[BlueSky]

The consensus seems to be that hypoglycemia may have something to do with the "dead-in-bed syndrome", but it is not the underlying cause. They have no idea what causes it. There was a big hoo-haa about this a while back, with speculation that dead-in-bed was somehow caused by the switch to intensive therapy (MDI) and the use of modern insulins. But that seems to have died down, and I have not been able to find any new data about it ...

[alicat61]

Originally Posted by BlueSky

The short answer is that death is extremely unlikely. The often -quoted anecdotal reports of this happening are mostly urban myths.

The liver will always come to the rescue if blood glucose drops too low. It does this every night in normal people. When you haven't eaten for a while, glucose requirements are sourced from the liver. Death would only occur if the liver glycogen reserves of the person having the hypo were depleted. This wouldn't happen to a healthy person. Glycogen reserves are continually being topped up. You don't even need to eat carbohydrate for this to happen. The liver makes its own glucose if necessary through gluconeogenesis.

You really shouldn't get too tense about the consequences of a hypo. You liver will pull you out a hypo before it becomes life threatening. Unless of course if you Glycogen Storage Disease, in which case you could be in big trouble.

Hi
Not only with Glycogen storage disease. Also alcohol . This stops the release of glycogen. A diabetes specialist told me once that young peoplewith diabetes who live alone have died
after a night out . They use their energy up dancing, They don't eat enough and drink . Go home fall asleep and never wake up.So yes death can happen from a hypo

[jpnairn]

I know of two diabetics who died from low blood sugars.
If you have frequent lows, they reduce your liver's ability to release glucagon. The glycogen stores and the hormones used to release glucose can both become depleted.
If you've had any alcohol, even one or two drinks, that can also reduce your liver's ability to react to a low blood sugar.
I am a long-distance runner, and that can also result in depleted glycogen.
I'm not trying to say that you should always be terrified of having low blood sugars, but I would hate for anyone to read this forum and think it's not dangerous, potentially lethal, to have your blood sugar go extremely low.

[Alice]

This is one of the main reasons I don't do the "low carb" thing...meaning close to no carbs as some books recommend. If your liver is always struggling to provide glucose to your body then it is running on thin ice when these critical lows hit.

I've not heard of this "dead in bed" syndrome from a doctor, but only on these forums. When I asked an endo years ago about my concern of hitting a 32...he said that my liver would have kicked in to provide the necessary emergency glucose and that I should not reduce carbs for that reason.

Please don't start one of those Bernstein debates...I just think this is the main reason I don't run things on an empty tank...so to speak. And in 43 years, I have always been able to treat severe lows. I'm no fool...that could change any day...but my "carb padding" sure has come to the rescue many days.

[BlueSky]

Originally Posted by Alice

This is one of the main reasons I don't do the "low carb" thing...meaning close to no carbs as some books recommend. If your liver is always struggling to provide glucose to your body then it is running on thin ice when these critical lows hit. ....

This is a complete myth, and it is perpetuated by people who really should know better . It is not necessary to eat any carbohydrate to keep liver glycogen topped up. There is another biological process, gluconeogenesis, whereby the liver makes glucose out of other ingredients. This supply of glucose is adequate to meet all our glucose needs.

This is how it has been possible for the eskimos to thrive on a diet of fish and water. There is absolutely no carb in that diet. But these people have had no problems with lack of energy or hypoglycemia. In spite of the physically demanding environment and a very active lifestyle, people eating this way have had excellent health.

If eating little or no carb resulted in running low on glucose, communities like this would not have survived. It really is as simple as that. And the information that supports this has been around for ages. The eskimo way of eating was explained in detail way back in 1935 by Stefansson. Stefansson 1 - Eskimos Prove An All Meat Diet Provides Excellent Health..

It is a good read. Living in these conditions presented lots of challenges, but access to carbohydrate certainly wasn't one of them. Stefansson's writings were regarded with suspicion at the time because they disproved a lot of dietary theories. And mainstream thinking is very resistant to myths being exploded. It responded by simply repackaged this myth in a way that retains it's popular appeal. But it really doesn't change anything.

[REDLAN]

Bluesky - I am confused by referring to eskimos in reference to Alice's post about low carb diets and hypoglycemia risk.

Eskimos have a functioning pancreas, so it does not matter how much glycogen their bodies ultimately store. They will not suffer any ill effects, except perhaps from not being able to maintain extreme levels of exertion for as long as someone who has access to large quantities of glucose.

the point is and it is well known, that diets with extremely low amounts of carbs and we are talking below 30g of carbs per day are ketogenic - the bodies response to low glucose is to convert other substrates (protein and glycerol) into glucose. This prevents the liver completely metabolising fat, and it's response is to release ketones. This is what happens to eskimos - however there is a maximum amount of glucose available from this source and it is less than if you eat carbs.

what happens to eskimos physiologically is broadly this - the bodies response to the high fat diet is to increase insulin resistance particularly in muscle - this helps preserve precious glucose, and also forces the muscles to become fat adapted - that is they store large quantities of triglycerides (this response is seen in both insulin resistance due to syndrome X and endurance athletes). The body does NOT become more efficient at burning fats, it just has more fat stored. The increased insulin resistance, also helps eskimos store body fat, and prevents their bodies wasting it by turning it into heat.

on a slightly different tact...

low carb diets are not ketogenic unless they fall below this 30g threshold. i.e. they do not generate significant amounts of glucose. The problem comes with strenuous exercise the kind that burns large quantities glycogen - repeated sprinting, weight lifting, etc. This can deplete muscle glycogen (in as little as 30-45 minutes in someone who is not trained) - the body's response to this is to make the muscles very insulin sensitive - they will draw glucose out of the blood stream - post exercise hypos (several hours afterwards) are very common.

This can in some cases drain the liver of glycogen - which can be hazardous if you go low during the night. The remedy is extremely simply - make sure when you finish any form of strenuous exercise that you eat a carb based snack immediately afterwards, and that you have sufficient carbs before you go to bed - i.e in your evening meal. Choosing to go for 10-20 grams of carbs in your evening meal would not be sensible if for instance that day you've spent 4 hours cycling x-country, playing 45 minutes of basketball etc etc. This advice applies whether you low carb or not.

interestingly from the case study in the link I posted, the young man who died had played basketball the evening before.

and finally, when studies start quoting how healthy a particular lifestyle is, then all you need to do is look at lifespan figures to make yourself feel better...

Inuit lifespan stagnates while Canada's rises | Science & Health | Reuters

The Inuit have the lowest life expectancy among Canada's 3 aboriginal peoples. Yep all that meat eating must be very healthy.

[David_S]

My A1C is was just 6.1 down from 14.2 at diagnosis. I asked if I should aim for lower and the endo told me.. 6.1 is great.. I am doing well.. and the risk of LOWS is high for me if I try to modify more. The danger is.. what if you are driving.. I have kids.. I can't risk it. I don't want to pay for the low either.. they make you feel bottomed out. I want good health.. a good balance. Your A1C is fantastic.. but you might need to modify your insulin at that rate. Talk to your endo.. but even if a low doesn't " kill me" it sure enough ruins the rest of the day. IT is exhausting to me.

[HelenM]

and finally, when studies start quoting how healthy a particular lifestyle is, then all you need to do is look at lifespan figures to make yourself feel better...

Stefansson (in the third pat of the linkprovided by Bluesky) distinguishes beween health and longevity conceding that meat eaters did not live long.The inuits ' lived on the average at least ten years less than we'
He suggests that meat eating may act as 'a speeder-up of metabolism ' and that the women, having become grandmothers in their early twenties ' usually seem as old at sixty as our women do at eighty.
Personally I prefer to eat a mixed diet. I've only 4 years to go until I reach 60.

Back on the original topic, I have a low HBA1C. I eat a balanced diet with a fair amount of wholemeal bread, potatoes and fruits, I do a reasonable amount of exercise. BUT I have hypos on a daily basis, albeit shortlived. I recognise them at a lower level nowadays and rarely sweat or shake... its usually a perception of lowered concentration and raised heartrate. My average meter reading for the last month is 74mg/dcl. This thread and peoples opiions on other threads is begining to convince me that I should try to raise my levels slightly.
I have two problems, the main problem is psychological, I'm scared of having high levels so often fail to reduce insulin after exercise . The second is that I tend to eat fairly low GI . I frequently have a low reading at 2 hours after a meal (in the 60s and if I've exercised sometimes lower) it then slowly rises for another couple of hours after which it stays steady but only if I am inactive. It falls again with tiny amounts of activity such as shopping or housework. My basal is probably OK (I've reduced it to 15u from 18 but BS doen't vary much overnight) I need to bite the bullet and lower the amount with meals.

[HelenM]

After writing previous posts I've just got my Blood test results back everything fine but HBAIC 4.9% . I think I have got to do something about it. I know my doctor won't be too happy when I see her.

[mark-TN]

Originally Posted by REDLAN

and finally, when studies start quoting how healthy a particular lifestyle is, then all you need to do is look at lifespan figures to make yourself feel better...

Inuit lifespan stagnates while Canada's rises | Science & Health | Reuters

The Inuit have the lowest life expectancy among Canada's 3 aboriginal peoples. Yep all that meat eating must be very healthy.

"Yep all that meat eating must be very healthy." This is an entirely unfair statement as the article is about the life expectancies of modern Inuit aborigines populations after the effect of western influences no doubt. There current life expendency has nothing to do with their native diet and life style. It has everything to do with their current diet and life style:

From the article: "The overcrowding on the one hand disrupts the social life of the people, and on the other hand is a recipe for chronic diseases to develop, like respiratory problems in babies," said Simon.

Other health problems such as diabetes and tuberculosis are more prevalent among Inuit than in the rest of the country. As well, natives are far more likely to commit suicide.

"Although we have the right to medical services, ours is lagging behind in the north," said Simon. "This is what brings life expectancy way down for Inuit."

Mark

[Jill-O]

SO FAR, I've only had 2 low readings both fairly recently. The lowest was 44 and I felt really hungry and noticed my finger tips felt numb or tingly. So I tested and gasped and tested again to verify... I treated it but I was really scared and shaky / sweaty / light headed, etc., waiting on my numbers to get up to where they needed to be. I do not know if that was the scare of seeing the number or if I'd have felt those things soon (had I not thought "oh, maybe I should see if I'm low").

[JJM335]

There was a recent case here where a care assistant/nurse was convicted of murdering several elderly residents of a care home using insulin. Apparently they were "annoying" him with demands for attention, so he gave them a full syringe of Actrapid (R). That must work out at about 50U.

[Alice]

After 43 years of insulin, it is safe to say I don't listen to many "myths" of diabetes. I can only speak from experience and advice from my doctors about my carb intake. I have found absolutely no reason on insulin to "low carb" and find it almost suffocating that I almost always get the "eskimo knows best" message whenever I post about my experience.

There is a danger from death due to low blood sugar in any form whether it be a car accident or worse...killing someone else....my personal goal is to never test the "eskimo theory" or any "theory" that doesn't work for me. It's not worth the risk.

I have no reason to "low carb" to the point of bad judgement. I have a responsibility to others...others may not.

I think the original point was an excellent question on a matter that is rarely discussed. Unfortunately, many deaths are reported under different categories such as heart failure, stroke and such...it is very difficult to know the true nature of the "dead in bed" situation.

[Alice]

I should add that I've experienced many "bad lows" where it took a great deal more than my liver to come out of them...just because I haven't had a "911" or "ER" trip, I want to stress that I've pulled myself out of some doozies. Waking up to a 32 and calmly treating is much different than the incidents where I felt I was floating off to the ceiling...every step an effort. All "lows" aren't the same, it depends on how long you've been down there, so to speak.

These are all bad enough to remind myself to learn from each incident. I haven't had my last one, I'm enough of a realist to know from where I've come...

This is one of those subject that is very difficult to discuss with friends and family. But, very easy to discuss on this forum.