Hypoglycaemia and liver response

bulkbiker said:

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

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Interesting question. I suppose that was the goal before insulin could be used. I think it would still be possible to hypo due to all the various uncontrollable factors unless the liver (and the other organs involved) can maintain a stream of fuel responding to variable greater or lesser need. This is another reason it seems to me that it's a good thing for a Type 1 to consume as few carbs as possible. Fat seems to be a more reliable source of fuel.

bulkbiker said:

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

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A T1 no longer in the honeymoon period will always need exogenous insulin irrespective of what their diet.

But surely if a type 1 didn't take any insulin at all, then they would go hyper, not hypo? I believe this is what @bulkbiker was questioning?

Jim Lahey said:

But surely if a type 1 didn't take any insulin at all, then they would go hyper, not hypo? I believe this is what @bulkbiker was questioning?

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A type 1 not taking insulin is signing their own death certificate. Hyper or hypo is irrelevant.
As I said earlier. We don’t do this for fun. We don’t inject exogenous insulin to justify eating carbohydrates. We inject insulin to live our lives.
Consider yourself fortunate you do not have this condition. Even your current diet wouldn’t negate a need for exogenous insulin.

Jim Lahey said:

But surely if a type 1 didn't take any insulin at all, then they would go hyper, not hypo? I believe this is what @bulkbiker was questioning?

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Yes, I think Bulkbiker was responding specifically to a poster that said going low could equally be as much to do with not eating enough carbs as taking too much insulin but it can come across as if you eat carbs you're doomed!

helensaramay said:

As has been previously mentioned, someone with type 1 (I am more than my diabetes so refused to be called “a T1” and offer the same level of respect to someone with type 2), does not take zero insulin: they will still need basal insulin. Exercise, etc can lead to hypos without carbs due to the reduction in basal needs. For example, with an insulin pump, I suspend my basal when exercising to avoid hypos but when injecting, this is not possible.
And don’t forget that bolus insulin is needed for protein when someone with type 1 eats a low carb meal. Another reason why it is difficult for someone with type 1 diabetes to have no “exogenous insulin”.

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Fair enough you don’t like to be called type 1 or diabetic. We all have different experience and feel differently. I have no problem thinking I’m type 1 and I’m diabetic. Doesn’t mean I’m just that, so I don’t think people are being disrespectful by calling someone diabetic/type 1/type 2 etc at all.... ?

Can we all go back to the original question, please?
I think it's wonderful when non T1's are interested in how things work.

I think your question @zbluebirdz is great and I applaud you and anyone who tries to get a better understanding of any of the types of diabetes. I can't answer your question although having T1 means I should. I reckon my liver can't help much when I'm having a hypo because of the wine.

therower said:

A type 1 not taking insulin is signing their own death certificate. Hyper or hypo is irrelevant.
As I said earlier. We don’t do this for fun. We don’t inject exogenous insulin to justify eating carbohydrates. We inject insulin to live our lives.
Consider yourself fortunate you do not have this condition. Even your current diet wouldn’t negate a need for exogenous insulin.

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Yes I know. That wasn’t my point. I’m done here now.

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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I think one of the fundamental differences with T1 (and other flavours where there's no insulin produced) is that exogenous basal insulin cannot be immediately suspended when levels drop - usually because glucose is being processed by a mechanism that doesn't need insulin.

OTOH, if the drop is due to an error in bolus dose or timing, the drop can be ferocious and the poor liver simply cannot dump the glucose fast enough.

Shiba.

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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Its a good question.

Injectable insulin may save our lives but it is a blunt tool compared to the sensitivity of a working pancreas!

Insulin acts to increase the uptake of glucose by the liver. Type 1s always have insulin in their system (our background insulin if not some fast acting) so in the liver's world if there is insulin floating about then why should it release glucose? From its perspective the only reason there should be insulin floating about is if it is required to take in glucose, not to start releasing it.

So if its a bit slow to react then who can blame it? In a 'person with working pancreas' it is doing its job just fine. In an insulin injecting diabetic it takes a while to realise that it needs to release glucose and there are a host of other hormones such as adrenaline that jump in at hypo stage.

Here's the proper techie stuff
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991551/

Shiba Park said:

I think one of the fundamental differences with T1 (and other flavours where there's no insulin produced) is

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I love 'and other flavour's' lol

Glucagon is released in response to too low insulin levels. This means if type 1s have too low insulin they can have a glucagon response which pushes their sugars even higher than they will be anyway due to lack of insulin. If the insulin levels are very high and that's what the low sugar levels are from then technically there should not be a glucagon response. Its adrenaline that solves the low sugar levels.

"Elevated glucagon is the main contributor to hyperglycemic ketoacidosis in undiagnosed or poorly treated type 1 diabetes. As the beta cells cease to function, insulin and pancreatic GABA are no longer present to suppress the freerunning output of glucagon. As a result, glucagon is released from the alpha cells at a maximum, causing rapid breakdown of glycogen to glucose and fast ketogenesis"

If glucagon is released in response to low levels of insulin then a type 1 diabetic on enough insulin should not be releasing a lot of glucagon. And a type 1 diabetic on too little insulin may have plenty of glucagon but will already have high sugar levels.

It is not the glucagon that saves a type 1 when they are low at night - it is the adrenal response, adrenalin - the hormone that makes T1s have cold sweats and shiver and have their hearts pounding. At least that is what I have experienced. I have been given glucagon only once by a paramedic and it pushed my sugars very high and left me feeling very nauseous.

Circuspony said:

Injectable insulin may save our lives but it is a blunt tool compared to the sensitivity of a working pancreas!

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Amy Berger's blog post highlight the challenges, especially for T1D ...
http://www.tuitnutrition.com/2019/03/insulin-glucagon-pancreas.html

Circuspony said:

Here's the proper techie stuff
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991551/

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Here too they acknowledge that ketones has been found to be protective against hypoglycemia. But the practical challenges is that our typical diet will result in insulin levels that are too high to consistently achieve adequate ketones levels...

just before i got my insulin pump in 2013 (my old one had completely died, i didn't have health insurance, and my 2013 ADA deductible hadn't been met (the $8000 insulin pump took care of that), i lost just over three hours while sitting at my desk. apparently, that was enough time for my liver to kick in and get me glucagon. i ended up on the floor, across the room, and fractured a bone in my right thumb (didn't find that out until the thumb swelled up to twice the size; the cast was on for six weeks as a reminder).

ironically, the first thing i did upon waking up was to grab the jar of glucose tablets on my bed and stuff a fistful in my mouth...i don't know why as i hadn't tested and had no idea what was going on, but my brain knew better. by the time, i did test it was about 80. i will unlikely never forget this event. and it hasn't happened since then, thankfully.

Hi ,

Just found this topic.
I'm a person with type one. On basal bolus.
With 13 units of Lantus I feel my basal is spot on at the moment. Taken last night at 23.00 before retiring to bed & having a couple of glasses of wine prior.

During the early hours of the morning (around 2am this came up on my scan. I awoke a good 20 minutes? before my 4am alarm, remained in bed getting my head round it all then I got up and scanned...
Strangely, it levelled out at 6.1. I felt great when I woke. The sensor is located inside my arm, so I can't see how I was sleeping on it giving a phantom low. certainly hadn't been sleep treating either.
Had the liver finished dealing with the wine & decided to help me out?? The lowest showed 3.2. First time I've seen this & historically (the last 43 years.) would wake still low...?