How effective is glucagon as a treatment for lows on a low-carb diet?

David49 · May 6, 2018, 5:11pm

In a thread on backpacking while eating low-carb, the topic of correcting lows was raised. Standard suggestions are to pack glucagon for dangerous lows, but it got me thinking about how glucagon might not be effective in a state of glycogen-depletion. I suspect that glucagon injections will be less effective if liver-stored glycogen is depleted, and that a different treatment for lows might be needed for low-carbers while hiking, biking, mud-running, etc.

Have any of you tried using glucagon to correct a low when you’ve been consistently eating very low-carb and exercising? How effective was it at raising blood glucose? Have you found quick carbs to be more effective when eating low-carb?

Eric2 · May 6, 2018, 5:30pm

I am not a low-carber. In fact, quite the opposite, I am on the high carb side.

But in answer to your question, I tried using glucagon for lows as an experiment when running. And after 10-12 miles, it did absolutely nothing for me.

Totally makes sense. After that number of miles (at least when running with a reasonable intensity), your body doesn’t have a whole lot of glycogen left to spare.

Walking 10 miles is different than running 10, so all of this depends on the individual’s liver glycogen storage and how much they deplete with their activity. Lower intensity activity would deplete at a lower rate.

But for me, being a high-carber, I know that at least when I started the run my liver glycogen was full. And glucagon proved to be worthless for me in this situation.

Terry4 · May 6, 2018, 7:32pm

This article does not directly address liver glycogen, emergency glucagon, and diabetes but does add some interesting perspective and context on the issue. It is a 2011 interview of Dr. Steve Phinney, a proponent and researcher of a low-carb high-fat eating style. Here’s his short bio taken from the article:

I’m a medical doctor and have my training in internal medicine. Early in my career developed an interest in nutrition and got a PhD in nutritional biochemistry. That was 30 odd years ago, and since then my primary interests have been in weight management, ie, obesity, exercise and the human economy of the various fats we either put in our mouths or make in our bodies.

While the interview does not focus on the T1D metabolism per se, it does discuss and compare glycogen usage in low-carb versus high-carb eating styles.

Right. But what if your rate of glycogen use can be cut by a factor of four? And while you’re starting out with half as much glycogen as the person next you eating a high carbohydrate diet, but you’ll use up your glycogen four times more slowly than the person on a high carbohydrate diet. Whose glycogen will be more likely to last? The person whose rate of glycogen is a quarter as much, and their tank is half empty? Or the person whose glycogen level is twice as high but uses it up four times faster?

And those are actual numbers. We took bits of muscle out of their thigh muscles and measured muscle and measured glycogen before and after. On the same duration of riding and the same intensity, their rate of glycogen use was one-fourth as much.

I’ve read a few books by Steve Phinney and found them interesting. I’m not a highly physical athlete by any stretch but I do walk about 1000 miles per year. I’ve been following a low-carb high-fat diet for six years and it’s helped with my glucose control. But I don’t have first hand experience with exercising to exhaustion and then asking the liver to release glycogen when prompted by an emergency glucagon shot. I suspect, however, that a T1D who is adapted to a low-carb high-fat way of eating is a different case than a T1D who eats high-carb.

mohe0001 · May 7, 2018, 6:13pm

This is an interesting question, I’m gonna try and think through it.

Found this. Although, I dont know what it says.

I’ve always appreciated the built in safety measure of having my my liver kick some sugar when I’m low or when I’m exercising. I do believe that I have been in situations where that mechanism didn’t work as effectively. Sometimes I’m really low energy when I exercise and I don’t believe my liver is helping me. Or, sometimes I get a particularly ‘severe’ low, where it happens quickly and I don’t think my liver is buffering that. But, if I ate high protein diet = low carb diet, I still think I would kick sugar where needed. Unless I had completely depleted my energy reserves, like if I were starving to death on a deserted island. But, then I would be tired and not performing much physical exercise.

Like, if I were not a diabetic and I were in a prison camp and was starving to death and doing lots of physical work (say, I was in the goulauge), then I would be loosing weight and not have energy and eventually I would just die. I don’t think thats whats people are enacting with their low cab/high protein diets. That seems like a situation where glucagon definitely might fail (on one side of the spectrum).

Once, when I was given glucagon, I was told to eat immediately afterwards because it was only a temporary fix and I would drop rapidly again soon. That happened within a half hour or hours time. Has anyone else ever been told this? (“13- You will need to continue to closely monitor blood sugars throughout the day after this, as a glucagon use will raise blood sugar substantially, but you will usually have an after effect of going low again. There is also a greater risk for another severe low for 24 hours after glucagon use. Because glucagon depletes the excess glucose storage in your system, some doctors recommend running your BGs a bit higher for a few days following glucagon use to help restore emergency sugars.” https://beyondtype1.org/diabetes-glucagon-information/)

I’d like to hear more input from others. But, I don’t know how we answer this question since glucagon is used so rarely. Just a quick fix for us when we are unconsious.