Glucose tissue uptake

Control of secretion of anterior pituitary hormones also includes inhibition by hormones produced by target organs. For example, CRH stimulates the anterior pituitary to secrete ACTH, which in turn stimulates the adrenal cortex to secrete corticosteroids. Corticosteroids then feed back to inhibit the secretion of ACTH. Feedback mechanisms are important for the control of most hormones. For example, insulin (qv) secretion from the pancreas increases in response to increased blood glucose resulting from ingestion of a meal. Insulin increases tissue uptake and metaboHsm of glucose, which lowers blood glucose and in turn reduces insulin secretion. 

Blood-bome fuels are glucose, which is derived from liver glycogen, and fatty acids derived from adipose tissue. Uptake depends on the flow of blood through the muscle, the concentration of the fuel in the blood and the demand for ATP within the muscle. During sustained exercise the flow of blood to the muscle can increase up to 50-fold and the rate of utilisation of the fuel can increase to a similar extent, yet the concentration of the fuels in blood remains remarkably constant (Table 13.5). 

Morris BW, Gray TA, MacNeil S. 1993a. Glucose-dependent uptake of chromium in human and rat insulin-sensitive tissues. Clin Sci 84 477-482. 

In a steady-state situation in which there is a constant rate of appearance of a substrate (e g, glucose) into i sma or extracellular fluid that is matched by an equal rate of tissue uptake, a constant infusion of an isotopicaHy-labeled tracer that is not distinguished metabolicalLy from the unlabeled tracee will cause... 

It is important to note that the SUV values are affected by several factors. The time period between tracer injection and scanning (i.e., the uptake period) is perhaps the largest single source of error in determining the SUV. Time to reach maximum uptake in a given tissue varies with the type and condition of tissue, i.e., different forms of neoplasm and also with tissues before and after therapy. Tissue uptake of FDG decreases with increasing blood glucose level, which affects the SUV. Excess body fat falsely elevates... 

Metabolic Functions. Chromium (ITT) potentiates the action of insulin and may be considered a cofactor for insulin (137,138). In in vitro tests of epididymal fat tissue of chromium-deficient rats, Cr(III) increases the uptake of glucose only in the presence of insulin (137). The interaction of Cr(III) and insulin also is demonstrated by experimental results indicating an effect of Cr(III) in translocation of sugars into ceUs at the first step of sugar metaboHsm. Chromium is thought to form a complex with insulin and insulin receptors (136). 

FIGURE 5.13 Two basic types of biological transport are (a) transport within or between different cells or tissues and (b) transport into or out of cells. Proteins function in both of these phenomena. For example, the protein hemoglobin transports oxygen from the lungs to actively respiring tissues. Transport proteins of the other type are localized in cellular membranes, where they function in the uptake of specific nutrients, such as glucose (shown here) and amino acids, or the export of metabolites and waste products. 

The complex thioamide lolrestat (8) is an inhibitor of aldose reductase. This enzyme catalyzes the reduction of glucose to sorbitol. The enzyme is not very active, but in diabetic individuals where blood glucose levels can. spike to quite high levels in tissues where insulin is not required for glucose uptake (nerve, kidney, retina and lens) sorbitol is formed by the action of aldose reductase and contributes to diabetic complications very prominent among which are eye problems (diabetic retinopathy). Tolrestat is intended for oral administration to prevent this. One of its syntheses proceeds by conversion of 6-methoxy-5-(trifluoroniethyl)naphthalene-l-carboxyl-ic acid (6) to its acid chloride followed by carboxamide formation (7) with methyl N-methyl sarcosinate. Reaction of amide 7 with phosphorous pentasulfide produces the methyl ester thioamide which, on treatment with KOH, hydrolyzes to tolrestat (8) 2[. 

Antidiabetic Drugs other than Insulin. Figure 3 The antihyperglycaemic effect of metformin involves enhanced insulin-mediated suppression of hepatic glucose production and muscle glucose uptake. Metformin also exerts non-insulin-dependent effects on these tissues, including reduced fatty acid oxidation and increased anaerobic glucose metabolism by the intestine. FA, fatty acid f, increase i decrease. 

There is weak expression of PPARy in muscle, liver and other tissues, enabling TZDs to support the effects of insulin in these tissues, notably increased glucose uptake in muscle and reduced glucose production in liver. TZDs may also affect nutrient metabolism by skeletal muscle through a direct mitochondrial action that is independent of PPARy. 

GLUT4 is a glucose transporter exclusively expressed in tissues with insulin-sensitive glucose uptake (heart, muscle, fat). Under basal conditions, GLUT4 is predominantly located in intracellular vesicles, and is... 

The exact mechanism by which PPARy ligands affect insulin resistance (improved glucose uptake by peripheral tissues, most notably skeletal muscle) remains unclear. 

The rate of mitochondrial oxidations and ATP synthesis is continually adjusted to the needs of the cell (see reviews by Brand and Murphy 1987 Brown, 1992). Physical activity and the nutritional and endocrine states determine which substrates are oxidized by skeletal muscle. Insulin increases the utilization of glucose by promoting its uptake by muscle and by decreasing the availability of free long-chain fatty acids, and of acetoacetate and 3-hydroxybutyrate formed by fatty acid oxidation in the liver, secondary to decreased lipolysis in adipose tissue. Product inhibition of pyruvate dehydrogenase by NADH and acetyl-CoA formed by fatty acid oxidation decreases glucose oxidation in muscle. 

GLUT 4 Heart and skeletal muscle, adipose tissue Insulin-stimulated uptake of glucose... 

Insulin is secreted as a direct response to hyperglycemia it stimulates the liver to store glucose as glycogen and facilitates uptake of glucose into extra-hepatic tissues. 

In starvation, glucose must be ptovided for the brain and erythrocytes initially, this is supphed from hver glycogen reserves. To spare glucose, muscle and other tissues reduce glucose uptake in response to lowered insuhn secretion they also oxidize fatty acids and ketone bodies preferentially to glucose. 

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