Hypoglycaemia and liver response

I’ve never quite understood this one myself. Obviously glucose has to be quickly administered orally in the event of a hypo, but I wonder do the alpha cells still secrete glucagon when required, or is the entire pancreas just a passenger both in terms of insulin and glucagon? I may have asked the question some time ago but can’t recall.

I think we need to remember that the hypo will have been caused by an excess of insulin exogenously.. this may prove to be too much for the liver to cope with hence the hypo in the first place.
A truly vicious cycle?

bulkbiker said:

I think we need to remember that the hypo will have been caused by an excess of insulin exogenously.. this may prove to be too much for the liver to cope with hence the hypo in the first place.
A truly vicious cycle?

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Good point. My comment was more of a general one. Does a type 1 pancreas still secrete glucagon that allows the liver to raise glucose when the person doesn’t eat? In other words can they hypo even without overusing insulin?

Jim Lahey said:

Good point. My comment was more of a general one. Does a type 1 pancreas still secrete glucagon that allows the liver to raise glucose when the person doesn’t eat? In other words can they hypo even without overusing insulin?

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Hi Jim, I would say yes, that is precisely why we need background insulin whether we are eating or not. It all sounds so easy doesn't it, simply use the exact right amount of insulin and all will be well. The reality as we all know is completely different, even when we get the bolus more or less right the basal can suddenly kick in at any time of the day and wham, hypo. Forget the insulin altogether and the levels still go up and down, exercise, illness etc, etc. I know that when I go low even without taking a glucose tablet my levels will rise a few notches. I don't recommend that anyone test this out of course but a few times I have been distracted, intended to remedy a hypo, forgot for 20 minutes, tested again and it's risen on its own. I suppose that it could all be down to an excess of the correct amount of insulin that causes hypos but even when I was of insulin for 3 months I STILL dropped into the 2s and 3s. Sigh. x

Thanks. With 20/20 hindsight I suppose the answer to my question was obvious, since we already know that T1 use basal insulin.

As a full-on-T1 hypo is a medical emergency it needs treating quickly with fast acting glucose. You can’t rely on a pretty slow glucagon response to get you out of it. Just take enough glucose to get you where you need to be.

I think the liver is quite slow and it may or may not save you depending on how much insulin is on board. In my case where I had a severe hypo where I couldn't assist myself, my body was actually slowly shutting down because it didn't have enough energy to keep all my organs running. Until paramedics came to assist, any longer I would be somewhere deep in a coma. My liver couldn't save me, even if it did, it wasn't enough glucose to bring myself out of the severe hypo. So I needed help and needed fast acting glucose.

My opinion based on my own experience is that the pancreas can be deficient in, or unable to produce glucagon, in addition to insulin.

zbluebirdz said:

I'm trying to understand a bit more about T1D. I have T2D.

If a T1D is starting to have a hypo (low bsl), can the liver release more glucose into the blood to correct the low levels?
- I know that T1D need to use some form of glucose to quickly raise the bsl, however, I'm trying to understand some of the reasons on why the liver is failing to boost the bsl accordingly.

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Looks like others already provided very good answers so I'll just add that I like your question a lot!

The liver delivers the Glucagon response...thats why it cant process alcohol and deliver glucogon at the same time hence no saviour in crisis. so i believe.

bulkbiker said:

I think we need to remember that the hypo will have been caused by an excess of insulin exogenously.. this may prove to be too much for the liver to cope with hence the hypo in the first place.
A truly vicious cycle?

Click to expand...

The True difficulty being, one day there may be a hypo and another day there may not be. Even though you have got up at the same time, eaten the same food and injected the same amount. Because today happens to be warmer/colder! A hypo is an awful event where your brain ceases to function properly. You often do not make the right decisions. I tend to bargain with myself that if I ignore it it will go away. It is important to treat with pure sugar based treatments, as they kick in quickly, unfortunately the liver doesn’t. The little devil has been activated though and releases the sugars to help. This can then cause higher than wanted levels. As you say a truly vicious cycle that even with the best will in the world we fall into the trap of no matter how hard we work at it.

Depending on how you view things then I think the idea that a hypo is caused by an excess of exogenous insulin is questionable.
A hypo can be caused by a lack of carbohydrates.
A hypo can occur with a perfect balance between carbs and insulin. Throw in unexpected exercise/ work/ stress. Hello hypo.

Its a great question, but I have noticed that when people think about diabetes (any type) it is easy to fall into the trap of binary thinking.
Type 1 or 2. Nope, there are lots more variations than that.
Carbs or not. Nope, it is an infinite spectrum.
Insulin v glucagon. Nope, adrenalin is another insulin antagonist, with cortisol and growth hormone as runners up. https://www.ncbi.nlm.nih.gov/pubmed/2043222

I have slowly come to view my body’s hormones and their regulation as the classic spinning plate stage act.
Everything is permanently in flux, and none of us have a full overview.
And, of course, we can all get plates crashing to the floor from other problems (glucagon going wrong, or thyroid problems, or...), which then have a knock on effect of the overall balance of everything else.

Brunneria said:

Insulin v glucagon. Nope, adrenalin is another insulin antagonist, with cortisol and growth hormone as runners up...

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Yes but glucagon is made inside the pancreas which is why it’s of significance in this particular context. I believe adrenaline and cortisol are made in the adrenal gland? But yes you’re of course dead right, there are no binaries in this business!

Jim Lahey said:

Yes but glucagon is made inside the pancreas which is why it’s of significance in this particular context. I believe adrenaline and cortisol are made in the adrenal gland? But yes you’re of course dead right, there are no binaries in this business!

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Adrenalin and cortisol may be made in the adrenal gland but they stimulate reactions throughout the body, including inhibiting insulin’s action and the subsequent rise of blood glucose. In fact, that is another binary to reject; pancreas or nothing.

therower said:

A hypo can be caused by a lack of carbohydrates.

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So a T1 eating a zero carb diet can still hypo without any exogenous insulin?

Brunneria said:

Adrenalin and cortisol may be made in the adrenal gland but they stimulate reactions throughout the body, including inhibiting insulin’s action and the subsequent rise of blood glucose. In fact, that is another binary to reject; pancreas or nothing.

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For sure. My only point was that glucagon is of particular signifance here (to me anyway) because it is made inside the pancreas. The same organ that makes insulin. Personally I find it curious that the autoimmune reaction attacks the beta cells that make insulin, but not the alpha cells that make glucagon.

This is Interesting :

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• Liver and Blood Glucose Lervels

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  • Glucagon
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  • Liver
  • Liver and blood glucose levels

The Liver and Blood Glucose Levels


The liver produces, stores and release glucose


Glucose is the key source of energy for the human body. Supply of this vital nutrient is carried through the bloodstream to many of the body’s cells.

The liver produces, stores and releases glucose depending on the body’s need for glucose, a monosaccharide.

This is primarily indicated by the hormones insulin - the main regulator of sugar in the blood - and glucagon.

In fact, the liver acts as the body’s glucose reservoir and helps to keep your circulating blood sugar levels and other body fuels steady and constant.

How the liver regulates blood glucose
During absorption and digestion, the carbohydrates in the food you eat are reduced to their simplest form, glucose.

Excess glucose is then removed from the blood, with the majority of it being converted into glycogen, the storage form of glucose, by the liver’s hepatic cells via a process called glycogenesis.

Glycogenolysis
When blood glucose concentration declines, the liver initiates glycogenolysis.

The hepatic cells reconvert their glycogen stores into glucose, and continually release them into the blood until levels approach normal range.

However, when blood glucose levels fall during a long fast, the body’s glycogen stores dwindle and additional sources of blood sugar are required. To help make up this shortfall, the liver, along with the kidneys, uses amino acids, lactic acid and glycerol to produce glucose.

This process is known as gluconeogenesis.

The liver may also convert other sugars such as sucrose, fructose, and galactose into glucose if your body’s glucose needs not being met by your diet.

Ketones
Ketones are alternative fuels that are produced by the liver from fats when sugar is in short supply.

When your body’s glycogen storage runs low, the body starts conserving the sugar supplies for the organs that always require sugar, including the brain, red blood cells and parts of the kidney. To supplement the limited sugar supply, the liver makes ketones in a process called ketogenesis.

Ketones are burned as fuel by muscle and other organs in the body, and the sugar is saved for the organs that need it.

Like glucose, the production of ketones in the liver is controlled by the hormone glucagon.

I had my first big hypo when I came home from having my baby, I woke up in the night to paramedics in the room. Now, if I was on my own, would my liver have eventually kicked in, at some point and brought me round.
I think most Type 1's will have a slightly different reaction to getting out of a hypo ( unassisted), depending on how low it goes, the person's overall health, any build up of Insulin already in body, maybe different foods eaten that day, or even the day before, I know my levels can be affected in this way.
Type 1 diabetes - predictably unpredictable.
A good question @zbluebirdz. and have you gained any information from member's posts ?