Glycogen stores, hypos and low carb/keto diets

Hi, thanks for the topic @EllieM ,

I'll tag in @MarkMunday ,

Because from my understanding the "100 to 130gees" estimated in the liver is by non D sporting types rumnning about for a few hours.. (Done a little Googling too.)
Where as I personally scoot up 3mmol with "foot on the floor" after something like a dog walk & prep for work within 2 hours of getting up, then stay there if I don't correct? So I am looking at something like the equivalent 10g of carbs...

I low carb too.. & never do breakfast opting for a "brunch" or lunch.. & also use a calibrated sensor CGM set up.

Generally, death where hypos are suspected are often caused by something else. There is no way of telling post-mortem what blood glucose was at the time of death, so when hypoglycemia appears on a death certificate, it is guesswork. With the so-called dead-in-bed syndrome, death is now thought to be caused by an otherwise benign congenital heart defect.

People on ketogenic diets are thought to have 50% less glycogen in their livers. That could just be speculation, but in any case, such people have a much smaller need for glycogen. Simply because fat is the main source of energy. Bolusing is much smaller and basal is reduced too. Even the brain learns to use use fat for energy. I guess the implication of reduced liver glycogen capacity in people doing Kato is that they should avoid injecting large amounts of insulin. But that is like preaching to the converted ...

EllieM said:

Not going to disagree with you there, but I am actually wondering if a decreased liver dump is a factor if you go low carb.... There are lots of low carb pros, is this a low carb con for a T1?

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Well my FBG was 5.9 this am 4.9 yesterday go figure.. about 15 g of carbs both days before (naughty oppo) ...

I even had a 6.1 a couple of weeks ago so for me ultra low still get liver dumps.

EllieM said:

OK, a bit of googling suggests that the people on low carb or keto diets have less glycogen in the liver? So what's the implication of this for those of us T1s who rely on a bit of help from their livers when they go hypo?

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I do not believe we can ever rely on our Livers helping out. Just one sniff of Insulin in the body and it just wont happen anyway. I am fortunate though to not have to worry about it as I do not believe I have ever had a night time Hypo.

Reducing the amount of carbs should also mean a drop in Insulin which may mean the Liver helps out more to begin with but the body should adapt to using stored fat instead.

I have been playing with low carbs for 3 months with 50g to less than 80g a day. I feel better for it now but the first couple of weeks I felt very tired and lethargic. I have now reduced my Basal Insulin by half and my Bolus by much more. The trouble with me is I am not strict enough with it so probably have not ventured too far into the Ketososis phase although I did lose over a stone in weight.

My BG levels used to fluctuate wildly with varying highs between 8 & 15, probably due to my bad management but with low carb the average was around 6 with whole days of between 5-6 readings including night time. I have never been able to do that before.

This you tube video is a discussion with Dr Ian Lake a T1 from age of 30 who is an advocate of low carb diet. There are so many interesting points in it. The main one for me is that only 10% of T1's in the UK reach a Hba1c of 7% or lower whereas those on a Keto diet it is 90%!

He also talks about his (and others) recent "Zero 5 100" event. No food for 5 days running/walking 100 miles. Around the 40 min mark he says that many of those taking part were regularly showing BG of 3 with no adverse effect or any of the usual Hypo symptoms.

EllieM said:

I agree with you there, which is why I find a cgm with an alarm that goes off at 4,4 so valuable. (Before that I had to keep my levels much higher). Of course, I can't count on the alarm working 100%, but since self funding my dexcom my hypos have drastically reduced. Loss of hypo awareness is a real risk for T1s who have too many hypos, and though the liver may or may not protect us from death by hypo, it certainly doesn't protect hypo unaware T1s from unconsciousness and trips to hospital (plus seizures and/or loss of driving licenses).

But back to my original question, I'm pretty sure that my liver partially mitigates the effects of mild and bad hypos, so I was wondering about the trade off between lower carb and less mitigation but less insulin to require that mitigation....

But as a T1, you have to learn to live with hypos. Too much hypo fear can be as debilitating as the hypos themselves. (Think of it this way, you always look both ways before crossing the road to avoid being hit by a car, but don't refuse to ever leave your house because you're afraid you might be hit by a car.) Always, always carry glucose or equivalent if you're on insulin.

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If you do watch that video I suggested above I would be very interested to see if it has changed your thoughts or fears.

EllieM said:

... Basically they started with 20 units and kept increasing the daily dose until the patients went into comas, with coma rates as low as 40 and as high as 600 units (guess there were T2s with schizophrenia). ...

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A doctor in Dunedin murdered his wife using this approach. She was ill but not a diabetic and he injected insulin every day until she died. It took three weeks. A single insulin dose is seldom fatal, though, and attempted suicide using insulin is usually not successful.

EllieM said:

... brittle diabetes ...

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That term raises various reasons. What exactly is brittle diabetes? Why don't T1s eating low carb or keto ever have it? What is the difference between poorly controlled and brittle diabetes? And what evidence backs up the assertion that these people don't make glucagon when required?