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Re: [IP] Glucagon production in Type 1s
Ted Quick wrote:
> I don't really know, but rather doubt it. If you had NO glucagon production
> achieving any balance would be incredibly hard. Glucagon keeps you going when
> you don't have newly digested food flooding the bloodstream with glucose.
> Seems like without gluagon available we'd tend to die before the next meal in
> many situations. Of curse there IS glycogen from the liver and muscles to
> support some need, but think that would be insufficient for the whole system
> to be survivable.
As I understand it, it is the LACK of insulin which is the main trigger
for the liver (and muscles) to release their stored glucose into the
blood stream. Glucagon merely accelerates this process. So provided your
insulin level drops appropriately between meals, your liver supplies the
goods instead, and there's no need for glucagon.
Of course, in us diabetics, if the basal rate (ie the insulin level) is
too high, then we go hypo between meals and, yes, we do tend to die, or
nearly: other emergency backup systems thankfully cut in!
Insulin has several actions, at different levels in the blood:
At a very low level, insulin stops the breakdown of fat. Levels drop
below this point when fasting for at least several hours, since that is
when the body must draw on fat for energy. (Combine that with a high bg,
which would only happens in diabetes, and you've got DKA)
At a somewhat higher level, insulin stops the liver releasing glucose.
At a much higher level (which normally occurs only after eating or, for
diabetics, bolusing), insulin promotes storage of glycogen in the liver
At a yet higher level, insulin promotes conversion of glucose to fat.
It's my theory that it was the arrival of human insulin in the 1980's,
and MDI, which gave many people these "spikes" of insulin activity,
which causes the body to lay down fat, far more than it really needs to.
Hence the weight gain in DCCT. Animal insulins don't peak so high, so
this "lay down fat" level of insulin doesn't occur, so less obesity. Of
course, Humalog makes the fat problem even worse, as it peaks very
quickly and very high, but since I started pumping I now have tiny
boluses compared with on MDI. I used to take about 12 units of Regular
with a typical meal. Now I have 3 or 4 units of Humalog, and I've lost
Ah, the joys of pumping.
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