Hypo unawareness and ketones?

[kyrani99]

Using continuous glucose and adrenaline/epinephrine monitoring researchers have found that at the lowest level of sugar, in hypoglycemic aware subjects, that adrenaline was increased sharply. And they have seen that when a hypoglycemic is unaware there is little or no adrenaline (epinephrine) present. Thus the justification that the body’s response to raising blood sugars is to use the counter-regulatory hormones such as adrenaline. And that the person adrenaline response is not working properly in hypo unawareness conditions. I see a different explanation that makes better scientific sense.

Firstly, it is well known in the biology of mammals, that when heat is too low, the muscle cells vibrate to generate extra heat. So it is far more reasonable that the person becomes aware of a life-threatening problem, which generates fear or what physicians call the fight or flight response, hence the release of adrenaline. I see this is a clue to understanding hypo unawareness.

If there is not enough insulin the cells can’t use the glucose for fuel but if there is not enough glucose, as far as the cells are concerned, the same problem arises. If glucose is not available the body breaks down fats to use for energy. I would suggest that the body of the person, who has frequent hypoglycemia, has moved to using fats for energy during such time. The problem with high ketones in the body doesn’t arise because another problem, which is the lack of glucose for the brain, arises before the rise of ketones in the blood becomes a problem.

This explains why patients experiencing unawareness of their hypoglycemia do not have the presence of adrenaline. It is more reasonable to say that there is no “impairment of epinephrine/adrenaline response”. It only happens when hypoglycemia has happened in the immediate 24 to 48 hours previously or has happened many times in a short period of time. This can be seen in patients with longstanding diabetes, especially type 1 diabetes. These people also suffer from a reduced glucagon release too, which might be more evidence that point to energy fuel usage and not impairment of the adrenaline system.

If the person takes measures to avoid hypoglycemia for several weeks, ie careful watching their blood sugars and eating frequently then their hypoglycemia awareness improves. If it was due to impairment of adrenaline release this measure would not work. It works because the body is encourage to use glucose for fuel all of the time and not to habitually revert to using fats.

What do others think?

 

[phoenix]

The reason why the response system is not triggered until a lower level than in non diabetics is insulin excess not insulin deficiency . Since insulin tends to inhibit ketogenesis it seems unlikely that they are useful during hypos. (people need more insulin to reduce ketone production during DKA.)

The 'direct' causes of hypoglycemia-associated autonomic failure are sleep, previous exercise , and previous antecedent hypoglycaemia. All three cause reduced counter regulatory responses. This is when hypoglycaemia is not recognised until even lower levels.

There is however some research showing that lactate produced in astrocytes ( a type of cell in the nervous system) may act as an alternative fuel in people with T1. ( why many of us find we can function reasonably well at much lower levels of glucose than non diabetics ?) This is may help to preserve neuronal function but is thought to be insufficient to completely replace glucose in the brain)

In some people the reduced response is actually absent, this can't necessarily be changed by avoiding hypos since it is caused by a functional failure of the autonomic system due to autonomic neuropathy)

 

[Lamont D]

I had a period before diagnosis when I must have had many hypos. I was mostly unaware of them. It was my sense of hunger that probably saved me being worse. The symptoms are not easy to diagnose if you are not told or the state of being in a hypo situation. I believe after a number of visits to my doctors, that I had gotten use to them. It became my norm.
The docs gave me a hard time not recognising the state I was in. One locum told me if I wanted to get better, that I had to lose weight.
The fug of constant high and low blood levels the body responds by adjusting to get you to do things that are very difficult to understand.
I have read the science and yours is as good a theory as any I have seen. Some chemical was driving my body whilst the over flushing of insulin was occurring.
The fats stored in our bodies come from mainly unsaturated and polyunsaturates and these create the visceral fat that hinders so much of the endocrine system.
Is the whole problem of diet the way the majority cook their food?

 

[kyrani99]

The reason why the response system is not triggered until a lower level than in non diabetics is insulin excess not insulin deficiency . Since insulin tends to inhibit ketogenesis it seems unlikely that they are useful during hypos. (people need more insulin to reduce ketone production during DKA.)

The 'direct' causes of hypoglycemia-associated autonomic failure are sleep, previous exercise , and previous antecedent hypoglycaemia. All three cause reduced counter regulatory responses. This is when hypoglycaemia is not recognised until even lower levels.

There is however some research showing that lactate produced in astrocytes ( a type of cell in the nervous system) may act as an alternative fuel in people with T1. ( why many of us find we can function reasonably well at much lower levels of glucose than non diabetics ?) This is may help to preserve neuronal function but is thought to be insufficient to completely replace glucose in the brain)

In some people the reduced response is actually absent, this can't necessarily be changed by avoiding hypos since it is caused by a functional failure of the autonomic system due to autonomic neuropathy)

@phoenix

Yes there may be insulin excess but….
The response system is not triggered at all in hypo unawareness and it can happen in both types of diabetics but also non-diabetics, though extremely rare, from what I have read. But on second thoughts, I can see a case for it being triggered but unconsciously and that can contribute to ketogenesis!!!!!!!!!!
To give first the normal case….
In type 1 diabetes there is insulin deficiency so FFA (free fatty acids) and KB (ketone bodies) are increased. Ketogenesis is activated to provide a substitute energy source. FFA uptake across the splancnic area is increased. The delivery of FFA substrate to the liver is not blocked because of the absence of the blocking effect of insulin. KB Clearance is diminished. And if there is unrestricted KB accumulation it leads to metabolic acidosis (Diabetic Keto-acidosis ).

However in type 2 diabetes FFA and KB are usually elevated. Circulating KB may increase 3 fold in non obese diabetics even if FFA are normal. Why the KB increase in spite of increased insulin? The insulin should counteract ketogenesis! The reason is because of Glucagon is also increased. So there is a lower Insulin / Glucagon ratio.

So what happens if a type 1 has also an elevation of glucagon? I would suggest it has a lot to do with the causes of hypoglycemia in the first place. I suggest that if the cause of the hypo is simply a miscalculation of the amount of insulin injected, then the person would be hypo aware.

It is possible to have fear / fight or flight reaction and not be aware of it. It only feels as if you have a lot of energy or feel unusually hot. (In fact the “fall in love at first sight cheat uses unconscious fear and sells it for love as you can read here if you’re interested. (http://kyrani99.wordpress.com/2011/12/31/two-simple-uses-of-fear-and-esp-in-foul-game-play/)

So in actual fact there is a fight or flight response, which means the counter-regulatory/ adrenal hormones are triggered and raise the glucagon level necessary for glucose release into the bloodstream. But if there is too much insulin then the insulin /Glucagon ratio is too high.

So yes, there may be insulin excess but even in this case it is the glucagon to insulin ratio that plays the big role. A high Glucagon / Insulin Ratio increases lipolysis and activation of oxidative ketogenesis , a low ratio counteracts ketogenisis

Diabetes is not only a disease of Insulin deficiency but also excess Glucagon.
Glucagon has ketogenic activity. It acts in the regulation of ketogenesis independent from insulin. It activates FA oxidation at the expense of TG synthesis.

The Glucagon / Insulin ratio is more important than the absolute value of either glucagon or insulin, in determining the metabolic events in liver cells.

Sleep!
Have you had dawn phenomena.. you’ve been awakened by a fight /flight response.. and typically glucose are high. Awareness in sleep is involved so sleep can hardly be a cause! The Mayo Clinic doesn’t give any of the causes you site nor other health sites. They mainly say it is due to medications.
http://www.mayoclinic.org/diseases-conditions/hypoglycemia/basics/causes/con-20021103
I don’t agree with them because there are cases of hypoglycemia in people who are not on medications.

 

[kyrani99]

I had a period before diagnosis when I must have had many hypos. I was mostly unaware of them. It was my sense of hunger that probably saved me being worse. The symptoms are not easy to diagnose if you are not told or the state of being in a hypo situation. I believe after a number of visits to my doctors, that I had gotten use to them. It became my norm.
The docs gave me a hard time not recognising the state I was in. One locum told me if I wanted to get better, that I had to lose weight.
The fug of constant high and low blood levels the body responds by adjusting to get you to do things that are very difficult to understand.
I have read the science and yours is as good a theory as any I have seen. Some chemical was driving my body whilst the over flushing of insulin was occurring.
The fats stored in our bodies come from mainly unsaturated and polyunsaturates and these create the visceral fat that hinders so much of the endocrine system.
Is the whole problem of diet the way the majority cook their food?

@ nosher8355

In obesity, FFA and KB levels are elevated and this is true independent of normal or impaired glucose tolerance. And KB clearance is also diminished. And it is hard to see sometimes because following an oral glucose load FFA and KB levels are lowered.

I had a period of time where activity actually camouflaged my problem. I had a new job in real estate after being in an office. I saw that I started loosing weight but I didn’t do anything because I thought it was good. Actually my body was burning fats and even protein because I ended up underweight.

And I had a bad time with doctors too until I found a good one. The first doctor did not recognize that I had diabetes, even though I told him I was thirsty all the time, going to the toilet all the time and he was repeatedly treating me for thrush. Then I ended up with doctors, who did recognize the problem, but were keen to push drugs. I finally found a guy that was good but even he didn’t understand anything about diet and nutrition and how the body is affected.

You say “some chemical was driving my body whilst the over flushing of insulin was occurring”. This may well have been glucagon and it can be being triggered by the fight or flight response/ i.e., adrenaline.. the counter-regulatory hormones but you were unaware of it. If you end up with too high a glucagon/ insulin ratio then your body will increase lipolysis and activate oxidative ketogenesis. (see the answer I gave for phoenix).

 

[Lamont D]

It is possible to have fear / fight or flight reaction and not be aware of it. It only feels as if you have a lot of energy or feel unusually hot. (In fact the “fall in love

So in actual fact there is a fight or flight response, which means the counter-regulatory/ adrenal hormones are triggered and raise the glucagon level necessary for glucose release into the bloodstream. But if there is too much insulin then the insulin /Glucagon ratio is too high.

So yes, there may be insulin excess but even in this case it is the glucagon to insulin ratio that plays the big role. A high Glucagon / Insulin Ratio increases

Diabetes is not only a disease of Insulin deficiency but also excess Glucagon.
Glucagon has ketogenic activity.

Sleep!
Have you had dawn phenomena.. you’ve been awakened by a fight /flight response.. and typically glucose are high. Awareness in sleep is involved so sleep can hardly be a cause! The Mayo Clinic doesn’t give any of the causes you site nor other health sites. They mainly say it is due to medications.
[url]http://www.mayoclinic.org/diseases-conditions/hypoglycemia/basics/causes/con-20021103[/url]
I don’t agree with them because there are cases of hypoglycemia in people who are not on medications.

I had the symptom you described as flight or fight. I also have as well as insulin flushing but high glucagon levels.
I have had sleep disruption but not dawn phenomenon. Due to working patterns I always had sleep deprivation. But it increased when I became ill. The symptoms were akin to wild and weird dreams. Kicking and sweating, at one stage I was looking for stupid causes on the web. Throughout my prediagnosis I have been warm. I sat with the door open in winter. Now I'm putting the fire on in August. I have never been on meds that would cause this. I do believe that sleep disorders are major symptoms in hypoglycaemia and high glucose.
I have a rare condition because of the way my RH has occurred. Not by the usual recognised paths, like surgery.
The fight or flight response had occurrd in sleep and also when out. I went to my local co-op, I was looking for something I couldn't find. Then I started panicking and froze. A huge headache and confusion. It was a very low hypo 2.3 if I remember. I just went outside forgetting to pay what I had in my basket. Didn't know I had it! And stood outside till I calmed down.
The change in my life has been dramatic since being put on a gliptins which inhibits glucagon and insulin.

 

[kyrani99]

I had the symptom you described as flight or fight. I also have as well as insulin flushing but high glucagon levels.
I have had sleep disruption but not dawn phenomenon. Due to working patterns I always had sleep deprivation. But it increased when I became ill. The symptoms were akin to wild and weird dreams. Kicking and sweating, at one stage I was looking for stupid causes on the web. Throughout my prediagnosis I have been warm. I sat with the door open in winter. Now I'm putting the fire on in August. I have never been on meds that would cause this. I do believe that sleep disorders are major symptoms in hypoglycaemia and high glucose.
I have a rare condition because of the way my RH has occurred. Not by the usual recognised paths, like surgery.
The fight or flight response had occurrd in sleep and also when out. I went to my local co-op, I was looking for something I couldn't find. Then I started panicking and froze. A huge headache and confusion. It was a very low hypo 2.3 if I remember. I just went outside forgetting to pay what I had in my basket. Didn't know I had it! And stood outside till I calmed down.
The change in my life has been dramatic since being put on a gliptins which inhibits glucagon and insulin.

Your post came up in red underlined. No one has answered in red before, is there some significance to this?

A lot of what you describe involves fear (or the fight or flight response). It can awaken you from sleep and you can be kept awake by it. You can do a couple of things. One is you can use the time to meditate and that is often better than sleep if you do it properly. Just be mindful of your breath without trying to influence your breathing.

The other thing to realize that these dreams have no reality - no validity. I strongly suspect that these are done by related toxic people but you take the wind out of their sails knowing that they are only suggestions and nothing more, just discard them. Instruct your mind to disregard them and reject them.

The other thing that I would suggest is if you feel panicked again don't run away. Look around and eyeball everyone around you. If there is someone hassling you they won't like this. So grab back your power by going up to them and politely asking them for the time or if they know where the nearest newsagent is or some street etc. You will soon see that they will be most uncomfortable.

 

[Lamont D]

Thanks for the considerations. I have never used meditation to calm myself or use the benefits of it. I have spoken to friends that have and swear by it.
I try to clear my mind but I can't get that deep as I have a very busy mind. What I do is think 'nice' thoughts that make me smile and go from there. It has taken me on journeys of wishful dreams and memories that does relax me and my mind. I do send all the evils away, it is my switch to sleep that has my awareness hightened . I have sat with a cuppa at all times during the night. On perfect quiet trying to ease my mind. I have a large family and the worries that that unfurls can lead to stress and the wife is housebound and needs a lot from me. She can't get to sleep and I couldn't sleep long enough. What a pair!
We all work it through thinking that we are doing the right things.
Sleep is crucial for everyone and any lack or disruption must have cause and effect. The third stage of sleep is remedial and recharges the batteries. It is restorative and healing. If you don't get that regularly it can as destructive. As REM sleep.
A lot of anger and mood swings are typically symptomatic of hypers and hypos! Tiredness, fatigue and generally feeling **** must be a counter indication of sleeplessness.
I have tried to read up on sleep deprivation and it's role in disease especially diabetes and my condition of RH. My sleep is a lot better now. Hope yours is as good as mine is now. I had to set my alarm last night!

 

[kyrani99]

With meditation don't look to try and clear your mind. It is more like being on a high building and looking down at the traffic and pedestrians and just noticing them all dispassionately. Sometimes it is hard to do if there are some troubling issues. Just try to be an observer of your thoughts.. a mindful observer. Switched on but not running any thought trains. Just watch the thoughts rise up and then when you don't give them any value, don't hook onto them, they just fall away again into the void.This is a simple early form but it is one that advance mediators use too.

 

[Lamont D]

I have a busy mind that won't behave to be in that state. I appreciate the post. I subconsciously alienate all the terrible things that happen on the path of our lives. I have known most dreadful things. I have lost really close family and best friends and have had diseases within my wife and my children that have had me and my family almost resident In my local hospital. Nothing surprises me any more. I can't believe in religion because no god or diety could do the things that have happened to me, my family or my friends. No god or diety would deprive my family of my brother on the day of my wife's brothers funeral!
If you have watched any of your parents have died in front of you very slowly. And there is nothing you can do to stop or help them. Sitting day after day watching them suffer. Then you know what I mean. I deal with it through my own way. I would have been mental if I hadn't been able or on constant meds for it.
The sleeplessness is I'm certain to do with hypers and hypos. As my BSLs have stopped flushing insulin I have not had those symptoms.
Thanks again I do appreciate the interest and the post.