How Low Before A Liver Dump?

Congratulations on your great control.

I wouldn't worry about liver dumping. It happens all the time, even to non-diabetics.

It might put your BG a bit higher for a while, but I'd guess that is less harmful than trying to regulate it by eating carbs.

Metformin helps to prevent your liver from dumping too early, I think.

I would say it's not the level that's dangerous but the rate at which it's falling. In any event your 3.9 reading may well have been in the mid 4's as meters aren't entirely accurate. I'd be very pleased to get fasting levels at 3.9 or the low 4's it's my long term aim. Look at it this simplistic way.

Put a T2 and a non diabetic person on exercise bikes when their BG's are say 4. Make them do loads of exercise. In the end both will liver dump to get the energy their muscles need to continue exercising so their BG's will temporarily rise because of the liver dump and then fall again as their muscles take up the energy released. In some people (doesn't matter if they're diabetic) they may start to feel bad (dizzy, exhausted etc.) prior to their liver dump and in others (like me) they don't notice a thing.

Its only then dangerous if you then keep making either do more exercise as the liver can only dump so many times. At some point both the T2 and the non diabetic will no longer be able to compensate and BOTH will begin to hypo so again being diabetic makes no difference. What makes the difference is in an insulin injecting diabetic who injects too much the overdose effectively overrides the livers dump capability making a hypo inevitable unless they take on extras glucose by eating it. That's why a hypo is defined as a RAPID drop in BG's.

The normally accepted "hypo has started BG" is set to 2.7 but even then its not that simple. Our bodies are not stupid and will maintain a higher level of BG's around critical things like the brain for as long as possible. If you read some of the Type 1 hypo accounts on the forum you will see some people can fall into the high 1's and still be alert and conscious.

All of this is why there is a very big difference between an insulin using diabetic who dangerously hypos and the sensations of dizziness and tiredness that many non insulin dependent diabetics think are hypos. In those cases they are experiencing exactly the same sensations that a non diabetic would get in the same conditions.

Yes nothing to worry about. I've always read the "four is the floor rule" as a T1 (or insulin injecting) diabetic thing and to mean the level you should start to get concerned about if after you inject your levels fall through as it could be an indicator of a hypo onset i.e you've injected too much.

For a T2 or non diabetic person 4's are fine as a fit healthy non diabetics normal fasting range is somewhere between 3.8 and 5. The lowest reading I've ever had is 3.2 after some significant exercise, felt fine but obviously my muscles didn't as 5 minutes later I was over 7 with a liver dump. Twenty minutes after that was back in the 5's. You can also get your muscles to soak up a bit of excess glucose by taking a nice hot bath.

Trust your body to regulate your BG's, it did it fine at those "low" levels before you were T2 and there's no reason why it won't do it again if you bring your levels right back down to normal again.

This is what happens if everything is functioning fine (it's actually a diagram used in the about diabetes in dogs wiki but it's the same in humans.

In normal circumstances when you get too low, no more insulin will be produced from the beta cells and the alpha cells (both in the pancreas) will release glucagon. This will cause you liver, and muscles to release some stored glucose to get levels back to normal. Once enough glucose has been released and blood glucose levels start to rise then insulin will once more be released (and glucagon stops) Its all kept beautifully in balance, an insulin/glucagon see-saw. Unfortunately, in people with insulin resistance they will need to produce more insulin to stop the glucagon. Hence the bigger than normal rise in glucose levels. Also if they don't have enough effective insulin to stop the rise then levels can get very high.

Of course if people are using insulin or some types of oral medicines you can't stop them working so the glucagon may not be released until very low levels are reached, hence the advice about 4 is the floor. Nevertheless even that's variable.. the DAFNE course for T1 diabetics suggests that at 3.5mmol/l they eat, at below that they treat (subtle difference) My docs in France, say a similar thing though at slightly lower leves(

Thanks, Phoenix, that's very helpful.

Certainly I don't treat for mild hypos (down to 3.5) - depending on how much injected insulin is in my system at the time - I simply eat as normal if it's nearly meal time, or eat a very, very small amount of carb if between meals and test frequently. I would only treat with coca cola, orange juice etc if my BG had gone down into the 2s, or I believed I had too much insulin still active. I have been 'told off' for this, but I know from experience that if I correct as advised by the NHS (i.e. 100ml of sugary drink followed by 10g slow release carb) I would be in double figures within 20 minutes. It's reassuring to know that I am not completely mad in my thinking around correcting hypos!

Smidge

I think though the advice on 4 is a safety thing. It important when first diagnosed though when you get to know what your body does then you may begin to act differently. Personally, I have a hunch that that some of ust who were diagnosed later in life have better counter-regulatory systems than those who have had D for a long time (when there's evidence it is lost ), or are diagnosed as children .
However if you are going below 3,5 regularly , then you may begin to lose hypo awareness and not recognise things until far too low (been there and it's not good to get off a bike , or out of the swimming pool, test and realise that your meter says you are 'lo' and you feel fine, (though TBH it still didn't require much to raise the level again) Also pragmatically, I think that you have to be aware that when it comes to driving licence renewal in the UK your doctor may be taking frequent hypos into account as they may suggest a lack of awareness .

Thanks, Phoenix. I try not to go under 4 very often - I just don't correct in the 'official' way when I do because of the high/low rollercoaster it puts me on. With LADA, my BG seems to hold up very well and can hang around low 4s and high 3s for ages without falling further, so I just don't panic and over-correct it.

Fortunately, my Consultant is very supportive of keeping BGs low and doesn't class occasional high 3s as a problem - my GP is another matter - he wants me to keep it between 8 and 9 for some reason! I always test before driving and make sure I'm 5 or above before I drive, but thanks for the advice - it does worry me that an uninformed doctor could cause issues for me with my driving license

Smidge

I've been on Very Low Carb for several years and I suspect I've exhausted my liver's glycogen stores. I've had a couple of pretty low fasting readings lately [2.4/2.5] I even suspected my meter battery, because Ifelt absolutely ok. The last couple of days, however, I've been back to my usual 4.5, so it wasn't the meter. I've not figured out the cause.
Since my only medication is Metformin 500, I'm not really scared that I might have a REAL hypo episode.
They do say that the horrid symptoms of hypo may not be the actual level, but the feeling of the level dropping. That would account for my not feeling ill at 2.5 and people who are accustomed to high levels feeling poorly at 10 [ I do know one diabetic, who claims that!!!]
Hana