Tuesday, May 28, 2013

Question - Define glucose sensitive insulin release .


    

    Yesterdays questions:
    Define glucose sensitive insulin release. 
      
       Non- Diabetic:

           Beta cells in the pancreas normally respond to any increase in blood glucose levels with an 

           initial burst of insulin( first phase insulin release that begins with in 2 minutes of food intake) 

           followed by more sustained insulin release ( second phase insulin release ) as needed to
 
          maintain glucose levels in a normal range.    
 
       Type 2 Diabetes: 

           The decline of insulin sensitivity to increasing glucose levels occurs very early in the 

           development of type 2 diabetes and is an early marker of Beta cell dysfunction. 

        Significance :

             Sulfonylureas drugs and meglitinides* stimulate beta cells to release insulin with no 

             regard for blood glucose levels which increases the risk of hypoglycemia.

             
             Some of the newer medications such as GLP-agonist and DPP-4 inhibitors ** restore

             and preserve beta cells ability to release insulin when stimulated by a meal time

             increase in glucose levels. This reduces the risk of hypoglycemia.

       Summary:

             Sulfonylurea type medications produce a continuous unregulated insulin release

             irrespective of a person glucose level and increases the risk of low blood sugars.

             GLP-Agonist and DPP-4 inhibitors produce meal stimulated insulin release and 
             reduce the risk of hypoglycemia               
        
            *Amaryl ( glimepiride ) , Glucatrol ( glipizide ) , Diabeta ( glyburide ) and others.
             Meglitinides - Starlex (nateglinides ) , Prandin (repaglinide )

          ** Byetta ( exenatide ) , Victroza ( liraglutide )
             Januvia ( sitagliptin ) ,Onglyza ( saxagliptin ) , Tradjenta ( linagliptin ) , Nesina ( alogliptin )



        Where is glucagon made and what does it do ? Hint . Click on the link below.
        Glucagon effects your life every day
    New question -  An A1c test result of 8  is equivalent to a mean glucose of_____ . 
        A little tip for  interpreting your A1c results will be revealed tomorrow.
       
Have fun , Be Smart and reduce your risk of hypoglycemia
David Calder,MD


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Your comments and questions are appreciated. David Calder,MD