regulation of blood glucose
TRANSCRIPT
REGULATION OF BLOOD GLUCOSE
Normal Blood glucose levelsFasting levels: 70-100 mg/dLPostprandial : up to 140 mg/dL
Maintained with in physiological limits by 1. Rate of Glucose entrance into blood
circulation2. Rate of its removal from the blood stream.
Plasma glucose level Glucose Concentration ( mg/dl ) 200 post prandial level Diagnostic for Diabetics 180 ( Renal thereshold ) Hyperglycemia 140 PP Normal 126 Fasting level Diagnostic for Diabetics 100Normal (F) 70Hypoglycemia 40 Hypoglycemic Coma
What goes wrong when the concentration decreases?
HypoglycaemiaThe symptoms associated
with low blood sugar are: tiredness, confusion,
dizziness, headaches, mood swings, muscle weakness, tremors, cold sweating , irreversible CNS damage, coma, death
What goes wrong when the concentration increases too far?
HyperglycaemiaThe symptoms include: Excessive thirst; frequent urination; fatigue; weight loss; vision problems, such
as blurring; increased susceptibility to infections, Dibetes mellitus
Rate of glucose entrance in to the blood by:1. Absorption from intestine2. Hepatic glycogenolysis3. Gluconeogenesis4. Glucose obtained from other carbohydrates,
eg: fructose, galactose etc
Rate of Removal of Glucose from blood depends on:
1. Oxidation of glucose by tissue to supply energy2. Hepatic glycogenesis3. Glycogen formation in muscles4. Conversion of glucose to fats in adipose tissues5. Synthesis/formation of fructose in seminal fluid,
lactose in mammary gland.6. Formation of ribose sugars and nucleic acid
synthesis.
Stages of maintenance of blood glucose level
Absorptive stage
• Absorptive stage starts from feeding and lasts upto 3-4 hours after meal. During this phase following activities takes place with regards to glucose.
• Dietary glucose to liver and then to most tissue.• Glucose is used as a fuel by most tissues.• Excess of glucose is stored as glycogen in liver
and muscles.
Post absorptive phase
The post absorptive phase lasts for about 16-18 hours after the absorption(3-4hours after meal) is completed. The main activities necessary with regards to glucose are as follows:
• Lever glycogenolysis become the major source of blood sugar.
• Muscle use its glycogen stores for energy.• Gluconeogenesis starts gradually and peaks about 24 hours
after the last meal.• Glycogenolysis starts declining after 16-18 hours and by
about 24-30 hours is negligible.
Starvation
• After about 1-11/2 day of the starvation, gluconeogenesis is the main source of glucose.
• Fatty acids mobilized from adipose tissue become an alternate fuel for energy for most tissue.
• Lactate and glycerol are reutilized for gluconeogenesis .ATP produced in fatty acid oxidation is used in liver for gluconeogenesis and other body functions.
• High rate of hepatic gluconeogenesis continues for few days in early starvation.
Prolonged starvation• If starvation continues further beyond 2-3 days and
extend into weeks, hepatic gluconeogenesis decrease and gluconeogenesis in kidney becomes more significant.
• Protiens in muscle are broken down to provide gluconeogenic amino acids. Fats are the energy source of most tissue.
• If starvation continue beyond without any feeding, lipid stores are also depleted and several associated complication, like ketoacidosis, dehydration, etc., occur ultiemately death follows.
Response to low Blood Glucose
In the fasting state there will be decreased blood glucose levels.
This stimulates the secretion of Glucagon from pancreas.
The Glucagon released into the blood will stimulate hepatic glycogenolysis and gluconeogenesis, there by increasing the blood glucose levels.
Once the blood glucose levels raises to the normal levels, the stimulus for the release of Glucagon will diminish.
In the post prandial state (after a meal) Remember there are two separate signaling events First signal is from the ↑ Blood Glucose to pancreas
To stimulates insulin secretion in to the blood stream
The second signal from insulin to the target cells Insulin signals to the muscle, adipose tissue and
liver to permit to glucose in and to utilize glucose This effectively lowers Blood Glucose
Response to Elevated Blood Glucose
Role of Liver and Extrahepatic Tissues• GLUT-2 is freely permeable to glucose and is the
main hepatic glucose transporter ( None insulin dependent).
• GLUT-4 is main glucose transporter of extrahepatic tissues i.e muscle, adipose tissues, etc. ( insulin dependent).
• Hence,the glucose uptake from blood by extrahepetic tissues is regulated by insulin. This is become rate limiting step in glucose utilization in the absence of insulin.
• But the glucose uptake by liver is independent of insulin.
Role of Hexokinase and Glucokinase• Liver has glucokinase and hexokinase while most extrahepetic
tissue have only hexokinase.• Hexokinase is saturable, has low Km for glucose and is
product feed back inhibited.• Glucokinase is non-saturable , has high Km for glucose and not
product feed back inhibited.• Liver continues to have high glucose uptake during
hyperglycaemia.• Extrahepatic tissue is product feed back inhibited due to
accumulation of glucose-6-phosphate even though insulin is present.
• So at high blood glucose concentration, liver has a net uptake of glucose. But it is net producer of glucose at low or normal blood glucose concentration.
Hormonal Regulation of Blood glucose
There are two categories of endocrine influences.
a) Hormone which will decrease the blood glucose levels : Insulin
b) Hormones which will increase the blood glucose levels: Glucagon, Epinephrine, Cortisol and Glucocorticoids .
Summary of feedback mechanism for regulation↑ blood glucose
↓↑ insulin
↓↑ transport of glucose into cells,
↓ gluconeogenesis, ↓ glycogenolysis↓
↓ blood glucose↓
↓ insulin
Regulation of Insulin Secretion
Insulin Control
Muscle Glucose uptake Glycogen synthesis
Liver Glucose uptake Glycogen synthesis Fatty acid synthesis¯ Glucose synthesis
BrainNo effect
PancreasBeta cells
Gastrointestinalhormones
Feedback
¯ amino acids
¯ glucose
¯ triglyceridesAdipose Glucose uptake Glycerol production¯ Triglyceride breakdown Triglyceride synthesis Insulin
Most Cells Protein synthesis
Amino acids
Bloodglucose
GLUCOGON• Overall effects of glucogon are hyperglycemic.• It is produced by α-cells of islet cells of pancreas in response
to hypoglycemia.• Its action are mostly opposite to those of insulin and most
actions are on liver.• It promotes glucose sparing by inhibiting glucose utilizing
pathways, i.e.– ↓ glycolysis through PFK-1 by decreasing fructose-1, 6-bisphosphate.– ↓ Citric acid cycle due to reduced PDH activity due to low insulin levels.– ↓ Glycogenesis by inhibiting glycogen synthase through phosphorylation
• It promotes glucose production by the following:– ↑Glycogenolysis by stimulating phosphorylase through phosphorylation.– ↑ Gluconeogenesis by inducing pyruvate carboxylase, pyruvate carboxykinase
and glucose 6-phosphatase.
Glucagon Control
Liver Glycogen breakdown Glucose synthesis Glucose release
BrainNo effect
PancreasAlpha cells
Exercise
Feedback
Adipose Triglyceride breakdown¯ Triglyceride storage
Blood glucose
Fatty acids
Epinephrine(stress)
Amino acids
Insulin – Anabolic and Glucagon - Catabolic
Metabolic Action Insulin GlucagonGlycogen synthesis ↑ ↓Glycolysis (energy release)
↑ ↓
Lipogenesis ↑ ↓Protein synthesis ↑ ↓Glycogenolysis ↓ ↑Gluconeogenesis ↓ ↑Lipolysis ↓ ↑Ketogenesis ↓ ↑
Epinephrine
– The second early response hyperglycemic hormone.
– Epinephrine causes glycogen breakdown, gluconeogenesis, and glucose release from the liver.
– It also stimulates glycolysis in muscle– Lipolysis in adipose tissue, – Decreases insulin secretion and– Increases glucagon secretion.
Role of Epinephrine
Glucocorticoids Hormones
• Glucocorticoid hormones are mainly secreated from adrenal cortex and some amount is also synthesized in adipose tissue.
• They induce aminotransferase enzyme synthesis leading to enhanced amino-acids catabolism.
• They also cause the induction of key enzymes of gluconeogenesis (Fructose-1,6-biphosphatase, pyruvate carboxylase ).
• Overall they increase the glucose level. ().
• These are long term hyperglycemic hormones. Activation takes hours to days.
• Cortisol is a steroid hormone – Cortisol act to decrease glucose
utilization in most cells of the body– Effects of these hormones are mediated
through the CNS. -- It is synthesized in the adrenal cortex.
Cortisol
Growth hormone: i)Decreases glucose uptake in tissues
ii)Increase liver gluconeogenesis
iii)It promotes fatty acids mobilization from adipose tissues leading to incressed fatty acid oxidation and ATP production
. iv)Increased ATP and NADH inhibit glucose
utilization by cell in glycolysis .