[Subby]

A question I have often wondered, prompted by the thread about alcohol. Can you get and is it healthy to use, some kind of inhibitor that prevent or cuts down the glucose released from the liver?

I have no idea about what might be an inhibitor or even if such a thing is possible. So please forgive me if it is a stupid question.

The reason I ask is that the day after a night of moderate drinking, I almost always have the most wonderful, easy to get along with blood sugars for about 12 hours. From this I can only deduce that I normally may get a lot of variability and extra drag from liver released glucose. I think my blood tests that involve the liver are generally fine... but I wonder if those blood tests would pick up an overactive liver? (Again, no idea if that is a possibility either)

[morrisma]

Never heard of a drug specifically to do that except maybe a few beers as you've possibly discovered.

Most of my high bg readings are not from liver dumping but lows do cause that rebound. Probably wouldn't want to inhibit it on a regular basis though because it has saved my butt on a few occasions.

I'd rather correct for highs than go too low & the liver can protect me by dumping if I drop too low too fast to catch on my own.
Mike

[JJM335]

Symlin

Amylin

[Subby]

Thanks JJM335... checking.

Yes Mike, I'm not wanting to cut my liver out of the relationship... so to speak... it can be a very useful someone to have around!

Bluesky also mentioned that metaformin functions by reducing the amount of "hepatic glucose"... I may keep this in the back of my mind. As both of you point out it's preferable to adjust dosage up if possible...

however I think if there is something to this theory, I might have a highly excitable, fluctuating, liver, because my BG control is like trying to balance a basketball on a speedbump - it's always going one way or the other. My body HATES to be in the range. And that's after taking into consideration rebounds. And constant adjustments to dose.

Argghh... one of these days I will find something that does substantially help these fluctuations. Perhaps a trial of metaformin is in order after all.

[BlueSky]

Originally Posted by Subby

... I might have a highly excitable, fluctuating, liver, because my BG control is like trying to balance a basketball on a speedbump - it's always going one way or the other. My body HATES to be in the range. And that's after taking into consideration rebounds. And constant adjustments to dose....

That sounds very familiar ... . We need to control all the sources of glucose as far as possible. Using Metformin or Symlin should help. And so does eating low-carb. Doing both restricts the supply of glucose from the liver and from food at the same time. The net effect is a big reduction in blood glucose volatility. My experience has been that, without eating low-carb, an acceptable level of BG stability continued to evade me.

[Subby]

Thanks for the info. I have been doing some of the basal fasting and saw not only a little less fluctuation with low carb, but also felt a lot better during that time. I think I might be in the same boat - carbs just seem to react hopelessly dramatically for me. Will ask the doc about oneof those drugs to try. OK, some things to go on with here... cool.

[Subby]

Been thinking more about what may be my problem and solutions.

Something Owlyn said in another thread:
Anything less than 20 minutes will cause your BG to rise. During the first 20 minutes of exercise, your liver starts dumping glucose, as it assumes you will need fuel now that you are doing physical work.

So if exercise can set off a liver dump, perhaps the fact I have chronic fatigue (generally remitted, but still present) and am often physically pushing myself past a bit of tiredness and wooziness just to do the basics... this could be the cause of the liver dumping often through the day?

EG. This morning I got up at 4am in the morning and had to do some care needs for someone - 5 minutes of moderate activity, rolling and dressing someone. At the time of waking it was 10 mmol/l and had jumped to 14 half an hour later. It took about twice "normal" corrections to bring it down over the next 4 hours. At the 4 hour mark I had breakfast etc, and by that time the insulin seemed a lot more effective. BTW, my basals are definitely not so wrong as to account for the jump and resistance...

So is it safe to assume this was a liver dump? Or should I be considering other hormonal responses as well?

As well as considering the metformin etc, are there other technique I can try to avoid this constant problem? I will revisit trying to keep fatigue stress off my body... but I've modified my life quite a bit already, not a lot of room to move. And the CFS requires staying active somewhat.

Are there other approaches to take? I remember someone mentioning sports drink might help prevent a liver dump? Also wondering if the liver glucose store is something I can milk a little, set it off with exercise and deal with it deliberately, if that might help it settle down for a while? Ideas much appreciated.

[BlueSky]

Originally Posted by Subby

... Something Owlyn said in another thread:
Anything less than 20 minutes will cause your BG to rise. During the first 20 minutes of exercise, your liver starts dumping glucose, as it assumes you will need fuel now that you are doing physical work. ....

I am not sure that this explanation goes far enough. It may be helpful to understand the process in more detail. The liver stores about 120 grams of glycogen, which is used to stabilise blood sugar during the day and provide access to a quick form of energy. Glycogen is converted to glucose by Glucagon, which is made in the pancreas. And increased levels of the stress hormones, Cortisol and Adrenaline, cause glucagon to be secreted. So it is when exercise causes a stress response that you get a "liver dump". This normally only happens during intense exercise, like sprinting or lifting heavy weights. More gentle aerobic exercise doesn't usually do this.

When you get up in the morning and become active, levels of those stress hormones increase too. That is why it is common to see a sharp increase in blood glucose during the hour after getting up. It is part of the dawn phenomenon, and there is nothing you can do to stop it. You certainly don't want to mess with the glycogen stored in the liver. It serves a very important purpose, especially for T1 diabetics - it stops you going dangerously low.

The best you can do is to learn to live with this. I inject insulin as soon as I get up in the morning, to deal with the DP effect. As you are using a pump, you can increase your basal rate at this time of the day. And any additional liver dump has to be dealt with by doing a correction.

[NoraWI]

I totally agree with everything Blue Sky has recommended. Eating low carb is absolutely crucial for a diabetic. When our bodies can't process carbohydrates, it makes no sense to overload on them and then expect exogenous insulin to do the job of bringing high BGs down. Metformin could help inhibit your liver dumps. However, as already pointed out, why knock out your body's own safety system that helps bring you out of a hypo? I wouldn't.

[Subby]

Yes, I agree that a KO of hepatic glucose stores is extreme. Understand, I am not hedging to talk myself into some potentially dangerous action here, but just exploring the issues, I have learnt an open mind is absolutely vital in finding solutions for my health issues.

To deal with metformin etc, I don't know how dosages can work but my interest would only lie in "taking the curb" off liver dumps (if indeed they are my problem). I would talk to a doctor as to if this kind of graduated effect is even possible with these drugs. Of course I wouldn't undergo a course of action that removed my ability to recover naturally from a low. I can be thick sometimes, but not that stupid

I actually don't have DP as such, my biggest background (not carbs) peaks are actually often in the afternoon, but overall they shift quite rapidly over a few days. Thus I am constantly trying to keep up somewhat, even with regular basal fasting testing it's very hard to pin down any pattern beyond broad brushstrokes that are in a flux.

This seems a little unusual (although by no means unique I'm sure) and I am still interested if there is a direct cause between my chronic fatigue and extra, random liver dumps. I understand the point they occur during anerobic exercise: what if the body and muscles are already fatigued and stressed, could less exertion than typically needed, possibly trigger inappropriate dumps? I am guessing it is a possibility...

I am asking for illumination and knowledge, not to justify any particular action... just want to make that clear

[Mich]

Hi Subby,

In addition to the good info from Blue Sky on liver dumps, I would like to mention another possible factor. It isn't always the DP that causes a liver dump, the stress factor is important too.

If your morning work caring for someone is stressful either mentally or physically (is there pain with your CFS?) your liver will also jump in to respond to that. Sometimes things are stressful that we don't even recognize. It wasn't until a few plane flights that I learned how stressful the whole business is for me. Liver dumps were my first clue.

Just another thing to consider.

Mich

[BlueSky]

Originally Posted by Subby

... .. I am still interested if there is a direct cause between my chronic fatigue and extra, random liver dumps. I understand the point they occur during anerobic exercise: what if the body and muscles are already fatigued and stressed, could less exertion than typically needed, possibly trigger inappropriate dumps? I am guessing it is a possibility...

That CFS could cause liver dumps sounds quite reasonable to me. The body is stressed, and this could raise cortisol levels, causing the alpha cells to spit out glucagon when it is not wanted. Metformin might help. When I tried it, I took 500mg before bed, and my blood glucose was definitely lower the next morning than it had been beforehand. It sounds like the extended release form of metformin could be more suitable for you. It might, as you say, just take the edge off those liver dumps. Discuss it with your doctor and explain why you want to try it. Metformin is a cheap and safe drug, so he will probably agree to testing it. But be aware that it can cause GI distress in the initial stages.

[dbc]

Notwithstanding being T1.5, I am on 3x500mg metformin/day in addition to Lantus & Apidra. It's a historic thing - the endo put me on metformin shortly after diagnosis when my A1c was slowly creeping up but my general numbers were such that he was worried about hypos if I started insulin. It worked a treat for 6-9months or so, then I had to start low doses of insulin.

I'm staying with the combination for now - "if it ain't broke, don't fix it" . I reckon I have a trade-off between no DP problems and supressing the liver's rescue action from the occasional low experienced.

Can't agree with Bluesky enough though - low carbing is the only way to keep reasonable control. I find on the few occasions I do splurge with the carbs, even with appropriate insulin, things invariably go wrong, sometimes too high at 2 hours, sometimes too low.

Subby, metformin may be worth a tryout . . . .

[Subby]

Thanks so much for your wisdom and comments guys. I am very happy to at least understand a little better the kind of reasons my fatigue/body stress seems to cause more instability. Frustrating how doctors in my experience shrug their shoulders and just say "it's possible" when I ask about this kind of thing, but don't educate me.

Mich I'm sure you've got something there, the high-needs caring is actually my job and not generally psychologically upsetting, but it can be taxing and invole some semi-strenuous body movements. I don't get much fibromyalgia but low grade aches regularly.

The flip side of this job, is that it is a good mix of activity and rest, it's satisfying to care for someone one on one, and I can pace myself - I can cope with this work along with my fatigue issues. The night shift sleepover I refer to usually involves pretty good sleep! Overall, I have found this line of work far less stressful than office work. Sitting on my butt on the phone etc, sends me sky high in no time.

Metformin idea is on my check-it-out pinboard, so to speak. I'll post here my experiences if I try it.

[NoraWI]

Keep in mind, too, that metformin will make you more sensitive to insulin and reduce your doses. I was initially diagnosed as T2 because of age and took metformin. When a positive GAD65 antibody test showed I was really T1 (LADA), I continued taking metformin (even after beginning an MDI regimen of insulin) until it dawned upon me that I was inhibiting my body from those same liver glucose dumps you refer to. When I stopped taking metformin, my insulin need went up by about a third... still lowish, but definitely higher than before. To control GI distress from metformin eat a small amount of plain full-fat yoghurt. And don't discount changing your eating to low carb. It isn't really that big a sacrifice and you will find you feel so much better! It might even lessen your fatigue...