Tuesday, August 18, 2015

Glucagon, The Forgotten Hormone In Diabetes.

Type 2 Diabetes is almost always thought of as a disease of simple blood sugar management.  In reality there is nothing simple about diabetes.   There are multiple factors involved on many levels.

In my experience with many Diabetics in my group settings there are always reports of crazy blood sugar swings when the person claims that they have not had any carbs or sugar,   Many report high blood sugar either at wake up or after wake up before eating.   It is not uncommon to see raised blood sugar after exercising, gardening, or fasting.  An argument or bad news can raise blood sugar.  What's going on here?


It isn't the most recognized hormone insulin that is the culprit behind these issues.  Insulin is the hormone that is supposed to lower blood sugar.   People often say "Your blood sugar went up due to an adrenaline response or a cortisol response".   But why and how?


I am no scientist but I spend a lot of time teaching others about managing blood sugar so I manage to learn from a lot of sciency people around me.   I pick up on a few things along the way.


There is the forgotten hormone Glucagon.   It seems that nobody talks about it.  Your doctor or diabetes educator won't.   They may know of it's use in patients who are passed out in a diabetic coma but that is the only time that they are going to think about it.


Glucagon is a major player in diabetes and blood sugar control.  One of the problems is that no one is able to figure out how to manage it.  Certainly drug companies would love to find a way to add an additional medication to control the over production of glucagon.   Many so-called Brittle Diabetics are thought to have a dis-regulation of glucagon.   


Glucagon is secreted into the bloodstream by the alpha cells, insulin is secreted by the Beta cells.  When insulin is produced, glucagon is suppressed.  (after a meal).  When glucagon is released it suppresses insulin.

In diabetics many of the beta cells are gone or are overworked so insulin is not working so well.  On the other hand the alpha cells are just fine and releasing lots of glucagon when signaled to do so.  Your insulin is not responding normally so your blood sugar does not come back down quickly like it would in a normal person.

Glucagon tells the liver to start churning out glucose and the next thing you know, for seemingly no reason that you can think of, you have an unexpected blood sugar high even while fasting!  What the heck. 


HOW GLUCAGON WORKS  (link)

What are some reasons why glucagon is released?  Here are some:

Low Blood Glucose, even in a normal range when insulin levels are also low: Good normal blood sugar is great and that is what you want.  For many who are new to eating a low carb diet you may see some rises in blood sugar as glucagon is released to compensate.  Just keep going and things will level off.

Fasting:  Again while fasting insulin levels are low so the brain signals the pancreas to release glucagon. This is a normal response so don't panic.  This is why many see higher blood sugar in the morning. 


Protein-rich meals: stimulate both insulin and glucagon.  Too much protein will have to be stored as glycogen (sugar) in the liver and the hormone glucagon stimulates this process.  This is the reason that I always advise against large protein portions.   Your blood sugar goes up from both the carbohydrates and the protein you just ate.  Your body only needs an adequate amount of protein for the use of essential amino acids.  Glucagon, Dietary Protein, and Low-Carbohydrate Diets


Stress, Exercise, Bad News, an Argument or Injury:   Your body perceives all stress the same way. physical or mental stress cause the same release of various "fight or flight" hormones.   Beyond that, a person with chronic and long lasting fear or anxiety is in a constant state of stress.  Glucagon is stimulated by these various stress hormones.  As long as you are under the stressful condition the liver will receive it's instructions to provide more glucose to give you the energy you need to fight off the dangers around you, perceived or real doesn't matter.    This is all a good reason to try to discover what may be causing your stress and anxiety on a daily basis and try to find ways to combat it for your blood sugar health.
There isn't much you can do about illness and injuries but at least you will be aware of why it is affecting your blood sugar and you won't make matters worse by panicking and then adding to the stress!   In some cases there may be some natural remedies that will reduce pain and inflammation or you may have to rely on some medical help.

From: Minireview: Glucagon in Stress and Energy Homeostasis

http://press.endocrine.org/   Nov. 2011


"Evidence for glucagon release in a wide variety of stressful situations began to accumulate after improvements in glucagon assays made accurate measurement possible in the early 1970s. In animal models, large elevations in plasma glucagon are observed immediately after acutely stressful stimuli. Hyperglucagonemia is also well recognized in patients under a range of physiological stress states, including trauma , burns , surgery,  sepsis ), hemorrhage, acute myocardial infarction, cardiac arrest, and hypoxia including in neonates Very high plasma glucagon concentrations are seen in diabetic ketoacidosis and contribute to hyperglycemia in this setting."

While I have barely scratched the surface of this issue it is important to understand that glucagon may be affecting your blood sugar negatively and some changes may be in order in your life. Try to reduce stress, arguments, negative work environments, etc. 

My final word on this is that I hope you will remember not to beat yourself up over things that you can't control. Don't assume that every blood sugar rise must be due to something you ate or drank. Don't blame yourself and assume you must have "cheated" or eaten some forbidden food.  Give yourself a break! 

I will end by saying what I said when I started.  Diabetes is not a simple disease.  It is complicated and involves many hormones and various other factors.  Some you can control and others you may not be able to.   I am not an expert on diabetes.   I am growing and learning as I continue to discover how to manage diabetes with a ketogenic lifestyle. 

A good book to read that goes into these factors and hormones is one written by Dr. Richard David Feinman called
  "The World Turned Upside Down. The Second Low Carbohydrate Revolution".   

Please do not take anything you read here as medical advice or make changes to medications based on what you read on my blog. 


 

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