Brief Answer:
Can you get a bit more specific?

Detailed Answer:
Hello

Welcome to Health Care Magic.
My name is Dr Muhammad Ahmad, Resident M.D.

I have gone through your query and would try to help you in the best possible way.......


That is a real broad thing you have asked in a single sentence , Response to stress actually depends upon the reason of glycogen deficit, and immediate circumstances, are you concerned about response in glycogen storage diseases or you are just trying to co-relate theoretical glycogen deficit with other glucose production mechanisms under stress?

Waiting for your input.

Regards.

Dr.Muhammad Ahmad

Resident M.D.

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Brief Answer:
It is a multi layered mechanism.

Detailed Answer:
Hi,

Thanks for writing back,

It has got a bit more precise after your reply, now I will try to summaries things as comprehensively as i can.


You see, we have been created real smartly , there is nothing which works alone in our body , if one thing is lagging some other mechanism comes up to help it, until and unless there is a real chaos involving multiple systems.

For example if one gets brain infarct ,heart increases blood pressure to compensate for lack of blood to brain areas , and to open collateral vessels.

If sinus node(pace maker of heart) fails in heart , Atria kick in to produce pace-making activity, if atria fail AV node paces if even this fails ventricles start pacing, so its well over four compensatory failures before a patients dies of cardiac arrest.

Same way IF blood pressure falls heart comes into play, brain jumps in , kidneys jump in and they get together and buy quite much of time for the patient to recover.

same is the case with defence against infections , there is an acute defence which is aggressive and doesn't really care what it's destroying and then long term defence which comes with a plan and does surgical strikes.

This happens in almost each and every system , system of glucose(energy production) ain't any different , as you must be knowing it's a multi layered system , when energy is required first the body searches for it, in glucose present in blood already and quick release carbs which can immediately be produced by breaking down the food.

As body prepares it self for a prolonged stress so it starts preparing gluucose through Glycogenolysis , so that if stress gets prolonged , and blood glucose runs is in a danger of running out, it is replaced by glucose produced ,utilizing glycogen, now this needs two important things to take place well, a healthy liver and ample glycogen in stores. If liver isn't healthy the answer to your basic question is "yes surely patient will go into hypoglycaemia" (that's what happens in liver cirrhosis).

This needs a good balance of insulin and glucagon and other hormones plus a healthy response to these hormones as well but as you are asking about normal person who is deprived of glycogen due to, say , a long fasting, so we wont jump into hormone issues.

For a person who hasen't eaten anything for half a day there are enough resources for the body to coup up stresses but lets take it to 48 hours fasting this is our point of interest when glycogen stores are dwindeling. To your one statement that will liver make up its glycogen stores to prepare for a tress situation i will say no, because then energy producting reactions switch to glucose production from other sources and they don't really lead in direction of glycogen production.

This is because reactions of gluconeogenesis and glycolysis are so interconnected that when glycolysis is taking place not much gluconeogenesis can take place but with time as glycogen dwindles the reactions shift to gluconeogenesis...there isn't really an on and off button that first glycogen will end then body will send signals to emergency services to come up with gluconeogeneis ,,, glycogen is going down and gluconeogenesis is going up thats how it goes, just like a seesaw, a healthy liver wont let an energy gap to happen.

Plus i would also like to say here that even glycogen system has many back ups, liver glycogen ,muscles and even red cells have glycogen.




Anyways here we have a person who hasen't eaten anything for 48 hours and lets say his glycogen stores are depleted, Now what can you expect in his body? his insuline would be low, adrelaine would be high and glucagon would be high, adrenaline and glucagon function to increase gluconeogenesis so in a person who has low glycogen in his body , his gluconeogenesis would already be taking place before he would completely run out of glycogen.


Plus there is an independant mechanism whose triggers are not known , this is called LIVER-BRAIN ADIPOSE neuronal axis....liver glycogen shortage directly activates a liver–brain–adipose neural axis independently of blood glucose and insulin/glucagon levels, having an important role in switching the fuel source from glycogen to triglycerides under prolonged fasting conditions .


So if you meet a person who hasn't eaten for 40 odd hours his glycogen would be low but his body is already using amino acids and lipids through different mechanisms to produce energy.


This energy is theoretically good enough to keep a person alive for well over a couple of weeks.


WHAT IF WE PUT THIS PERSON TO STRESS:

If this is a physiological stress: Like fear, anxiety , cold etc ..then he will not go into hypoglycaemia because normal physiology has many defence mechanisms like if he would put to extreme fear , he will pass out due to vaso-vagal reflex(syncope) well before his glucose runs out, same goes with other stresses.

But if he is put under some stress like a some body is trying to kill him and he is running and hiding then body will push it's energy producing mechanisms to limits, like heart rate will get high, lungs will start absorbing more oxygen, adrenaline will rush till limits to produce more energy(glucose) from every last resources he has, even kidneys will start gluconeogenesis in this cases, intestines will be shut down, skin blood supply will be shut down to conserve energy ...all this things coming together will keep him going, yes he might get tired cramped up well before a well fed person but still theoretically there are very minor chances that he will go into hypoglycaemia.


Now we come to stress like a major surgery, or a super infection when he isn't fed well, in this situation he definitely can go into hypoglycaemia because body can not coup up with such stresses specially if intake ain't much.

CONCLUSION:

I would like to conclude My response by saying that in normal persons like you and me who have hormonal and liver kidney system intact, there is theoretically very little chance that we can go in hypoglycaemia under physiological stress unless it's pathological, then scenario changes.


It's been seen that healthy people who are found alive under the rubble after earthquakes have sugar levels around 90mg/Dl not eating, and stress if fear anxiety and death doesn't really cause hypoglycaemia in them, but yes, for that you have to be healthy and your liver hormones and other systems should be intact.



Hope I have answered your query. If you have any further questions I will be happy to help if not then don't forget to close the discussion and rate it.
Wishing you good health !!


Regards.

Dr.Muhammad Ahmad.

Resident M.D.

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