to start storing the excess glucose and lipid fats which is a longer term process. Insulin does a lot more than deal with just glucose. It is also the storing and the unstoring hormone snd also controls energy transfer and use in the cells themselves both from glucose and lipids since we are actually a dual fuel system.

But most endocrinologist studies I have read describe insulin as a dynamically produced enzyme, but not stored except by the blood transport system. Crystalline insulin is a man-made medium with zinc that produces long or slow acting insulin for exogenous use only.

 

[Jaylee]

Yes. My question is why, as an unmedicated type 2 diabetic, my body does this.

I can't help you on that one. But I can epathise it has to be a frightening & disorientating experience for you.

Nowhere in my investigstions into insulin have I ever seen mention of it being stored in the body on crystalline form for later use. Do you have a reference for this claim?

My understanding of Stage 1 insulin response is that amylase in the saliva starts to breakdown the simple sugars into smaller molecules before they get to the stomach and that the pancreas secretes some insulin to kick off digestion of these simple glucose sugars, thus mitigating the sharp spike,
https://diabetes.diabetesjournals.org/content/51/suppl_1/S117

The main insulin surge follows to tackle the more complex carbs, but also to start storing the excess glucose and lipid fats which is a longer term process. Insulin does a lot more than deal with just glucose. It is also the storing and the unstoring hormone snd also controls energy transfer and use in the cells themselves both from glucose and lipids since we are actually a dual fuel system.

But most endocrinologist studies I have read describe insulin as a dynamically produced enzyme, but not stored except by the blood transport system. Crystalline insulin is a man-made medium with zinc that produces long or slow acting insulin for exogenous use only.

Hi,

This comment by @jonathan183 has been bugging me too.. But I feel I may have managed to chop some sense into it?
Something to do with the GLUT-4?? https://www.futurelearn.com/info/courses/understanding-insulin/0/steps/22455

But alas... (I'll hold my hands up to this one too.)
We seem to be shifting a little off the topic.

 

[pixie1]

An explanation I have seen may explain why I too get a short period of feeling faint after eating a high protein or high-fat meal. It is that the digestion of these macronutrients places a high demand for water, which causes temporary dehydration. This may be affecting how the bgl meter is reading since they are susceptible to being affected by dehydration altering the blood chemistry.

My symptoms have gotten worse since my last stay in hospital, and it follows a change in medication where I am now on a water tablet and dapagliflozin for my heart, which is designed to dehydrate me. I was taking these meds just before my breakfast, which is a high protein meal, and in the morning following the nightly micturition that elderly men tend to suffer from, so this may be worth investigating. I will try moving these tabs to the midday slot, which in my lifestyle is a fasting period.

Maybe its the meds causing the problem, rather than the diet. However it is recommended to drink more fluids on low carb high fat diet. taking water tablets may exceserbate your condition.

 

[pixie1]

Bernstein must have had to do research. its a bit suspect that there is no evidence to base their idea on. I found out that, written work cannot be taken on face value, information is not always correct. There is so many claims and so called research out there. when delved into deeper, its not quite what it seems.

 

[Oldvatr]

Bernstein explains this in the section on Blood sugars: the nondiabetic versus the diabetic (page 45 to 47). I have not searched elsewhere so can't provide another link at the moment ... I'll add one when I come across something.
This might help https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4324607/

That report reads like it is a thesis or application paper for professorship. I do not think it is a working document, and is not documenting any experimental evidence. It is a super-blog so is somebody's explanation, as a theory. The whole document reads like it is out to baffle the reader and impress the academic body.
For example:
"In the postprandial state, a variety of nutritional factors in circulation including amino acids, fatty acids and glucose serve as insulin secretagogues resulting in the release of insulin that initiates signaling cascades responsible for the suppression hepatic glucose output,"
This is a high faluting way of saying insulin is secreted to lower blood glucose and is triggered by food intake.

I would not hang my hat on it yet until someone does some experimental work to validate the theory.

 

[ert]

well, a fuller explanation, rather than a book reference, would have been helpful. Looking at the first phase insulin response on google indicates that it is a common initial indicator of insulin resistance, not something unusual in type 2 diabetics, which my dropping down to 2 and fainting is.

I hope you are being referred for further investigations. As you are not on diabetic medication, then your medical team need to also consider the causes of non-diabetic hypoglycemia.

 

[Mr_Pot]

Nowhere in my investigstions into insulin have I ever seen mention of it being stored in the body on crystalline form for later use. Do you have a reference for this claim?

This has an indirect reference..
https://www.sciencedirect.com/science/article/abs/pii/S0065323308601436
Within many β granules, grains can be seen that almost certainly contain zinc insulin hexamers packed in a crystalline array

 

[jonathan183]

Bernstein must have had to do research. its a bit suspect that there is no evidence to base their idea on. I found out that, written work cannot be taken on face value, information is not always correct. There is so many claims and so called research out there. when delved into deeper, its not quite what it seems.

I made reference to Dr Bernstein's book as I thought it might help provide an avenue for investigation ... I consider him an expert - I am not. I'll go with the explanation provided by a type 1 diabetic for over 65 years and a doctor who treats diabetics. Others may wish to search for other published information on this subject 8)