Abstract
It is important to understand the insulin physiology, to comprehend in full the changes that occur in insulin deficiency state, and to facilitate the attempts to bring up the insulin levels to an effective state. In particular the differences in the metabolism between the portal insulin levels and the pharmacodynamics of the exogenously administered insulin should also be understood. In the same section, we will also describe some nonmetabolic actions of insulin underscoring the significance of insulin. Unless these actions and the scope of insulin physiology are precisely understood, the insulin and diabetes management will become a mechanistic unintelligent centered only on glucose control. Sadly this is the state of care in this area across the subcontinent and possibly other less developed countries as well.
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Notes
- 1.
In normal persons as well as those with diabetes, the quantum, duration, and the peak of insulin response are less, when stimulated by intravenous glucose infusion compared to oral ingestion. Intravenous glucose stimulation does not invoke the action of enteroinsular axis as no food enters the stomach. In addition to it, there is believed to be a cephalic phase in food intake, which strengthens the enteroinsular axis.
- 2.
This is a commonly met situation in routine clinical practice as well. In newly diagnosed type 2 diabetes, the blood glucose can often be as high as 400 mg/dL. Yet the symptom profile is mild. Hence it is unnecessary to be alarmed by it. Simple measures like significant diet control and primary medication with oral drugs cause a quick reversal of glucotoxicity, and the blood glucose falls rapidly often with small quantities of drugs. It can then be brought under control with little intensification of treatment.
- 3.
In the initial stages of newly detected diabetes with high levels of glucose, fasting generally above 250 mg, it is a recommended practice to start the patient on insulin for a few weeks. This gives beta cells rest and replenishes its contents and can respond to glucose challenges of the newly detected diabetes better, offsetting the need for insulin. The results of this intervention could be remarkable.
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Kelkar, S., Muley, S., Ambardekar, P. (2019). Physiology of Insulin. In: Towards Optimal Management of Diabetes in Surgery. Springer, Singapore. https://doi.org/10.1007/978-981-13-7705-1_10
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