Blood glucose level change

Insulin, a hormone produced by the pancreas, acts to maintain blood glucose levels within normal limits (60-120 mg/dL). This is accomplished by die release of small amounts of insulin into die bloodstream tiirough-out the day in response to changes in blood glucose levels. Insulin is essential for die utilization of glucose in cellular metabolism and for die proper metabolism of protein and fat. 

Sometimes it is not possible to measure the direct effect of the drug. Endpoints or surrogate biomarkers are used to monitor the pharmacodynamics and pharmacokinetics of the drug. These markers may be changes in blood pressure, cholesterol level, concentrations of certain enzymes, proteins, blood glucose levels, and similar factors (see Table 6.2 for serum tumor markers and Appendix 7 for general biomarkers). 

Figure 12.10 The effects of cortisol. These can be divided into two classes, (i) Physiological levels of cortisol result in changes that maintain the blood glucose level, (ii) Higher levels (pharmacological doses) have an anti-inflammatory effect and a central effect on wellbeing. It is the breakdown of protein that provides amino acids, which along with glucose are used to synthesise glutamine (Chapter 8).

Figure 12.18 Sites at which insulin stimulates glycogen synthesis in muscle. An increase in the blood glucose level, after a meal, increases secretion of insulin from the p-cells in the Islets of Langerhans. Insulin increases the transport of glucose into the muscle fibre and the activity of glycogen synthase (Chapter 6). The result is that insulin increases the rate of glycogen synthesis without marked changes in concentrations of glucose 6-phos-phate, glucose 1-phosphate or UDP-glucose in the liver.

The effects of the glucose/fatty acid cycle and those of the hormones on the cycle, on the regulation of the blood glucose level, can be extended by two further changes in metabolism, (i) Fatty acids are taken up by hver and converted to ketone bodies, which are released... 

Somatomedins are insulin-like polypeptide hormones that should be used with caution in diabetic patients since adjustment of antidiabetic therapy may be required. Before initiating therapy, a baseline ECG is recommended and, if abnormalities are identified, regular ECG monitoring during treatment is required. Somatomedins may cause tachycardia, cardiomegaly, ventricular hypertrophy and changes in blood glucose levels as side-effects. 

When lifestyle changes alone are insufficient to manage blood glucose levels, a variety of hypoglycemic agents can be used. 

Managing the Complications of Diabetes. Diabetes is more than just a disorder of elevated glucose it is a systemic disease that affects many organ systems. In addition to the metabolic problems there are numerous neurological, circulatory, and renal complications, even when the blood glucose level is properly controlled. The main reason is the unnatural administration of insulin by injection, instead of the constant secretion by the pancreas in response to changing blood glucose levels. Diabetics have a predisposition of atherosclerosis, with an increased risk for heart attacks and stroke. 

---