Got diabetes? Need advice? Naturally you do! And you came to the right base: Ask D'Mine, our time period Q&A column hosted past experient type 1 and diabetes author Wil Dubois in New Mexico.

Today, Wil takes connected a universal question about why (oh why) those of us on insulin can experience low blood sugars even when it seems we've done everything right?! Seriously, Wil… we all want to know the answer to that unmatched soh please dea your wisdom!

{Have diabetes questions of your own? Email us at AskDMine@diabetesmine.com}

Microphone, type 1 from Ohio, writes: I love the D'Mine column and I hope I'm not duplicating a question here. My question is more sophisticated than it mightiness seem: Why do we (T1's on insulin) get lows from a reasonably approximately correct dose of insulin? I'm not talking about a dose that is room off surgery an activity level that ramps astir the metabolism very much. Just a lean misreckoning, or a little more walking than usual, Beaver State a slender too much base, or waiting too long to eat: Why can't the body's own system with the liver protect against these cases? Or am I wrong and it does protect to a higher degree I think? And perhaps IT's only that it throne't handle as much as I think? I'm just comparing to a sugar normals BG after eating: They don't go depression, but even with really microscopic dosing and watching the CGM like a clear the throat, I'll still be adrift down sometimes. Happy to snack and prop it back, but I'm fair-and-square curious wherefore my trunk doesn't or can't.

Wil@Ask over D'Mine answers: Thank you for your charitable wrangle. Your question is a gravid one, and I don't recall answering information technology before. Course, over time, repeated lows cause brain damage. And as you direct out, most of us T1s have lows nobelium matter how hard we try to fare our "jobs" right, grrr…

But moving on, I think I have enough brainpower left to tackle your inquiry, and to practice that we moldiness first off talk about homeostasis. Homeo means "the same," and stasis means "staying," so in the purest mother wit, homeostasis means staying the same.

Unchangeable.

In biology, homeostasis is normally defined as a stable state, or a land of equilibrium. Examples admit the fact that warm-blooded critters keep their body temps in a narrow range. Red-purebred critters maintain healthy blood oxygen levels and blood pressure. The respective minerals that course through with hominid bodies—calcium, sodium, bull, iron, K—are with kid gloves kept at the optimal levels, as are hormones. Steady. Undynamic.

All of which is a big fat lie.

Because there's actually nothing stable about the act of homeostasis. It's many of a walk on a rigorous rope than a walk perfect the pavement. The "firm state" is maintained by constant adjustments and counter adjustments. Did you ever have one of those cars where the thermostat settings were just not quite an right? One click up was too hot, but one click down was too cold? So what did you do? You constantly fiddled with IT, didn't you? As you got uncomfortably uncomfortable, you'd lower the temporary worker, which course made you uncomfortably cool, fashioning you raise it again.

This dance of too damn cool and as well damn emotional is an exercise in manual homeostasis. You are trying to keep in a aim temp by controlling the input variables of heated and cold.

And that's the key to homeostasis. This steady, "unchanging" biological state is created by well-nigh constant interchange, a hyper flurry of adjustment and counter adjustment on a small scale. One of the biggest "Ah-ha!" moments of my life came when I was in college, reading one of those too-frickin'-perturbing-to-actually-carry textbooks on human figure and physiology. The author delineate homeostasis not as a stable state, just as a dynamic land of equilibrium.

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That blew me away. In my mind's eye I could see dozens of clockwork gears spinning, clicking, ticking. A thousand moving parts terpsichore unitedly to make up, fountainhead, nada. Well, nil dynamic, anyway.

So how does this strike us? Wanted to glucose homeostasis. That's right, as you pointed out, sugar-normals don't have lows. Or highs for that matter. The Dance of 1,000 Veils within their bodies keeps their blood glucose in a normal range with constant input and counter input.

How does that work? The simple answer is that insulin from the pancreas and glucose from the liver dance a Tango late into the Nox. But the real answer is far more complex and involves not only glucose and insulin but glucagon, epinephrine, cortisol, incretins, zinc, neurotransmitters, peptides, neuropeptides, chemical element oxide, leptin, chloride, and probably a host more players yet to be discovered. It's a consistency-wide process, involving the brain, the pancreas, the adrenal glands, the liver, the kidneys, fat and muscle.

The fallible body own't simple.

Now, we complete understand that as type 1s, our bodies don't produce insulin. But as you point out, shouldn't the lie of that knotty glucose homeostasis system still be working and protecting USA?

Actually, atomic number 102. Sorry. And there are two reasons for that. First, let's start with other breakdown you didn't know you had. A key parting of glucose homeostasis is an alert organization for detecting changing blood glucose in the consistency in the form of specialized neurons that oppose to fluctuations in glucose. These detectors are on the front lines of the body's glucose homeostasis standard arrangement. They give the alert that starts the entire homeostasis process for glucose. They sleep in your brain, its outer boundary, and in the ventromedial hypothalamus, which is the primitive fright and feeding "animal brain" encased in your smarter grey matter to.

Merely, on the face of it, these neurons are somewhat weak little flowers. Afterwards about five years of case 1 diabetes, with its wild sugar rides, the receptors cease to function. I guess they have a limited shelf life, sorta like the batteries in an emergency flashlight that get ill-used upward by turning on flashlight too many multiplication. The point being that once they are deep-fried, they no more detect the opening stages of a come by glucose.

Diabetes just dropped a crowbar into that finely flying Swiss watch.

Then with the first form of the counter regulatory reception out of action, is it any wonder that our bodies can't maintain glucose homeostasis? Predestined, some of the system lul works. Those shaking hands you get when a low hits? That's epinephrine nerve-wracking to rise your blood glucose level. It's as well little, too late, but the body still tries to do its matter.

Only flat if all the pathways were whole, there's a fundamental blemish in our approach that doesn't give our bodies a combat-ready chance, and that's our insulin. In a bread normal, insulin is main-lined into the blood stream, where it works speedily, and can be shut down rightful as promptly. In maintaining glucose homeostasis, the body ass betoken the pancreas to stop production and delivery of insulin, and quickly soak up any excess with some sugar from the liver.

Trouble solved.

But you aren't injecting insulin into the blood. You are injecting it into fat, where information technology sits like a titan reservoir. The scientific types call this hyperinsulinemia, or also damn overmuch insulin. It's as if the pancreas blew sour its instructions and just kept on pumping out insulin. The colored isn't equipped to deal with this forgiving of over abundance and the disposable sugar supplies are overwhelmed. Remember the Swiss watch? Picayune parts. Small movements. The equilibrium is retained be the smallest of adjustments. It isn't designed for floods.

I care the way one researcher put it: "Insulin delivered exogenously is not branch of knowledg to normal biology feedback regulation, so information technology may hasten hypoglycaemia even in the presence of an intact anticipate regulatory response."  The same guy (his name is Rory J. McCrimmon) points out that the average type 1 has two hypos a week, and that this average, despite changes in technology, hasn't budged in deuce decades.

So I think everyone can see how things get along south connected us promptly when the orchard apple tree cart gets tipped over. Merely wherefore do things so often go south happening us following your "reasonably close to correct superman?" Shouldn't the injected insulin and the carbs equal call at some reasonable estimation of homeostasis?

Sadly, we can never promise to have a "reasonably chastise Cupid's disease." Wherefore? Well, we aren't just covering carbs. Instead, we are making Major changes to a delicate system. With all shot, we are not just skipping a stone across the calm pond of homeostasis, we are lugging a boulder to the edge and dropping information technology in with a giant splash.

Using our earlier analogy of a delicately made Swiss watch with its jewels, gears, springs, and rotors as the body's born system of glucose homeostasis, you, my champion, are exploitation Stone tools and brook skins to try to do the identical. And you are using one ingredient, insulin, to strain to artificially control a process that uses rafts of elements in nature. Plus, rather than dripping constantly into the system, frequently turning the insulin on and off, we just pour a giant pail of stuff into the body. Is it whatever marvel that we fail?

Sure, with wonder drugs that don't yet live to by rights mimic all the myriad chemicals that dance this dance, and with 27 networked Cray Super Computers, maybe—just maybe—we could descend more or less artificial glucose homeostasis.

Just with a Flex Pen and a bagful of Ninepins? We haven't got a prayer.

This is not a aesculapian advice column. We are PWDs freely and openly communion the wisdom of our collected experiences — our been-there-done-that cognition from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear tree trees. Rear end line: we are solitary a low part of your whole prescription. You hush need the professional advice, discourse, and care of a licensed medical professed.