[mark-TN]

Here is my take on this topic. Copy and paste of this post from 12-7-07:

I agree … deaths from hypo are rare when you are safely at home. Most deaths from hypo are the result of accidents that are the result of impaired cognitive function. That being said it is important to understand the biology of what is going on and how it is that the body can or can’t bring itself out of hypoglycemia. The liver for the most part will not kick in to start raising blood sugar until the level of circulating insulin drops to a certain point. Low blood sugars are the result of higher than needed circulating insulin levels. In this state the liver thinks that blood sugar is elevated (even though in an insulin dependant diabetic the blood sugar level could be dangerously low) so it starts storing circulating glucose either as glycogen in the lever, or when glycogen stores are full as fat in fat cells. Hormones released during hypoglycemia such as epinephrine, cortisal, norepinephrine and growth hormone will help produce glucose and lower the level of circulating insulin, but the “work horse” hormone for countering high insulin levels is glucagon and its release is greatly blunted by high circulating insulin levels. When circulating insulin drops to a point the liver determines to be lower than normal the liver will signal the pancreas to release glucagon and this will trigger the release of glucose through the processes of glycogenolysis. Also at lower insulin levels the liver will create new glucose from circulating amino acids by the process of gluconeogenesis. In an insulin dependant diabetic these glucose raising processes will continue until insulin levels are normalized regardless of how high blood glucose levels get (FYI: Glycogen stores are limited, so the body can run out of glycogen during long periods of low insulin levels, but the availability of amino acids (proteins) is endless and gluconeogenesis will continue until circulating insulin levels are normalized). So the reason there are a lot of stories of diabetics surviving night time hypoglycemic attacks is eventually the levels of circulating insulin gets to the point where the liver is capable of raising blood sugar levels without any outside help. However, the ride most certainly is one that no one wishes to repeat after the first experience.

Mark