Liver Dump

[shel]

What is a "liver dump?" What can cause it? Is it harmful in some way? How can a liver dump be prevented or mitigated?

[BlueSky]

A liver dump is when glycogen stored in the liver is turned into glucose (glycogenolysis) and it is released into the blood stream. The result is that blood glucose goes up, in spite of no food having been consumed. It is a natural process, and it usually happens when it has been a long time since your last meal. This why a lot of people get liver dumps in the morning. You can reduce the chances of it happening by eating something before going to bed.

[TommyC1]

I think it is meant to supply your brain with glucose when you don't eat. It's also why your BS goes up when you are stressed or sick. Part of the fight or flight response.
It's a normal healthy part of what you liver does. Unfortuately for us diabetics it can make things harder to control.

Tommy

[Janlaton]

So the advise to have a small meal before bed is important to control your sugar to help prevent "Dawn Syndrom". It does not have to be a lot of food a few crackers with a small amount of milk is often all you need to carry you througn.

[bunbury]

So the advise to have a small meal before bed is important to control your sugar to help prevent "Dawn Syndrom". It does not have to be a lot of food a few crackers with a small amount of milk is often all you need to carry you througn.

Yes, a small snack can help. But be careful with the crackers - a surprisingly small number can contain a lot of carbs, and for some us that results in Blood Sugar spike (my once-upon-a-time favorite crackers contained 7.8 grams carb per biscuit). Speaking just for myself, I'd avoid the milk too

[robbytype2]

1/2cup to 1 cup of cottage cheese before bed also helps with people that work out it has an enzyme that keeps your body from eating on your muscles during fast time 1/2 cup works for me unless i am hungary then i do the cup

[Scrabblechick]

Yeah, a little protein helps stop the dump. I'll eat a piece of cheese, maybe a piece of lunchmeat, or a handful of nuts. Or peanut butter on a cracker. (Again, watch the carb counts in the crackers!)

Get the Hood's Calorie Countdown milk and the milk won't be an issue. If you can't stomach the "ultra-skim" taste, just add a tablespoon of cream. Adds taste without carbs!

[jims_forum]

A little more data would be useful as follows:

So far I have battled 3 versions of this as follows:

Dawn effect at night time to am. BG at night 140 and in am waking 238 to 258 reliably. 500 mg dose at 10:00pm and 12:00am midnight shuts off
from 12:00 am to 5:30 am whne liver comes out of barn to start adding glucose. Take dose of insulin on wakeup and next metformin dose - 500 mg at 6:15 am. This dropped my A1c from 13.3 per cent to 6.9.

Liver dumps dusing waking hours:

If BG drops below 70 will trigger this monster ( no metformin on duty) and BG soars to 511 and slides back to 278-311.
doctor says monitor ( and I do extensively) and prevent BG going under 100 using glucose tabs - that stops that.

The other liver dump [I] caught with CGM and is most nasty. BG value can be between 130 and 200 and it does not matter. It occurs when one sees gut exhausted and BG starts dropping. Take snack - some food and as BG starts stopping droop and reversing; liver will decide to help ride the increasing BG and do a nasty dump ( no metformin on duty blood - nasty dump; metformin on duty - Liver behaves itself.

If too much loose insulin in blood will also acerbate this ( my pancreas is still putting out sizeable doses now so I must be carefull not to add too much and on peaks only. I take metformin 500 mg standard 1 hour before meals - 3 times a day. That stops that. Suffice to say - you need cgm to watch this magic show.

ER metformin has not worked for me and seemed to have problems on Teva. Most genarics work fine. One large single dose does not work for me and
is waste of meds - contrary to alternate approaches some folks are on like heat seeking missle.

With this approach I am keeping my BG under control.

Taking met this way really keeps the Liver make sugar raindance clipped right back.

[cbes]

Yes, a small snack can help. But be careful with the crackers - a surprisingly small number can contain a lot of carbs, and for some us that results in Blood Sugar spike (my once-upon-a-time favorite crackers contained 7.8 grams carb per biscuit). Speaking just for myself, I'd avoid the milk too

Tell me about it. This weekend, I snacked on 6 pieces of Ritz crackers with some walnuts. the 2 hour reading was 241. Then I read through the packaging to find the HFCS in the ingredients list. A classic Duh moment

Yes crackers pack in a lot of punch as in carbs if not chosen wisely

[CMurdock]

Shel, there is one thing about liver dumps that is good to keep in mind. If you are starting a low-carb diet after eating high-carb for a while, the liver may dump sugar into the blood for days or even weeks. Thus, your blood sugar may remain high for quite a while, and you may think that your diet isn't working.

The same thing may happen when you first go on insulin (though I'm not certain of this). The insulin lowers your blood sugar, and the liver then sees that as an opportunity to get rid of its excess sugar stores.

Liver dumps can cause a lot of confusion among diabetics because your BS may not go down when you expect it to go down. Liver dumps are also responsible for "dawn syndrome", in which you wake up with higher blood sugar than you went to bed with.

From a biological standpoint, I believe that the purpose of liver dumps is to provide blood sugar when no food is coming in. Also, aside from getting stored as fat in your fat cells, sugar is also stored in your muscles and in a couple other places.

[xMenace]

From a biological standpoint, I believe that the purpose of liver dumps is to provide blood sugar when no food is coming in. Also, aside from getting stored as fat in your fat cells, sugar is also stored in your muscles and in a couple other places.

We constantly release glycogenolysized glucose. Constantly! This is how we feed our cells glucose.

When we eat, we release insulin which stores it. Insulin shoves food into cells for later use. Yes some goes into active cells. Think of this simple concept: we don't die when we miss meals. We may not even feel bad. We can survive for days or even weeks with no food. Without food, our cells die. They are constantly fed.

We type 1's know all too well how this works, especially pumpers who basal test and match our doses to our sugar output. My own basal dosing was calculated with a simple meter over many weeks. It is quite accurate and consistent. I can sleep in until whenever I want, knowing my sugars will be roughly where they were when I went to bed. I can get in my car at 5 o'clock with a 4.2mmol/l reading and feel confident I won't crash during the drive home [bg-wise] even if I get stuck in traffic. This sugar output is not flat, but it's remarkably consistent day after day.

The other "liver dumps" can be triggered various ways. It's our "flight or fight" syndrome, basically an adrenaline rush. When our sugars drop too low, adrenaline gets released. Anerobic exercise -- adrenaline.

The dumps due to fasting are a bit trickier. When I talk hormones, I often refer to sex because most people can relate to it. Sexual "performace" is not a constant. After sex, are you ready to go again? If yes, I'm envious. For many it will be days before they can partake. And what happens if you are not "relieved?" How long do you go without sex, days, weeks, months? And what's that experience like after two weeks of abstinence? Is it intense? I sure hope so.

Our glycogen constantly builds up. It is released when we consume food -- our gastronomic orgasm -- it then builds for the next meal. So what do we expect to happen if we skip a meal? Of course we expect our glycogen store to be elevated. When we eat, the extra glycogen gets released. It's job is to release glycogen stores, so we get our luiver dump. Will glycogen be released without food? Probably. Maybe we can call this gastronomic masturbation¿ After all, 95% of us do it.

[samorgan]

My understanding is that glycogen gets released not when we eat but rather when we haven't eaten and there is no longer any glucose coming from the digestive tract. Cells call out for glucose and none is available from the GI tract, so the liver responds.

"Liver dumps" in diabetics are some combination of confused hormone signalling (asking for it when it isn't needed, e.g., insulin resistant cells which continue to issue the "call", but can't use it when it gets there) and/or hepatic insulin resistance as one of the functions of insulin is to block the liver from releasing glycogen. Logical, because in a normal system whenever insulin is elevated, glucose is also plentiful (that's why the insulin is there), so no reason to release more. Just another thing that can be "broken" in us.

Also, for one on a ketogenic diet, the stores of glycogen in the liver are highly depleted. Most cells are "trained" to fuel on ketones so they don't bother the liver by "calling out" for glucose. The liver has very little glycogen (because so little glucose enters the blood from diet in the first place) and not enough to ever "dump" anything significant or harmful. It just hums along releasing enough glucose for the 5% of the body's cells which must have it because they cannot fuel on ketones.

My experience matches this description.

We constantly release glycogenolysized glucose. Constantly! This is how we feed our cells glucose.

When we eat, we release insulin which stores it. Insulin shoves food into cells for later use. Yes some goes into active cells. Think of this simple concept: we don't die when we miss meals. We may not even feel bad. We can survive for days or even weeks with no food. Without food, our cells die. They are constantly fed.

We type 1's know all too well how this works, especially pumpers who basal test and match our doses to our sugar output. My own basal dosing was calculated with a simple meter over many weeks. It is quite accurate and consistent. I can sleep in until whenever I want, knowing my sugars will be roughly where they were when I went to bed. I can get in my car at 5 o'clock with a 4.2mmol/l reading and feel confident I won't crash during the drive home [bg-wise] even if I get stuck in traffic. This sugar output is not flat, but it's remarkably consistent day after day.

The other "liver dumps" can be triggered various ways. It's our "flight or fight" syndrome, basically an adrenaline rush. When our sugars drop too low, adrenaline gets released. Anerobic exercise -- adrenaline.

The dumps due to fasting are a bit trickier. When I talk hormones, I often refer to sex because most people can relate to it. Sexual "performace" is not a constant. After sex, are you ready to go again? If yes, I'm envious. For many it will be days before they can partake. And what happens if you are not "relieved?" How long do you go without sex, days, weeks, months? And what's that experience like after two weeks of abstinence? Is it intense? I sure hope so.

Our glycogen constantly builds up. It is released when we consume food -- our gastronomic orgasm -- it then builds for the next meal. So what do we expect to happen if we skip a meal? Of course we expect our glycogen store to be elevated. When we eat, the extra glycogen gets released. It's job is to release glycogen stores, so we get our luiver dump. Will glycogen be released without food? Probably. Maybe we can call this gastronomic masturbation¿ After all, 95% of us do it.