In metabolically impaired states, the liver continues producing glucose while carbohydrate intake adds to it, and peripheral tissues have reduced glucose uptake, leading to hyperglycemia.

“the problem is you still have the liver producing glucose and then when you take in carbohydrate you're additive on top of that and because you have metabolic dysfunction at the peripheral tissues as well so you're not uptaking the glucose as well you leave you have this Jam where you're producing a bunch of carbohydrate and your tissues can't uptake that carbohydrate and now you're seeing hypoglycemia”