One key aspect in the type 2 diabetes treatment is to avoid hypoglycemia and further weight gain. In our topic on type 2 diabetes, we classified treatments based on their risks of causing hypoglycemia and weight gain, and today we will elaborate on this topic.
Hypoglycemia simply means low blood sugar and it happens when our blood glucose level drops below the normal range. In diabetic patients, a blood glucose level below 3.9 mmol/L or 70 mg/dL is considered to be hypoglycemia.
While having high blood glucose is usually harmless in the short-run (unless it is high enough to cause DKA), having low blood sugar on the other hand poses immediate danger and harm. This is because blood glucose is the only form of energy our brain cells can utilize. So when our blood glucose level drops below the normal range, two things will happen with the body:
- Our body releases high levels of several hormones including epinephrine/adrenaline and glucagon in desperate attempts to raise our blood glucose level, which manifests in symptoms include:
- Our brain goes into starvation due to low glucose levels in the blood and begins to malfunction and shutting itself off, which can be a very dangerous if not treated quickly:
- dizziness or light-headedness
- difficulty speaking
Normally, our body is able to regulate the blood glucose level by adjusting the amount of hormone released in our body including the amount of insulin the pancreas produces. For instance, when our blood glucose is starting to drop below the normal range because of fasting or from a strenuous work-out we are performing, our body will tell the pancreas to stop making insulin and instead produce hormones such as glucagon that facilitate the conversion of stored energy in our cells back into glucose to give our body a boost. But if we are receiving an external source of insulin by either getting an insulin injection or stimulating our pancreas’ insulin production by taking a medication from the sulfonylurea or meglitinide class, our body loses this ability to prevent hypoglycemia.
Theoretically, we may side-step this problem by adjusting the doses of our insulin injection and sulfonylurea or meglitinide mediations based on the anticipated carbohydrate intake level and exercise intensity, but even the most experienced and battle-hardened diabetic patients have trouble getting this perfectly right all the time. Instead what most people end up doing is carrying high energy snacks with them at all times and take a bite whenever they feel light-headed and before, during and after their work-outs to prevent hypoglycemia. As a result, it becomes very difficult for people on these therapies to lose weight because they are held hostage by the extra insulin they are getting and need to maintain a constant carbohydrates intake to match the activities of the extra insulin in fear of hypoglycemia.
As we can see, insulin, sulfonylureas, and meglitinides, which have high risks of causing hypoglycemia also tend to lead to weight gain. Therefore, we do not recommend insulin injections, sulfonylureas and meglitinides for early stages of type 2 diabetes, especially in those who are active and motivated to adjust their diet, exercise and lose weight.