Question about glycogen

Type 1 and LADA
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So I was wondering if anyone has an answer for me on the question of glycogen. Esp when startled or stressed.

On my way to work I was cut off in traffic and it really got my heart going. I nearly hit this guy and then he ended up hitting another car. No idea what was up with him.

Then within 5 min my sugar went up and up. And normally I am 97 percent in range, but here I was 15 min later and I was at 250. This almost never happens to me. If I hit 190 it’s very rare.
Anyway my diabetes educator told me to never bolus for a glycogen dump because you will go low, but I stayed above 230 for an hour and then I corrected and it came to 140 then dropped to 88 a little later.
So I get that my liver dumped glucose on me as part of the fight or flight response but why is it that we are not supposed to correct it? I mean where is it supposed to go?
I think next time I will correct it a little less but I’m not going to just stay over 200.
I checked in with my endo who told me not to correct for situations like that but never told me where that sugar goes.
And why I should let it be high.

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That sounds odd to me. The not correcting part, I mean. I’ve never heard that.

I mean, in a true fight or flight situation, for which that sugar spike is intended, you would need that extra sugar to fuel your response. But in most cases, we aren’t actually in a situation in which we’re going to work off the spike immediately… like while sitting in a car! I’d definitely correct for it.

I’m interested to here anyone with with an argument for not correcting, too.

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Rather than glycogen, here is another possible explanation.

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Hey Tim. Hope you are well.

Your endo is going from the textbook, but not really putting ALL of it together.

The liver can take up glucose without insulin. It does not use the GLUT4 transport like most of the other tissues and organs. It uses different glucose transporters - GLUT1, GLUT2, and GLUT3. Because of that, it does not need insulin for glucose uptake on the transport level.

So the endo is thinking…your liver released the glucose, and it will take it all back without insulin. Because indeed the liver does not need insulin for uptake.

However what the endo is missing is that glucose uptake by the liver is up-regulated by insulin, and down-regulated by the release of epinephrine, which is what caused your spike.

Insulin stimulates the liver to store glucose in the form of glycogen (glycogen synthesis, or glycogenesis, the storage of glucose as glycogen).

While not necessary for uptake, insulin indeed has several effects which stimulate glycogen synthesis in the liver. It activates the enzyme hexokinase, which phosphorylates glucose, trapping it within the cell. Insulin also activates several of the enzymes that are directly involved in glycogen synthesis - glucokinase and glycogen synthase. In addition, insulin inhibits the activity of glucose-6-phosphatase, which would free glucose.

So your question was about why the endo told you not to correct it.

The difference between the endo’s textbook understanding and the real world application is this:

Endo - The liver is one of the 7 tissues/organs that do not need insulin for uptake, so don’t take insulin! (you can Google this phrase to see them all - “Tissues which don’t need insulin for glucose uptake BRICKLE”)

Real world - Without insulin, the liver’s uptake of glucose is greatly impacted. Take insulin to correct a liver dump and to help the glucose be returned to the liver’s storage.

It is easy to understand in this simple scenario. When would a person’s liver normally take up glucose? When they are in the fed state! When there is food in your stomach, your liver will take up and store.

And what happens when there is food in your stomach? If you are a non-diabetic, there is also insulin in your blood!

So the thing your endo is missing is that insulin, while not necessary for glucose uptake by your liver on a transport level, does play a part in the overall scheme of uptake.

Short answer - if you spike, take insulin,

If you need more details or info, or if I can clarify any of this, feel free to ask. You know how to reach me.

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@Timothy – I think @MM1’s suggestion that the likely metabolic culprits in your sustained blood sugar rise following a near-miss traffic accident are adrenaline and cortisol. This makes more sense than the glycogen/liver dump explanation, although I do think the liver was involved. The one-two punch of an adrenaline burst followed by a cortisol release provide a better representation of what likely happened.

My understanding is that adrenaline prompts the liver to release an immediate burst of glucose (glycogen) and the subsequent secretion of cortisol then sets up a longer period of insulin resistance that keeps the blood sugar elevated.

@MM1’s linked article provides a concise description of this scenario.

I agree with @Eric2’s analysis that if you spike, take insulin. It’s been my experience that it takes more than the typical amounts of insulin to correct a cortisol-provoked high BG.

Happy to read that you avoided injury!

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I don’t think that anybody has concrete evidence for how to deal with this. I think they are giving you an opinion.

Just for the record, I dump a lot of glycogen when I ski. Sometimes that might be a little bit because I am scared, but its also just what your body is supposed to do when your having physical fun.

I will tend to go high (250 - 400) for, maybe, 2 days straight. I gotta bolus like crazy. Then, when all that built up liver sugar storage of sugar is exhausted (I’m guessing), maybe on the third day, I’ll start to see wicked lows. They will be wicked - like fast and hard because I don’t think that I have any liver stores to counteract them.

On the third evening, when I’m driving home, I always crash profoundly exactly 4 hours after leaving the hill.

So, its not all cut and dry as she is suggesting. These are my inferences and opinion on glycogen, from what I can infer from experience. Take it with a grain of salt.

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I also jump up from exercise and crash afterwards. But I have managed to deal with that.
Thanks for all that explanation though I’m going to read more on the subject.
I mean clearly I needed to correct the spike, and I eventually did do in my case I will continue to do that.
I want to talk to my endo about it too but I’m thinking it’s gonna take too long do I’ll probs won’t.