1. Diabetes Edutool: Tutorial 2 Low blood glucose and the liver

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

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

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

5. 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

6. 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

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

8. Normal blood glucose is close to 5 mmol/l

9. Now let’s add 5 U of insulin

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

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

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

13. Let’s add more insulin to see what will happen

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

15. The liver cannot release more The blood glucose starts to drop

16. The liver cannot release more Hypoglycaemia occurs

17. Let’s add 2 more units of insulin

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

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

20. To counteract the hypo, we must eat

21. 6 was needed to raise the blood glucose to a normal level To counteract the hypo, we must eat

22. 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 --