michael raiti wrote:
> Wht is a liver dump?
>   
Just as the pancreas secretes insulin to attempt to keep blood glucose 
below a certain level, the liver *produces* glucose to keep BG from 
falling too low.  Severe hypoglycemia can kill you faster than an 
equivalent hyperglycemia.  This is why diabetics carry glucose tablets, 
in case they inject too much insulin and BG falls too low.  If they 
don't act quickly they can go into a coma within minutes.  Anyway, when 
BG drops, the liver produces glucose in two ways: by converting stored 
glycogen (in the liver) back to glucose and releasing that, and by 
gluconeogenesis, i.e., making glucose from amino acids.

There is something known as the "dawn phenomenon," which is a rise in BG 
in the morning, even though one has eaten nothing since the previous 
evening's dinner.  As far as I know, this is a natural phenomenon, and 
it probably provides a good evolutionary purpose, so that when we wake 
up and face the day we have a little extra fuel on hand for vigorous 
exertion.  This dawn phenomenon is a "liver dump."  In an insulin 
resistant person, however, the DP, like any influx of glucose, will tend 
to cause a higher rise in BG, that takes longer to drop back to 
baseline.  That's because even though the liver is putting out glucose, 
the cells are not getting it quickly, and so the liver thinks there's 
not enough glucose in circulation and puts out more.  So an IR person 
can get some fairly high readings in the morning, and diabetics (T1 or 
T2) are very familiar with this.  If you're IR and do a *short* burst of 
intense exercise first thing in the morning, you can push it even 
higher, because the exertion sends a fire alarm to the liver that you 
*really* need glucose.  I once did a set of 25 pushups and then tested 
and got a reading of 125 md/dl.  I guess the moral of the story is: If 
you're going to do exercise in the morning, do enough so that you not 
only trigger a liver dump but also use up the glucose produced.

Now for an actual update....

I'm almost through my third week of very lowcarb, pretty nearly paleo, 
intermittent fasting.  As I mentioned recently, I've been unhappy with 
my BG readings.  At my last physical in the fall, my Hba1c was 5.2, 
which indicates an *average* BG (including times after meals etc.) of 
108.  My actual readings on my home glucometer tended to be about 90-93 
fasting, and 105 two hours after a meal.  But these numbers were 
whole-blood based.  Lab results are plasma-based, and there's a 12% 
difference.  So to get a true picture I'd have to add 12% to my 
readings, which would indeed suggest an average of about 108.  So, okay, 
I'm overweight and have been eating SAD so I shouldn't be too shocked.  
However, even in the past when I was pretty strictly paleo and 30 or so 
pounds lighter, the lowest reading I *ever* got was 84, and with the 
added 12% that would really be a 94.  And that was only once.  One other 
time I got an 88 (plus 12% = 98.6).  My doc considered these numbers 
fine, but I don't, for reasons I've already explained.

First, I decided to upgrade to a new meter.  You can get them for free 
from various places; I used http://onetouch.orderpoints.com/.  This one 
is plasma-calibrated, so I'm getting plasma-based readings now, 
comparable to the numbers in lab reports.  I carefully calibrated it 
with the control solution and started testing.  To my surprise, my 
fasting BG (mid-afternoon) is 78-80, which is a respectable HG level, 
and definitely the lowest I've ever tested in 3 or 4 years of having a 
meter.  And I'm still significantly overweight (10 lbs. down since Jan. 
15, but 30+ to go).  My morning reading is 88, and my 2-hour 
postprandial readings, after my big evening meal, are 84-86.  Assuming 
the meter is reasonably accurate, these are good readings, especially 
considering that I've known I've been IR for years and have been unable 
to get those numbers down by manipulating the *what* of my diet.

The only plausible conclusion is that the intermittent fasting has 
already improved my insulin sensitivity significantly, in just under 
three weeks.  I also had one "bad" meal, with a lot of stuff that I 
shouldn't be eating, and when I tested 2.25 hours later, it was 90.  I'm 
happy with the weight loss too but these BG readings were really 
unexpected, but are good motivation to keep doing what I'm doing.

Todd Moody
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