hypoglycaemia

[kitedoc]

I note the hypoglycaemia video of 2022 and the advice given. Whilst I agree with the advice about use of glucose to combat or remedy a hypo, (assuming the person can safely swallow, I have come, at 58 years on insulin as a T1D, to realise that use of fizzy drinks, fruit juice and lollies is not an ideal remedy - UNLESS as a last resort - glucose supply being exhausted, unusable etc.

Why? Think about how often hypos happen, particularly on high carb diets with 'industrial' doses of insulin (as per the late Dr Bernstein), and in young children and adolescents with T1D.
Sucrose, the main sugar in these processed food remedies, is split by an enzyme in the mouth into glucose and fructose (fruit sugar). Glucose is rapidly absorbed to help raise the blood glucose level as expected. BUT the fructose in this rapidly absorbed form is dealt with by the liver - THE SAME way as alcohol -(in fact rapidly absorbed fructose is sometimes referred to as 'children's alcohol'.
Imagine repeated doses of fructose leading to fatty liver. Imagine this happening over years - the result of fructose exposure is linked to not only fatty liver, a pre-cursor fro cardio-vascular disease, but to formation of cataracts in the eyes, damage to retinas, kidney and peripheral nerves.
To add insult to injury: when one's BGL reaches > 7 mmol/l, a biochemical pathway, the polyol pathway, converts 30% of the blood glucose to fructose! Hence, should TIR exceed 7 mmol/l? Now look at the accompanying chart attached: an equivalent HBA1c to an average BGL level of 7 mmol/l = 5.7% (DCCT-derived) and of average BGL of 6 mmol/l = HBA1C off 5.2%.
So fructose happens to be the most powerful and rapid glycator (damage to protein when a sugar attaches to it): fructose> galactose (breakdown of lactose - milk sugar) and least, glucose.
All good reasons to avoid fructose and BGLs > 7 mmol/l. And sucrose & fructose affects out teeth more than glucose.
What HBA1c is recommended to you and did your health team point out the dangers of sucrose as a hypo remedy?

 

[EllieM]

Very interesting (if depressing) but could you supply some links to back up these statements?

 

[SimonP78]

I've not seen 7mmol/l as a threshold for the polyol pathway to become preferential/more significant than the glycolysis pathway (I must admit I've never investigated in any detail either), I'd be interested to see your reference.

I think in theory that it is preferable to treat hypos with glucose as, as you say, half of the sucrose one might use is broken down into fructose which isn't very useful for the immediate problem and generally ends up on the pathway to be stored as fat. With that said, if one tries to avoid being permanently hypo, this isn't really a major factor (unless you're mass/volume constrained in the quantity of treatments you can carry - any T1s going to Mars perhaps?)

The other point about sucrose-based treatments is that they are widely available and much more palatable than glucose/dextrose tablets (IMO), and when hypo getting a treatment fast and that is acceptable without needing to consider whether you might find something you prefer is quite a large factor in my experience.

I have a range of things to use if hypo, if I'm not dropping too fast I'll even eat chocolate (which contains fat that slows absorption, not recommended) because I prefer it to sweets (containing sucrose). I have sometimes taken dextrose (glucose) tablets for a very fast fix, but I'd far prefer to not eat them and I don't really find that they are significantly faster acting that sucrose-containing sweets, probably because the sweets are so much more palatable that I can easy eat twice as much mass (and therefore obtain the same total glucose content, and accept the other half is going to aid my long distance cycling )

 

[lovinglife]

@kitedoc can you post a link to the video you are referring to please

 

[Jaylee]

Hi,

I think the trick is for me knowing how much & what type of active insulin is on board & knowing how carbs raise me by so much pulling me back into the “zone?”
The use of CGMs has been a boom. Taking the edge of a hypo with an advanced warning..

Previously I had to act on the early symptoms which although treated, got slightly worse before getting any better..

 

[Lamont D]

I'm not type 1, so I'm not going to give advice.
But I have had a lot experience of controlling my blood glucose and having to treat hypoglycaemic episodes. Whilst feeling absolutely.......!!!!
From before diagnosis and experiencing the realisation that what was happening to me, then watching what happens after I tried to arrest the hypoglycaemic episodes, but the treatment from the health teams made it worse. Because of the rebound effect, that within a three hour time frame, I would go hypo again. And it was showing that my BG levels were on a rollercoaster ride and the effects and the symptoms (really bad) was just as worse as not knowing before diagnosis.
So not only was I experimenting, cos there was not a lot out there for RH, the food I was finding was not good for me, but I was also discovering, how to try and temper, to nudge it gently back into normal levels without causing the rebound effect.
Too much insulin is bad, insulinaemia, too much glucose, hyperglycaemia is also bad. I needed a happy medium, I needed something that I could rely on when my sensing an episode.
I also needed something that I could tolerate.
I have always been lactose intolerant and found to be wheat intolerant. Amongst others.
I did eventually find that a bit of fatty meat did stop the drop, but a low carb meal afterwards would settle me down as long as it didn't raise it too high again.
What I getting at, is that, the recommendations from the health services might not be what is right for you. Too much glucose in a situation where you are having an episode, could be very serious.
Moderation, or whatever stops both the the episode or the rebound effect. To get your BG levels into normal is what I really needed, however it is done.
I have found that above 8mmols, is my limit, before I over produce insulin(called an overshoot) and the longer I am in normal levels, my health and my symptoms are so much better.
So, I do stay there as much as possible.
Hope this is ok for the mods.