Why do diabetics either get hypoglycemic or hyperglycemic?
In: Biology
The amount of glucose in the bloodstream is under tight control by two hormones, insulin and glucagon. Hormones sound complicated but the underlying idea is simple: they’re short proteins that act as a liquid key, circulating in the blood. When they find a receptor on a cell, and they fit it, they can turn processes inside that cell on or off. Just like a key in a car ignition. Glucagon is an important hormone (its job is to release glucose *into* the bloodstream), but for simplicity’s sake we’ll just concentrate on its co-worker, insulin, which has the opposite job.
Insulin is the key that tells a cell: ‘Absorb Glucose From Bloodstream Now!’ Without it, two bad things happen. Your cells start running out of glucose, and the glucose level in the blood zooms: hyperglycemia. This is why there are two types of Diabetes. Type I is when the pancreas is unable to produce insulin (not enough keys in the bloodstream). Type II is when the locks on the cells that need glucose are jammed or sticky, so the bloodstream contains the right keys, but they still can’t work properly.
Without intervention, both sorts of diabetics understandably suffer hyperglycemia. But hypoglycemia is the result of *too much* insulin: too many keys, turning so many locks at once that glucose is whipped out of the bloodstream too fast for the body to keep up with. How does *that* happen?
In diabetics, the usual cause of a hypo episode isn’t injecting too much insulin, but doing things that use up glucose faster (like performing exercise, which makes you temporarily more sensitive to insulin), or don’t replenish it at the expected rate (like missing meals), without compensating for this by reducing the amount of insulin in the dose. It used to primarily affect type I diabetics, but type II people who use insulin to manage their condition (which is not that uncommon these days) can of course get it too.
Hopefully, in the future, [artificial pancreas systems](https://www.bbc.co.uk/news/health-60133358) that continually monitor blood glucose will free diabetic people from the continual balancing act between hypoglycemia and hyperglycemia.
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