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Liver dumping?

C

chocoholic

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Sorry if this is a dumb question but I've been wondering this for a while. Most of us know that early morning our bodies will often do a glucose dump, causing the dawn phenomenon. What I'd like to know is can this happen at other times of the day? For instance I have sometimes been in a situation where my reading has gone unusually high, when I know by rights, if anything, it should be on the low side. I've never really known if the liver dumps glucose just before your levels were to hit nought or if you would just black out if readings went that low. Sometimes I go as low as 2 something without realising and wondered if you can go lower...down to or below zero....without realising? Can anyone shed light on this one for me, please?
 
http://loraldiabetes.blogspot.com/2009/ ... -high.html

I don't normally get dawn phenomenon but my liver can certainly send me high if I overexert myself in the morning - and low if I do the same in the afternoon.

I knew a Type 1 with (probably) radiation damage whose life was a nightmare of sudden high and prolonged BG alternating with hypos which needed an ambulance run to the hospital. The control circuitry between his pancreas and liver appeared to be totally shot.

When and how your liver cuts in to rescue you may vary.
 
Not sure if the autonomic mechanism is that precise choc, and I'm sure it varies between people as twink says! A really bad hypo is normally the trigger for me, ie one that I am unconscious for, so bg will be less than 2 mmol/l. I only know this because I can feel totally fine at around 2.5. But when I do eventually come round after a bad hypo my bg levels are attempting a moonlaunch and I'm fighting the rest of the day to get back to normal levels. I've always thought of the liver dump as the body's defence mechanism, kicking in only when it absolutely needs to, but I have no scientific basis for that assertion.
 
Right, so by the sounds of it, the liver can dump glucose at other times. I suppose I'm interested to know why some folk black out and yet I never have.(Not that I want to obviously. It just intrigues me.) Is it just a case of some will have that liver dump kick in and others don't?
 
I'm having horrendous DP at the moment :( Waking up at ~8.30 and getting 7-9 (highest was 9.2).
I mean...what the hell? I go to bed , usually with ~5.

So annoying.
 
acron^ said:
I'm having horrendous DP at the moment :( Waking up at ~8.30 and getting 7-9 (highest was 9.2).
I mean...what the hell? I go to bed , usually with ~5.

So annoying.
Click to expand...

I am similar to you - except I go to bed with readings of 6 -7 and wake up with 8.5 - 10

Asked GP about it this morning and she was of the opinion that as I was managing to reduce blood sugar number throughout the day (lowest achieved to date is 5.8) I shouldn't be too concerned about the morning liver dump.
 
Some fact, some speculation. long answer, I got interested and kept finding new info, sorry!

Alpha cells secrete glucagon which stimulates the release of glucose from the liver. In a well working system, when the blood glucose levels go down the alpha cells stimulate the liver to produce the correct amount of glucose to restore normal levels. The beta cells communicate with the alpha cells as part of the initiation of this process.

People with diabetes have different malfunctions in this system. In type 2 and some type 1s there is an overstimulation , too much glucose is released from the liver. Glucose levels should normally rise to cope with increased needs in the morning, when too much is released... dawn phenomenon.
Metformin works in part by suppressing excess glucose from the liver..

In people with type 1 the signal from the alpha cell which says 'blood glucose is low please top me up,' doesn't work properly, not kicking in until blood glucose levels are very low and sometimes doesn't happen until levels are very low resulting in coma, fitting etc
Apparently alpha cells aren't destroyed by the autoimmune process but their function is impaired in type 1 and this impairment of the signalling system may become worse over time.

Speculation:
The first hypo I had after leaving hospital was a shock. I'd just popped out to a garden centre and was in the greenhouse when I started shaking etc. Tested blood, hypo just below 4mmol. Horror I I'd left dextrose on kitchen table. A scared husband drove me home quickly, thinking he'd have a comatose wife to deal with.By the time I got home BG was up, my own system had done what it should do. Four years down the line, my liver doesn't rescue me at 3.9, I can get down to very low levels without it kicking in. I think it does still work but only at very low levels, indeed I suspect that it sometimes does this at night.

With LADA, it might be that the more beta cell function remaining, the better the counter regulatory system works . As beta cells decrease there are less of them to communicate with the alpha cells so the system must deteriorate. This could also apply to classic type 1s , those that still have slight beta cell function (and some do after 50 or more years ) would be be more likely to have their livers come to the rescue.
Alternatively, it might be that frequent hypos, in some way blunts the response so everyone who has lots of hypos risks this lack of response in the long run.
Another recent theory (I only found after writing the above) is that alpha cells become desensitized by repeated insulin injections over many years and they start to behave abnormally.
seehttp://www.sciencedaily.com/releases/2009/04/090407130910.htm

The other thing that sometimes causes blackouts in type 1s is alcohol, if the liver is busy dealing with alcohol it can't come to the rescue .I read somewhere that about 20% of serious hypos that end up in casualty are related to alcohol
 
Just to add a little to Phoenix's excellent answer, it is estimated that in many type 2s the liver generates around 3 times more glucose than it should do. Although metformin reduces this, it can only reduce glucose output by a third, which means that many type 2s are still left with double the glucose instead of three time the amount.

There are two ways in which alcohol is believed to lower blood sugar. The first is that while the liver is so preoccupied with dealing with the alcohol in the blood stream, it stops producing any glucose. But the second, only discovered in January last year, is that alcohol stimulates the beta cells, resulting in increased insulin production and therefore reduced blood sugar.
 
Picking up on the alcohol point (I'm not obsessive about alcohol, honestly!), I remember being told at a fairly early stage by my consultant, that alcohol was a catalyst for insulin thereby speeding up the effect it has on blood sugar. So caution was always advised, along with other factors, when adding alcohol to the mix. I think I'm right in saying T1s don't have any beta cells to be stimulated? :?:
 
kegstore said:
I think I'm right in saying T1s don't have any beta cells to be stimulated? :?:
Click to expand...
Correct. My post was really aimed at the type 2s.
 
Phoenix is pretty spot on! There's miscommunication for various reasons between the two systems, the beta cell/insulin circuit which stashes dietary glucose into store and the alpha cell/glucagon circuit which fetches it back into the bloodstream.

What made my eyes pop when it was first pointed out is that the total blood volume only contains around 5g glcuose at any one time (100 mg/dl x 5L) so a liver "dump" that doubles your BG is a fraction of a teaspoonful of glucose
 
Dennis said:
There are two ways in which alcohol is believed to lower blood sugar. The first is that while the liver is so preoccupied with dealing with the alcohol in the blood stream, it stops producing any glucose. But the second, only discovered in January last year, is that alcohol stimulates the beta cells, resulting in increased insulin production and therefore reduced blood sugar.
Click to expand...

So how was that discovered then, a researcher the day after the New Year Party? <G>

Seriously I didn't know that one, thanks for finding it!
 
Does a diet low in carbs induce liver dumps?

Sometimes if i do more exercise than usual I find my bg a bit unexpectedly higher (and it doesnt drop later in the day either so no delayed effect) and often wondered if maybe If I dont have enough carbs to give me the energy needed whether your liver would then dump to compensate

Anyone know, Appreciate cortisol etc has impact to play in exercise but I actually have low cortisol so dont know how this would particularly effect me, esp in the afternoons when cortisol secretion starts to half and then taper off
 
Dennis said:
There are two ways in which alcohol is believed to lower blood sugar. The first is that while the liver is so preoccupied with dealing with the alcohol in the blood stream, it stops producing any glucose. But the second, only discovered in January last year, is that alcohol stimulates the beta cells, resulting in increased insulin production and therefore reduced blood sugar.
Click to expand...

Do you have a reference to a clinical paper on this side effect of alcohol consumption?
 
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