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[IP] RE: BG Really Low but You're Still Functioning

Counter-regulation is a complex function that is often ignored by a scientific
and medical community that seems to see hyperglycemia as the only problem
requiring their attention.  Unfortunately, hypoglycemia is largely blamed on
the patient, in spite of the severe limitations created by insulin therapy in
its current modalities.

The counter-regulatory function is impaired in many people with diabetes,
including virtually everyone with Type 1 and many people with Type 2. 
Normally during insulin-induced hypoglycemia, the sequence of primary hormone
counterregulatory responses is as follows:

1.  Suppression of insulin release (does not happen when exogenous insulin is
2.  Activation of the rapid-acting counterregulatory hormones glucagon and
epinephrine, which is a major effect.
3.  Release of slow-acting growth hormone and cortisol (during chronic
hypoglycemia of 3-4 hours), a minor effect

In patients with type 1 diabetes of longer duration (> 5 years), epinephrine
constitutes the parimary defense against hypoglycemia, because the pancreatic
alpha cell glucagon secretory response to hypoglycemia is irreversibly lost to
autoimmunity.  Clinical studies have also shown that the epinephrine response
is also impaired in type 1 patients undergoing intensive insulin treatment. 
This "double whammy" (lack of glucagon and epinephrine response) places
intensively treated type 1 diabetes patients at significant risk for recurrent
hypoglycemia.  Further, antecedent hypoglycemia increases the risk for future
hypoglycemia recurrence, resulting in a vicious cycle.

Even assuming that the counter-regulatory hormones circulating in the
bloodstream finally do cause the liver to release glucose, there is no control
as to how much it releases ... whatever is stored is let go, so you could end
up with really high BG afterwards (I believe this is called the Somogyi

Just my few notes on this thread ...


Dx'd Type 1 9/1976 at age 7; pumping with Animas R1000 since 6/2002 at age 33
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