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Awesome write up, but one thing I still don't understand; why is hypoglycemia such a big part of the problem? If insulin is your body's way of moving glucose ou

Awesome write up, but one thing I still don't understand; why is hypoglycemia such a big part of the problem? If insulin is your body's way of moving glucose out of your bloodstream and T1D means that lever is broken, why do you so often end up with too little blood glucose? Is it just because of overestimating the insulin dose? Or is there some other factor; i.e. does glyconeogenesis not work properly or something along those lines? If the problem is that the pancreas can't produce insulin, I would have thought something like a ketogenic diet would make it easier since you would have less of a need for insulin, and therefore less guesswork trying to counteract the blood sugar spikes from a high carb meal. But it sounds like bringing blood sugar up is a big part of managing T1D, so I'm just wondering why that would be the case for a diabetic but not for a non-diabetic.

Trasmatta 5y ago
> why do you so often end up with too little blood glucose? Managing the balance between insulin and BG is normally an automatic process performed by the endocrine system. A person whose pancreas stops producing insulin now has to manage that careful balance consciously, which introduces the possibility for errors. And it's complicated even more by all the factors that can influence BG in either direction (see the chart in the OP). A healthy body is very good at managing that balance automatically through complex feedback loops. Those feedback loops break down if the body can no longer produce insulin on its own. > If the problem is that the pancreas can't produce insulin, I would have thought something like a ketogenic diet would make it easier since you would have less of a need for insulin Some T1Ds absolutely do go on a ketogenic diet, or at least a low carb one. You still need insulin, just less of it. Because you still have to dose yourself with insulin, you still have the risk of hypoglycemia on a low carb diet. (Sometimes even more of a risk, because your insulin resistance typically goes down on those diets.) That being said, there are T1Ds that have a lot of success with keto / low-carb. Just don't believe anyone who says you can cure T1D with that diet. T2D can sometimes be reversed that way, but never T1D. > But it sounds like bringing blood sugar up is a big part of managing T1D It's less about "bringing blood sugar up" and more about balancing the blood sugar on the edge of a thin blade. Tipping in either direction is bad.
- fortran77 5y ago
  The majority of people with "Type 2" who are also obese would be asymptomatic (i.e., "remission") if they went down to a healthy weight. (Type 2 patients who are not overweight or obese aren't so responsive to diet.) https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/type2-diabetes-remission https://www.diabetes.org.uk/guide-to-diabetes/managing-your-... It's almost like there should be a different name for the disorder people get who are obese who develop Type 2 diabetes. Maybe "Type O" diabetes?
idealmedtech 5y ago
In short, severe hypoglycemia is an immediate risk to your life, and prolonged hypos <50mg/dL can lead to brain damage, especially in infants or people who don't have a lot of reserves. Gluconeogenesis still happens, but an insulin overdose can tank your blood sugar much faster than your liver can keep up.
sgmoore 5y ago
> But it sounds like bringing blood sugar up is a big part of managing T1D, so I'm just wondering why that would be the case for a diabetic but not for a non-diabetic. If you think of insulin as moving the glucose out of your blood stream into a storage area, eg your liver, then, when a normal person's blood sugar goes low, their body stops producing insulin and at the same time dumps some glucose from storage (eg the liver) back into the blood stream. But if I have injected some insulin, the insulin will still be working and I can't just tell it to stop. So even if my liver tries to help me by dumping glucose into my blood stream, the injected insulin will try to move it back! So it is harder and takes longer for my blood sugar to rise on its own. Hence non-diabetics can increase their blood sugar levels when needed, but that is a lot harder for diabetics who are on medication. The biggest problem that I find controlling my BS levels, is not overdosing, but dealing with the unexpected. For example, taking insulin before a meal and then dropping my dinner plate and then trying to find something similar that I can eat quickly or getting an important phone call and being interrupted before I get a chance to eat. Or maybe just getting stuck in traffic and missing a meal. Keto/low carb diets seem to work better for non-insulin dependent diabetics who are producing some insulin, just not enough. I think most Type 1's would still need some (significant) amount of insulin even on a keto diet, so the hypo problem still exists.
- mikenew 5y ago
  Ah thank you, that makes much more sense to me now. The other answers weren't quite was I was looking for. I really hope the CGM and "artificial pancreas" technology continues to progress. It really sounds like a very difficult thing to deal with day in and day out. Thanks for taking the time to help me understand it a little better.

Trasmatta 5y ago

> why do you so often end up with too little blood glucose? Managing the balance between insulin and BG is normally an automatic process performed by the endocrine system. A person whose pancreas stops producing insulin now has to manage that careful balance consciously, which introduces the possibility for errors. And it's complicated even more by all the factors that can influence BG in either direction (see the chart in the OP). A healthy body is very good at managing that balance automatically through complex feedback loops. Those feedback loops break down if the body can no longer produce insulin on its own. > If the problem is that the pancreas can't produce insulin, I would have thought something like a ketogenic diet would make it easier since you would have less of a need for insulin Some T1Ds absolutely do go on a ketogenic diet, or at least a low carb one. You still need insulin, just less of it. Because you still have to dose yourself with insulin, you still have the risk of hypoglycemia on a low carb diet. (Sometimes even more of a risk, because your insulin resistance typically goes down on those diets.) That being said, there are T1Ds that have a lot of success with keto / low-carb. Just don't believe anyone who says you can cure T1D with that diet. T2D can sometimes be reversed that way, but never T1D. > But it sounds like bringing blood sugar up is a big part of managing T1D It's less about "bringing blood sugar up" and more about balancing the blood sugar on the edge of a thin blade. Tipping in either direction is bad.

fortran77 5y ago
The majority of people with "Type 2" who are also obese would be asymptomatic (i.e., "remission") if they went down to a healthy weight. (Type 2 patients who are not overweight or obese aren't so responsive to diet.) https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/type2-diabetes-remission https://www.diabetes.org.uk/guide-to-diabetes/managing-your-... It's almost like there should be a different name for the disorder people get who are obese who develop Type 2 diabetes. Maybe "Type O" diabetes?

idealmedtech 5y ago

In short, severe hypoglycemia is an immediate risk to your life, and prolonged hypos <50mg/dL can lead to brain damage, especially in infants or people who don't have a lot of reserves. Gluconeogenesis still happens, but an insulin overdose can tank your blood sugar much faster than your liver can keep up.

sgmoore 5y ago

> But it sounds like bringing blood sugar up is a big part of managing T1D, so I'm just wondering why that would be the case for a diabetic but not for a non-diabetic. If you think of insulin as moving the glucose out of your blood stream into a storage area, eg your liver, then, when a normal person's blood sugar goes low, their body stops producing insulin and at the same time dumps some glucose from storage (eg the liver) back into the blood stream. But if I have injected some insulin, the insulin will still be working and I can't just tell it to stop. So even if my liver tries to help me by dumping glucose into my blood stream, the injected insulin will try to move it back! So it is harder and takes longer for my blood sugar to rise on its own. Hence non-diabetics can increase their blood sugar levels when needed, but that is a lot harder for diabetics who are on medication. The biggest problem that I find controlling my BS levels, is not overdosing, but dealing with the unexpected. For example, taking insulin before a meal and then dropping my dinner plate and then trying to find something similar that I can eat quickly or getting an important phone call and being interrupted before I get a chance to eat. Or maybe just getting stuck in traffic and missing a meal. Keto/low carb diets seem to work better for non-insulin dependent diabetics who are producing some insulin, just not enough. I think most Type 1's would still need some (significant) amount of insulin even on a keto diet, so the hypo problem still exists.

mikenew 5y ago
Ah thank you, that makes much more sense to me now. The other answers weren't quite was I was looking for. I really hope the CGM and "artificial pancreas" technology continues to progress. It really sounds like a very difficult thing to deal with day in and day out. Thanks for taking the time to help me understand it a little better.