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The Glycemic Explorer Challenge – Test Your Knowledge

How do hormones affect liver glucose metabolism

Take on this challenge and see if you can master the biologic complexities of type 2 diabetes.

Title: Hormones in T2DM

Welcome to the Glycemic Explorer Challenge series! I’m Dr. Helen Baron your host—and a clinical and academic endocrinologist. I’ll be challenging you on your knowledge of the complexities in type 2 diabetes and treatment, and sharing with you how your answers compare with thousands of your peers who have taken the challenge at various national meetings and conferences.

For all of us who see patients with type 2 diabetes, we are familiar with insulin resistance and insulin deficiency.

Today’s challenge looks at T2DM at the biological level, specifically with regard to 3 hormones: glucagon, GLP-1, and insulin.

So for each of these, please consider whether they directly or indirectly influence the glucoregulatory function of the liver.

What do you think?

First, let’s take a look at how other healthcare providers who took the challenge responded.

Most answered that glucagon and insulin had a direct effect and GLP-1 had an indirect effect. And those were the correct answers.

So let’s review how these 3 hormones influence the key glucoregulatory role of the liver, directly and indirectly.

GLP-1 is released postprandially from intestinal cells and plays a role in regulating postprandial glucose excursions. GLP-1 regulates PPG by:

  • Stimulating glucose-dependent insulin secretion
  • Suppressing glucagon secretion
  • And slowing gastric emptying

Insulin, as you may know, acts directly by promoting glucose uptake by the liver and promoting its conversion into glycogen, while glucagon stimulates hepatic glucose production.

Keep in mind that these 3 hormones and the liver are part of the larger system of glucose homeostasis, and that in a complex disease like type 2 diabetes, each aspect of this interdependent network contributes to hyperglycemia.

These hormones have many effects on peripheral organs, including the heart, brain, stomach, liver, and muscle, described as the Ominous Octet by DeFronzo.

What’s really important to remember is that type 2 diabetes is a complex disease that involves multiple physiologic abnormalities and may not easily be addressed by any single approach. And that’s why, for patients who are falling short of their HbA1c target, the use of therapies in combination that address different physiologic abnormalities may be appropriate. ADA and AACE guidelines also recommend combinations of oral therapies and combinations of injectable therapies that address different pathways.

So, in your patients with type 2 diabetes who are uncontrolled on their current therapy, will your next move do enough?

Thanks for joining us. Look for more chances to challenge yourself with the other videos in this series.

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