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The Liver's Role

Discussion in 'Parents of Children with Type 1' started by Junosmom, Dec 8, 2013.

  1. Junosmom

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    My son will drop from bedtime 140 mg/mL to about 100 by 3 a.m. Then, we will see a slight rise to by waking time, maybe 10 mg/ML. I'm aware that some of this may be due to the accuracy (~20% range) of the Nano meter. But it is fairly consistent, so maybe not. He's 11 yo, and growing but slowly right now (thank goodness).

    I was telling him how the liver will sometimes release glucagon when it detects low sugar during sleep, raising his blood glucose. He asked why the liver doesn't do this to rescue him during a low during the day? I thought it was a good question, though I have no answer. Do you?

    [As to putting him to bed high, I think?? some of this comes from our eating dinner somewhat late (7 - 7:30 p.m.) and he seems to have a four hour cycle, rather than three or three and a half. So by 10:30 p.m. (we homeschool, later bedtimes), he is still a little high from dinner. This seems to play out as by 3 a.m., he is in range (80 - 120). We are MDI right now.]
     
  2. nanhsot

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    I actually believe that a glucagon response from the liver IS preserved in some Type 1 diabetics~but not all. How to know if that's you...I am unclear on that.

    I would not assume that what's happening at night is from the liver though, and I can't personally see any reason it would happen at night and not day, so if that is something preserved in your son, it would happen during the day as well.

    Morning rise may be more from cortisol than from glucagon though, and it's what I would suspect is happening.
     
  3. mocha

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    It does happen in some diabetics at night (known as the Somogyi Phenomenon). Generally, though, this makes you feel terrible, mainly because you end up super high afterwards.

    Diabetes is a fickle beast. While the liver does play a major role, so do a billion other things (like, is the moon aligned with Mars? :rolleyes: ). It could be stress finally reduced enough that the body can relax. It could be the liver not kicking out at much during that time. It could just be that diabetes throws a temper tantrum every night (and day).

    Blood sugars tend to rise in the morning due to the dawn phenomenon (which is also a PITA).

    As far as why the liver doesn't rescue us from lows...because the liver is stupid. It's had it's control box taken away. It's not going to catch anything until it's far too late, and even then, it often just shrugs its shoulders and continues ignoring you. When it does catch things, it throws everything it has at it, which is why a 65 mg/dL reading can turn in to a 300 mg/dL reading without you doing anything.

    At least, that's my understanding of it.
     
  4. nebby3

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    The liver could help out during the day but the response is impaired in type 1 and you can't count on it, day or night. Rising numbers in the early AM is completely typically of puberty. My 11yo dd has the same pattern. Even if you don't see outward signs of it, his body is gearing up for it. I think the glucose is still coming from the liver but it is probably pubertal hormones causing the release, not a low.
     
  5. mmgirls

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    Personally what you describe I sounds more of growth hormones raising big prior to waking or Lantus wearing off, rather than liver spitting out glucose to raise a normal bg/ rescuing a low bg / rebounding.

    It is not just the liver with a release of glucose but various other hormones that respond to low bg. Some T1d's still have a healthy amount of beta cells that allow for a counter regulatory action to be accomplished, while others do not and miss that first saving action of glucose release.
     
  6. Junosmom

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    Thank you for all the replies. Based on the comments, maybe it is the cortisol. Will read up on that. He's on the brink of puberty, I think. He does go down until 3 a.m., raises a small amount until waking, but then, weirdly, I have to lower his insulin ratio or back off one unit or he tanks at lunch. He is still honeymooning, so it is all so confusing. Okay, so maybe then it isn't his liver, just a jumble of other things. I like the description of the liver as stupid :)
     

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