Monday, February 16, 2009

I Ate Nothing! Why Are My BGs high?

Most of us discover fairly quickly after we start testing after meals that eating carbs leads to a rise in our blood glucose levels. That seems logical, and it is, so managing those carbs and the resulting spikes becomes a cornerstone of home treatment.

But pretty soon we also discover that logic has limitations. We go to bed at night with good numbers and wake with high numbers. But we didn't eat in our sleep. Or we make the mistake of thinking 'food = spike, fasting = no spike' and find that after eating nothing for six hours we might be normal or even high when we expected to be low.

It doesn't seem to make sense, does it? "I Ate Nothing! Why Are My BGs high?".

I am no expert on this, but I am pretty good at looking things up and then testing the things I read against my own results. My body, my science experiment. So I checked this out a long time back when I first came across the term "liver dump". Here is my rough version, based on the best explanation I've seen (or that I could understand at my level:-) . This is the medical-speak version:

"Stores of readily available glucose to supply the tissues with an oxidizable energy source are found principally in the liver, as glycogen. Glycogen is a polymer of glucose residues linked by a-(1,4)- and a-(1,6)-glycosidic bonds. A second major source of stored glucose is the glycogen of skeletal muscle. However, muscle glycogen is not generally available to other tissues, because muscle lacks the enzyme glucose-6-phosphatase.
*snip*
The major site of daily glucose consumption (75%) is the brain via aerobic pathways. Most of the remainder of is utilized by erythrocytes, skeletal muscle, and heart muscle. The body obtains glucose either directly from the diet or from amino acids and lactate via gluconeogenesis. Glucose obtained from these two primary sources either remains soluble in the body fluids or is stored in a polymeric form, glycogen. Glycogen is considered the principal storage form of glucose and is found mainly in liver and muscle, with kidney and intestines adding minor storage sites. With up to 10% of its weight as glycogen, the liver has the highest specific content of any body tissue. Muscle has a much lower amount of glycogen per unit mass of tissue, but since the total mass of muscle is so much greater than that of liver, total glycogen stored in muscle is about twice that of liver. Stores of glycogen in the liver are considered the main buffer of blood glucose levels."

For the really detailed version click on the links.

Below I put that in words that I understand. I am no biochemist, so if any experts are reading this please correct any errors I make or omissions from over-simplification.

Liver Dumps.

We need glucose for energy. When we eat a meal it is usually a mix of carbohydrates, protein and fats. Carbohydrates are an easily converted source which quickly appear as glucose in our blood. We also, more slowly, obtain glucose by gluconeogenesis from protein or even fats and also from the stored energy in our liver and other organs.

When we create more glucose than our immediate needs some is stored. Some is stored as fat, especially if we have excess insulin floating around, and some is converted to glycogen. Glycogen is stored mainly in the liver and the muscles. The muscles are selfish because the glycogen stored in the muscles can usually only be used for the muscles, but the glycogen stored in the liver is our supply for any glucose needed by the rest of the body. When the body needs it the right amount is automatically released to the right places. As a result there is always a steady flow of energy to meet a person's needs, regulated to demand, regardless of when or what they eat.

At least, that is how it works in non-diabetics. It is the body's version of a fuel tank. Unfortunately, for type 2s, the system can be flawed. Type 2s on the internet use the term "liver dump" for the release of excessive glycogen fr0m the liver to become blood glucose at times when it wasn't really needed or wanted.

For example, one cause of the Dawn Phenomenon is thought to be the body sensing our need for energy when we are about to wake, leading to excessive glycogen release until we eat and send the signal to stop the release. That's why a breakfast soon after we wake is an essential meal for many of us. Similarly, fasting, exercise or heavy physical activity can lead to a liver dump if the body senses the reduction in blood glucose levels and over-compensates with excessive glycogen release.

Preventing liver dumps is complex and I know no general solution. For dawn phenomenon the most common treatment is to eat a late night snack; but the reports of successful snacks vary widely so it's best to perform your own experiments until, hopefully, you find the one that works for you. A minority never does, and others find that the only solution for them is basal insulin.

For those who experience liver dumps after fasting the solution is easy. Don't fast for long periods. Eat something every few hours, even if it is only a small snack.

For those who get them during or after exercise, I have seen reports of success from people who spread small carby snacks across the period of exercise, including a snack before starting.

Sorry I can't be more specific with answers on this one, just suggestions. Once again it's your body, your science experiment

Cheers, Alan, T2, Australia.

Everything in Moderation - Except Laughter

Postscript: Another good comment on the "Dawn Phenomenon can be found in the Misc.Health.Diabetes FAQs. Click on the link and scroll down to "Why is my morning bg high? What are dawn phenomenon, rebound, and Somogyi effect?".

13 comments:

Trinkwasser said...

Worth adding that the total blood volume only contains around 5g glucose at any one time, so a "dump" which doubles your BG may only be a comparatively tiny quantity of glucose. That's why they can be so tricky to control.

Sara said...

My current situation is that I wake with BGs that are acceptable, usually in the lower to mid 90s, but then after about 45 minutes to an hour of running around getting myself and my kids ready to go but not eating, my BG has jumped into the 120s -- these are often the highest readings I see during the entire day, since I eat a fairly strict low-carb diet. Obviously a liver dump; my liver plainly "thinks" that I need some glucose for that early morning activity.

I'm trying to figure out how I can revamp my schedule into something that I can reliably do without causing me to be chronically late, but that will let me eat first thing (typically, now, I eat about an hour and a half after I get up). One of the things I'm considering is taking a 4g glucose tablet (the kind used for hypo correction) right after getting up, and seeing if that gets my liver to calm the heck down and not dump.

Alan said...

Try a few different snacks, experimenting to see which works best. I'm not really in favour of glucose tabs used that way. Nor do I like pre-prepared foods like protein shakes or similar. I always prefer real food.

How long does it take to wrap a slice of cheese in a slice of ham? Or to eat cheese on a cracker, or a few olives as you get the kids sorted out? Or, if you find you really need carbs, a slice of buttered bread or toast?

Think outside the square, but please consider eating something within ten minutes of climbing out of the cot.

Sara said...

I agree with that in the long term, but for experimentation, I think repeatability is key, and reducing sources of variation is an important aspect. The question I'm trying to answer is "will a small dose of carbs stop the dump?", and I need to know, as closely as I can, what dosage I'm getting; the dosage of the tablets is significantly more predictable than with whole foods, where the less processed they are, the more potential variability you have. I should be able to see if 4g does it, and if it does, if half a tablet, at 2g, is sufficient; also, it's pure glucose, which is hard to find in whole foods, since most of them are mixed saccharides, so I won't have any confounding from fructose also doing things to my liver.

I'm not dismissing your advice, though; my plan was always to first find the effective dose (or if there IS an effective dose that doesn't do more to my BG than the liver dump in the first place), and then experiment with ways to get that in.

Delphine said...

Hello,
I've been researching the glycogen factor myself. I have major issues with it and am fighting some unknown malady at the same time, so things get tangled. Anyway, the breakfast thing - I'm fortunate in one way that I do not work so the morning is mine but I have discovered that carbs and glucose just create havoc, but you must try to find out. We are all different. But if it doesn't work, the ham and cheese is a good idea or I make mini meatballs. Make a stack of them to suit your own taste cook them in the oven and there you go. Store inthem in the fridge or freeze them. In the morning you can just pop a couple in your mouth. Eat them cold or zap them in the microwave. Protein stops my hunger problems and helps me cope with my all day 'liver dumps'.

Annievause said...

I, too, have a problem with liver dump. My situation is slightly different from that which I've read here. I have to take a pill (Lopid, for high cholesterol) 30 minutes before eating. I get up between 5:00a and 5:15a. My blood sugar is around 100-112 (still high, I know, but my new doctor and I are working on lowering it). I then take my pill, then take my shower while waiting for the 30 minutes to pass. When the time is up, I check my BS again before having my breakfast and my BS has jumped to mid-120s or higher. I usually end up having a low-carb Slim-Fast, but that leaves me very hungry a short time later (an "Optima" Slim-Fast keeps me full for a long time, but it has too many carbs when my BS is already at 125 or 130). I don't have much time to cook anything -- I have to leave my house by 6:30 to get to work on time. I can't eat lunch until 12:00, but I can have a snack whenever I need it -- I just don't know what to snack on. Maybe I should just ask my doctor for a pill that doesn't have to be taken 30 minutes before meals, but that would probably be a statin drug, which I can't take. Sorry this is so long. Any suggestions would be appreciated.

Alan said...

Keep experimenting with variations on a small bedtime snack. Maybe that won't solve it for you, but maybe it will. I have seen all sorts of different ideas work for different people, ranging from cereal to red wine and everything in between.

On whether or not you need to lower your cholesterol, I'll be posting some general comments on that shortly. For the moment I'll just say that I'm not a statin supporter. I'm afraid I know very little about Lopid so I won't comment on that.

On a different point, try a breakfast that you can re-heat in the microwave while you have your shower. Things like pre-cooked home-made casseroles frozen in one-portion serves, or microwave scrambled eggs or similar. A cooked breakfast does not take long. An omelette should only take a few minutes in a skillet. Think outside the square.

On snacks, see if some of the ideas here help: http://loraldiabetes.blogspot.com/2008/11/snacks.html

Simon said...

Annievause

Mornings can be difficult to make time for breakfast - but you have to, it's your health we're talking about here ;)

Slimfast is full of sugar, you might as well be eating chocolate. Please avoid it all costs!!

So what's my suggestion? Well, one of the best breakfasts for diabetics is to have some easy cook oats (porridge). You can even prepare it the night before, leave it in the microwave and simply turn on the microwave in the morning!!

Quick cook oats / porridge has a very low Glycemic index and has been proven to help stabilise insulin activity and help lower blood pressure. Add some cinnamon (not the Cassia type though) to your porridge (but NO sugar!!!!) which also greatly helps T2 diabetics.

You have to make time for your breakfast, even if it means going to bed half hour earlier :)

Good luck

Alan said...

Hello Simon.

I would like to add that oats has quite different effects on people at breakfast. There seems to be a lucky group who can eat them as you describe but there is also a group who cannot eat them at breakfast without a blood glucose spike. Unfortunately I am in that group.

I recommend that whatever breakfast you eat you should test it at your peak after breakfast to check on the effects, regardless of it's glycemic index.

Guillermo Lazo said...

How about drinking some juice in the middle of the night? Has anyone tried that?

Alan said...

Hello Guillermo

I haven't tried it myself.

I no longer drink juice at all, as it was worse than regular soda for spiking my blood glucose levels.

Try it if you wish to, but I would use something with a lower GI than juice.

Your body, your science experiment.

Cheers, Alan

Anonymous said...

Hi -

Great info. I'm not diabetic but I am currently in the process of reversing my pre-diabetic metobolic syndrome/insulin resistance in an effort to gain control of a healthy weight and reduce my cardiovascular risks. I recently eliminated all grain and bean products from my diet as well as starchy vegetables and all fruits (except berries) ... basically what is known as a paleo or caveman diet. I do intend to add many fruits back into my diet at a later date for their high nutritional value but not the grains or beans.

I began taking postprandial measurements to see just how certain foods were affecting my insulin levels. I was shocked to learn that what I thought was a healthy low glycemic diet was still causing severe BG spikes into the 150's to 180's ... I'm talking organic thick cut oatmeal cooked in almond milk or a small Gala apple or lentil soup made by myself without any sugar or other high glycemic ingredients.

Anyway, I'm trying to give my liver a chance to recover from fatty liver disease (one component of my metobolic syndrome) by staying in ketosis for a few weeks.

Hence your article regarding the "liver dump" has led me to this post. Does anyone know if the glucose "liver dump" is sourced from glucogensis? If I'm in ketosis, I don't see where else the glucose could come from.

BTW - I am monitoring my BG just as suggested on this blog. Since going on my diet I have maintained BG well under 100 with morning FG in mid 80's and postprndial #s in upper 70's to lower 80's. So far not too bad although some of my lowest BG #s have been as low as 70 ... don't know if that is considered a bad thing. I think I read somewhere that it should not go below 60.

Aries said...

I have pre-diabetic metobolic syndrome/insulin resistance and hypo-thyroid problem. I am trying to learn the options available for me since I am a vegeterian mostly using rice/lentil/veg for my whole life. Thank you so much for this blog.