Role of the Pancreas in the Glucose Homeostasis

The pancreas is required for glucose control in the blood. Insulin and glucagon are two hormones secreted by the pancreas to control glucose levels and prevent postprandial hyperglycemia and fasting hypoglycemia. These hormones have opposing effects on one another. Insulin works to prevent hyperglycemia while glucagon works to prevent hypoglycemia. Insulin-producing beta cells need glucose to function. However, in the absence of insulin, glucose cannot be metabolized leading to diabetes. If the level of glucose is raised in the blood, insulin regulates glucose homeostasis in a variety of ways, including reducing hepatic glucose synthesis (by reducing glucogenesis and glycogenolysis), enhancing glycogenesis (liver, muscle), and increasing glucose absorption, especially into striated muscle and adipocytes. Glucagon is a hormone produced by alpha cells in response to hypoglycemia. It is an antagonistic hormone to insulin. Pancreatic cells have a unique set of channels that generate sodium ion (Na+) and calcium ion (Ca2+) action potentials in the absence of glucose or at low glucose levels to increase the glucose level in the blood. Glucagon promotes the liver’s production and release of glucose, which helps to increase blood sugar levels. Gluconeogenesis and glycogenolysis are both stimulated and inhibited by glucagon. Somatostatin is produced by a variety of organs, including pancreatic cells, the digestive tract, and the central nervous system, and it is produced in smaller amounts in response to glucose. On a local level somatostatin production increases in response to glucose stimulation and is Ca2+ dependent. Amylin is produced and stored in secretory granules by beta cells. In the same way that insulin is produced from pancreatic cells, it is co-secreted with it. Amylin levels in the blood are low while fasting but rise during meals and after glucose administration, and they are linked to body fat.

Liver response to pancreatic hormones
The liver serves as the body’s glucose (or fuel) storage, assisting in the regulation of blood sugar and other body fuels in response to pancreatic hormones. In response to glucose consumption, the fasting liver changes from net production to net glucose absorption, resulting in hyperinsulinemia and hyperglycemia. Key enzymes in opposing metabolic processes, glycogenesis, and glycolysis, should be managed to produce net flow in the desired direction in the liver. The release of net glucose results from two carefully orchestrated systems working in tandem. Glycogenolysis begins 2–6 hours after a meal in humans, whereas gluconeogenesis is more essential after prolonged fasting. The fundamental regulation of gluconeogenesis is the stimulation of genes involved in gluconeogenic enzyme secretion, regulated by glucocorticoids, glucagon, and interleukin-6 family cytokines. Insulin suppresses gluconeogenesis by the inhibition of phosphoenolpyruvate carboxykinase and glucose-6-phosphatase, whereas glucocorticoids and glucagon promote the expression of these genes. Hepatic glucose synthesis increases rapidly in response to a physiological surge in glucagon. This rise in hepatic glucose synthesis is attributed to an increase in glycogenolysis in the short term, with little or no influence on gluconeogenesis. The newborn animals are in the process of achieving glucose homeostasis. Low-carbohydrate, high-fat milk is the primary source of sustenance for the newborn.

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Role of the Kidneys in the Glucose Homeostasis
In the postabsorptive and postprandial stages, kidneys play a critical for glucose homeostasis. The renal cortex uses gluconeogenesis to produce glucose and utilize it to meet the medulla’s energy needs.

Glycogenolysis is unable to release glucose from the kidneys. Glucose is mainly utilized in the medulla of the kidney. These enzymes can glycolyze, absorb, phosphorylate, and store glucose, but they cannot release it into the bloodstream. The renal cortex is the only place where glucose is released, and the cells in the renal cortex contain gluconeogenic enzymes that can release glucose in the bloodstream.

Lactate, glutamine, and glycerol are the most major gluconeogenic substrates in the kidney. After fasting overnight, the kidneys provide 20–25 percent of the glucose released into the circulation. The key regulators of renal glucogenesis are insulin and adrenaline. Insulin lowers the availability of gluconeogenic substrates and so lowers blood glucose levels via inhibiting renal gluconeogenesis. Adrenaline stimulates glucogenesis and glucose output in the kidneys while decreasing glucose absorption.

Around 162 g of glucose should be reabsorbed daily for maintaining an average fasting plasma glucose level of 5.6 mmol/L and daily 180 g of glucose must be filtered by the kidneys. In proximal tubule glucose reabsorption, glucose transporter proteins in cell membranes are implicated. In the postabsorptive stage, the kidneys utilize around 10% of the glucose absorbed by the body after a fasting period.

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