Diabetes Edutool: Tutorial 2 Low blood glucose and the liver

When we eat, the foods containing starches are broken down into glucose The glucose is first absorbed into the blood stream

Excess glucose from the blood is stored in the liver This glucose is then gradually released when needed for energy

Sometimes your blood glucose can fall too low. This might be due to: Too much insulin, relative to food eaten Insulin

Sometimes your blood glucose can fall too low. This might be due to: Too much insulin, relative to food eaten Too much exercise, relative to food eaten Insulin

Sometimes your blood glucose can fall too low. This might be due to: Too much insulin, relative to food eaten Too much exercise, relative to food eaten Not eating for a while, with active insulin still available Insulin

Let’s use Edutool to investigate. Initially, the blood glucose is normal, therefore the oval is green

Normal blood glucose is close to 5 mmol/l

Now let’s add 5 U of insulin

Insulin stores, causing the blood glucose to drop As insulin increases, more is stored

The liver prevents low blood glucose To prevent low blood glucose, the liver releases

There is a limit to how much the liver can release This is shown by the blue line

Let’s add more insulin to see what will happen

The liver has reached its maximum output level Notice the Energy from liver arrow

The liver cannot release more The blood glucose starts to drop

The liver cannot release more Hypoglycaemia occurs

Let’s add 2 more units of insulin

The blood glucose is now dangerously low Hypoglycaemic coma is a risk at this stage

Let’s recap… Look what happens to the liver arrow and the blood glucose level

To counteract the hypo, we must eat

6 was needed to raise the blood glucose to a normal level To counteract the hypo, we must eat

Lessons: - Relative to food eaten, too much insulin causes low blood glucose - The liver helps to counteract low blood glucose - There is a limit to the liver’s counteracting ability - After exceeding this limit, low blood glucose will occur -- End of Tutorial 2 --