Mother Nature is having a good laugh over this one. “Let’s create a condition where humans don’t produce any insulin — necessary for making use of glucose — and then make those same humans produce too much glucagon — something that increases glucose levels.
Beta-Cells & Alpha-Cells = Insulin & Glucagon
You’ve likely heard of beta-cells — which are produced by the pancreas and directly responsible for secreting the hormone insulin.
In a person with type 1 diabetes, your immune system is constantly attacking and destroying your body’s beta-cells. You make ‘em, you destroy ‘em. Rinse and repeat.
(In 60 percent of those with type 2 diabetes, beta-cell dysfunction is an issue, which means your body is producing unhealthy beta-cells that struggle to secrete normal amounts of insulin.)
Glucagon, on the other hand, is a hormone secreted by alpha-cells, also produced by your pancreas. This hormone tells your liver to release glycogen — which is basically stored sugar.
Your liver then releases glycogen, it’s converted into glucose, enters your bloodstream, and raises your blood sugar.
In a person with type 1 diabetes and type 2 diabetes, there is alpha-cell dysfunction.
“Patients with diabetes frequently have a deficient glucagon response to hypoglycemia and exhibit an inappropriately high glucagon response to a meal,” explains research from the American Diabetes Association.
In layman’s terms: Your body produces too little glucagon when you do need it (like when your blood sugar is dropping) and too much glucagon when you don’t need it (like after eating).
The explanation for why this happens is still a bit of a mystery. The alpha-cells are not being attacked and destroyed by your immune system like it does with beta-cells. One proposed theory is that because of the dysfunctional (or non-existant) insulin production, glucagon production isn’t able to accurately determine when it should or shouldn’t increase its production.
What can you do about it?
I’ve got good news and bad news for you when it comes to glucagon regulation.
The good news is that there are a ton of drugs on the market today that reduce the amount of glucose your liver produces — working to counter the pancreas’ overproduction of glucagon.
The bad news is that all of these medications are intended for those with type 2 diabetes, which means getting a hold of them as a person with type 1 means using it “off-label” and likely paying a hefty price for it.
There are 2 classes of diabetes drugs that reduce your liver’s glucose production:
DPP-4 Inhibitors (dipeptidyl peptidase-4 inhibitors)
- Januvia (sitagliptin)
- Nesina (alogliptin)
- Onglyza (saxagliptin)
- Tradjenta (linagliptin)
This class of drugs helps a person with type 2 diabetes produce more insulin and reduce the amount of glucose produced by the liver.
Now, for a person with type 1, there’s no point in trying to produce more insulin because the beta-cells will still be destroyed, but these medications should still impact the production of glucose by the liver.
Common side-effects: diarrhea, gas, feeling full, heartburn, muscle weakness or ache, stuffy nose, sore throat
- Glucophage (metformin)
- Glucophage Extended-Release (metformin XR)
This class of drugs works entirely by reducing the amount of glucose produced by your liver. This inevitably makes you more sensitive to insulin. It also reduces the amount of sugar you absorb from the food you eat and reduces your appetite.
And many type 1s have been experimenting lately with Glucophage, and seeing the benefits, particularly after eating.
The only trouble is this class of drugs also comes with some unpleasant digestive side-effects. If you can get the “extended-release” version, you’ll likely be more comfortable.
Common side-effects: diarrhea, sore muscles, gas, constipation, weight-loss, heartburn
At the end of the day, many of us can’t start taking an additional drug we would have to pay for entirely out-of-pocket because they aren’t approved by the FDA for type 1 diabetes.
But it’s helpful to understand that you have yet another variable working against you. That doesn’t mean you should give up. It means you shouldn’t be so hard on yourself when things don’t go perfectly.