I am writing this post to get into how the liver and pancreas work together to regulate blood sugar but also to ruminate on something that’s been a big mystery in my life for close to 15 years. Let’s dive right in:
I was 15. Only a couple years into largely managing my diabetes on my own and maybe a year or so into using insulin pens rather than syringes. My family and I lived in a split-level home with a kitchen, dining room, and two bedrooms upstairs and two more bedrooms plus a TV room downstairs.
On this night, I fell asleep on the couch downstairs. I woke up on the kitchen floor upstairs. Well, it was more like I woke up splayed out in the doorway connecting the kitchen and dining room. Pissed pants on the dining room carpet. Pounding head on the cool linoleum next to the dog’s food dish.
My grandmother woke me up: “Ryan, what are you doing on the floor?”
I rolled over. Mumbled something about not knowing how I ended up here.
“I think you got really sick.”
“Yeah. My head hurts. I think I peed my pants.”
“The refrigerator door was open. The clock is on the floor.”
“I’m sorry. I don’t know what happened.”
“I think you got really sick. Do you feel low? Let’s check your blood sugar.”
135 mg/dl. Oddly normal. But it had to be diabetes. To my knowledge, I’d never sleepwalked before. Plus, I had the kind of searing headache I only got immediately following an episode of particularly low blood sugar. Or, you know, the kind of headache you get after cracking your noggin on linoleum.
I didn’t go to the hospital like I maybe should have. I guess the thinking was the emergency had already passed, and I was ok now. Grandma and I went back downstairs. I went to sleep on the couch again. She slept on the chair on the other side of the room just in case anything else happened that night.
We’re still not completely sure what happened, but here’s what I do know:
To put things simply: your pancreas and liver work in tandem to keep your blood glucose levels steady throughout the day. When you eat a meal, your pancreas sends out insulin to break down carbohydrates into glucose for energy. The liver hangs on to any extra glucose and stores it for when you need it between meals or during sleep. The liver knows when to disperse its stored sugar because when glucose levels start to drop off, the pancreas will secrete a hormone called glucagon. When that glucagon is secreted, the liver knows to send some of its stored glucose into the blood stream to keep blood glucose levels and energy levels steady.
If you or someone you know has diabetes, you may have recognized the term glucagon. That’s because all diabetics are (or at least should be) armed with a glucagon kit. It is usually kept in a bright red case and works something like an EpiPen with the additional step of mixing the actual glucagon with the diluting solution contained in the syringe. When someone’s blood sugar is low to the point that they are unconscious or unable to safely eat or drink something, a glucagon shot is administered to kickstart the process of getting the liver to release more glucose into the bloodstream.
Let’s assume the reason I stumbled upstairs to the kitchen, knocked a clock off the wall, opened a refrigerator door, and passed out on the floor was extremely low blood sugar. No glucagon shot was administered. Yet, when I came to, my blood sugar was damn near perfect. So that leaves me with two ideas as to what may have happened. One: my liver began kicking out glucose at the very last minute. That doesn’t quite make sense, though. Any extra sugar my liver had would have been spent in trying to slow what was apparently a very rapid descent. From everything I’ve read, I just don’t think it’s possible that my liver just held out until the last second like that. But I am certainly no doctor. Maybe someone reading this can tell me if that’s a thing?
The second, and I think more likely option, is that I managed to eat or drink something right out of the fridge moments before collapsing. This is a scary thought, because I don’t remember doing that at all; I don’t remember any of it. And if my blood sugar was low enough to knock me out, it was low enough for me to forget how to chew and swallow. I could have easily choked on anything I managed to get into my mouth. By choking or by abysmally low blood sugar, the chances of my brain losing its supply of oxygen and/or glucose for a catastrophic amount of time that night were incredibly high. If things happened the way I think they did, I am incredibly lucky to still be alive with a functioning brain.