DIABETES:
- Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood sugar,
- either because the body does not produce enough insulin
- or because cells do not respond to the insulin that is produced.
- Type 1
- Type 2
- Gestational
Life with type 1 diabetes
- Frequent urination
- Weight loss
- Lack of energy
- Excessive thirst.
If you have type 2 diabetes your body does not use insulin properly. This is called insulin resistance. At first, your pancreas makes extra insulin to make up for it. But, over time it isn't able to keep up and can't make enough insulin to keep your blood glucose at normal levels.
3) Gestational diabetes
Common symptoms of diabetes
Frequent urination
Disproportionate thirst
Intense hunger
Weight gain
Unusual weight loss
Increased fatigue
Irritability
Blurred vision
Cuts and bruises don't heal properly or quickly
More skin and/or yeast infections
Itchy skin
Gums are red and/or swollen - Gums pull away from teeth
Frequent gum disease/infection
Sexual dysfunction among men
Numbness or tingling, especially in your feet and hands
Diabetes diagnosis
Some facts and myths about diabetes
Blood tests for diabetes diagnosis
Diagnoses of diabetes are confirmed through 1 of 3 types of blood test.
Urine tests for diabetes diagnosis
Diabetic retinopathy
People with diabetes should go for regular professional eye checks.
Diabetic nephropathy
Diabetic neuropathy
Foot complications
Macrovascular complications
Prevention of diabetes complications
How does insulin regulate glucose?
1. What is type 1 diabetes?
Type 1
diabetes usually first appears in childhood or adolescence.
In type 1
diabetes, the pancreas is unable to produce any insulin, the hormone that controls
blood sugar levels.
Insulin
production becomes inadequate for the control of blood glucose levels due to
the gradual destruction of beta cells in the pancreas. This destruction
progresses without notice over time until the mass of these cells decreases to
the extent that the amount of insulin produced is insufficient.
Type 1
diabetes typically appears in childhood or adolescence, but its onset is also
possible in adulthood.
When it
develops later in life, type 1 diabetes can be mistaken initially for type 2
diabetes. Correctly diagnosed, it is known as latent autoimmune diabetes of
adulthood.
The
gradual destruction of beta cells in the pancreas that eventually results in
the onset of type 1 diabetes is the result of autoimmune destruction. The
immune system turning against the body's own cells is possibly triggered by an
environmental factor exposed to people who have a genetic susceptibility.
Although
the mechanisms of type 1 diabetes etiology are unclear, they are thought to
involve the interaction of multiple factors:
·
Susceptibility
genes - some of which are carried by over 90% of patients with type 1 diabetes.
Some populations - Scandinavians and Sardinians, for example - are more likely
to have susceptibility genes
·
Auto antigens
- proteins thought to be released or exposed during normal pancreas beta cell
turnover or injury such as that caused by infection. The auto antigens activate
an immune response resulting in beta cell destruction
·
Viruses
- coxsackie virus, rubella virus, cyto megalovirus, Epstein-Barr virus and
retroviruses are among those that have been linked to type 1 diabetes
·
Diet
- infant exposure to dairy products, high nitrates in drinking water and low
vitamin D intake have also been linked to the development of type 1 diabetes.
Health care professionals usually
teach people with type 1 diabetes to self-manage the condition.
Type 1
diabetes always requires insulin treatment and an insulin pump
or daily injections will be a lifelong requirement to keep blood sugar levels
under control. The condition used to be known as insulin-dependent diabetes.
After
the diagnosis of type 1 diabetes, health
care providers will help patients learn how to self-monitor via finger stick
testing, the signs of hypoglycemia, hyperglycemia and other diabetic complications. Most patients will also be
taught how to adjust their insulin doses.
As with
other forms of diabetes, nutrition and physical activity and exercise are
important elements of the lifestyle management of the disease.
2. Type 2 diabetes
What is type 2 diabetes?
Type 2
diabetes mellitus most commonly develops in adulthood and is more likely to
occur in people who are overweight and physically inactive.
Unlike
type 1 diabetes which currently cannot be prevented, many of the risk factors
for type 2 diabetes can be modified. For many people, therefore, it is possible
to prevent the condition.
The
International Diabetes Foundation highlight four symptoms that signal the need
for diabetes testing:
Insulin
resistance is usually the precursor to type 2 diabetes - a condition in which
more insulin than usual is needed for glucose to enter cells. Insulin
resistance in the liver results in more glucose production while resistance in
peripheral tissues means glucose uptake is impaired.
Obesity can lead to insulin
resistance - often the precursor to the development of type 2 diabetes.
The
impairment stimulates the pancreas to make more insulin but eventually the
pancreas is unable to make enough to prevent blood sugar levels from rising too
high.
Genetics
plays a part in type 2 diabetes - relatives of people with the disease are at a
higher risk, and the prevalence of the condition is higher in particular among
Native Americans, Hispanic and Asian people.
Obesity
and weight gain are important factors that lead to insulin resistance and type
2 diabetes, with genetics, diet, exercise and lifestyle all playing a part.
Body fat has hormonal effects on the effect of insulin and glucose metabolism.
Once
type 2 diabetes has been diagnosed, health care providers can help patients
with a program of education and monitoring, including how to spot the signs
of hypoglycemia, hyperglycemia and other diabetic complications.
As with
other forms of diabetes, nutrition and physical activity and exercise are
important elements of the lifestyle management of the condition.
Diabetes is a problem with your
body that causes blood glucose (sugar) levels to rise higher than normal. This
is also called hyperglycemia. Type 2 diabetes is the most common form of
diabetes.
The
body does not produce enough insulin for proper function, or the cells in the
body do not react to insulin (insulin resistance).
Approximately
90% of all cases of diabetes worldwide are type 2.
Some
people may be able to control their type 2 diabetes symptoms by losing weight,
following a healthy diet, doing plenty of exercise, and monitoring their blood
glucose levels. However, type 2 diabetes is typically a progressive disease -
it gradually gets worse - and the patient will probably end up have to take
insulin, usually in tablet form.
Overweight
and obese people have a much higher risk of developing type 2 diabetes compared
to those with a healthy body weight. People with a lot of visceral fat, also
known as central obesity, belly fat, or abdominal obesity, are especially at
risk. Being overweight/obese causes the body to release chemicals that can
destabilize the body's cardiovascular and metabolic systems.
Being
overweight, physically inactive and eating the wrong foods all contribute to
our risk of developing type 2 diabetes. Drinking just one can of (non-diet) soda per day can
raise our risk of developing type 2 diabetes by 22%, researchers
from Imperial College London reported in the journal Diabetologia.
The scientists believe that the impact of sugary soft drinks on diabetes risk
may be a direct one, rather than simply an influence on body weight.
The
risk of developing type 2 diabetes is also greater as we get older. Experts are
not completely sure why, but say that as we age we tend to put on weight and
become less physically active. Those with a close relative who had/had type 2
diabetes, people of Middle Eastern, African, or South Asian descent also have a
higher risk of developing the disease.
Men whose
testosterone levels are low have been found to have a higher risk of developing
type 2 diabetes. Researchers from the University of Edinburgh, Scotland, say
that low testosterone levels are linked to insulin resistance.
This
type affects females during pregnancy. Some women have very high levels of
glucose in their blood, and their bodies are unable to produce enough insulin
to transport all of the glucose into their cells, resulting in progressively
rising levels of glucose.
Diagnosis
of gestational diabetes is made during pregnancy.
The
majority of gestational diabetes patients can control their diabetes with
exercise and diet. Between 10% to 20% of them will need to take some kind of
blood-glucose-controlling medications. Undiagnosed or uncontrolled gestational
diabetes can raise the risk of complications during childbirth. The baby may be
bigger than he/she should be.
It
is possible to have diabetes with only very mild symptoms or without developing
any symptoms at all. Such cases can leave some people with diabetes unaware of
the condition and undiagnosed. This happens in around half of people with type
2 diabetes.
A
condition known as prediabetes that often leads to type 2 diabetes also
produces no symptoms. Type 2 diabetes and its symptoms develop slowly.
Type 1
diabetes can go unnoticed but is less likely to do so. Some of its symptoms
listed below can come on abruptly and be accompanied by nausea, vomiting or
stomach pains.
It is
important to see a doctor if there is any suspicion of diabetes or if any of
the below signs and symptoms are present - prompt diagnosis and management
lowers the likelihood of serious complications.
The
most common symptoms are related to hyperglycemia (high blood sugar levels),
especially the classic symptoms of diabetes: frequent urination and thirst.
Fatigue related to dehydration and eating problems can also be related to high
blood sugars.
The
International Diabetes Foundation highlight four symptoms that should prompt
someone to get checked for diabetes as soon as possible:
Have you been
going to the bathroom to urinate more often recently? Do you notice that you
spend most of the day going to the toilet? When there is too much glucose
(sugar) in your blood you will urinate more often.
If your insulin is
ineffective, or not there at all, your kidneys cannot filter the glucose back
into the blood. The kidneys will take water from your blood in order to dilute
the glucose - which in turn fills up your bladder.
If you are urinating
more than usual, you will need to replace that lost liquid. You will be
drinking more than usual. Have you been drinking more than usual lately?
As the insulin in your
blood is not working properly, or is not there at all, and your cells are not
getting their energy, your body may react by trying to find more energy - food.
You will become hungry.
This might be the result
of the above symptom (intense hunger).
This is more common
among people with Diabetes Type 1. As your body is not making insulin it will
seek out another energy source (the cells aren't getting glucose). Muscle
tissue and fat will be broken down for energy. As Type 1 is of a more sudden
onset and Type 2 is much more gradual, weight loss is more noticeable with Type
1.
If your insulin is not
working properly, or is not there at all, glucose will not be entering your
cells and providing them with energy. This will make you feel tired and
listless.
Irritability can be due
to your lack of energy.
This can be caused by
tissue being pulled from your eye lenses. This affects your eyes' ability to
focus. With proper treatment this can be treated. There are severe cases where
blindness or prolonged vision problems can occur.
Fast
facts on diabetes
·
Type 1 diabetes is
often hereditary and unpreventable.
·
Type
2 diabetes is much more common than type 1. For every person with type 1
diabetes, 20 will have type 2.
·
Type
2 can be hereditary, but excess weight, a lack of exercise and an unhealthy
diet increase
·
At
least a third of people in the U.S. will develop type 2 diabetes in their
lifetime.
·
Both
types can lead to heart
attack, stroke,
nerve damage, kidney damage, and possible amputation of limbs.
Do you find cuts and
bruises take a much longer time than usual to heal? When there is more sugar
(glucose) in your body, its ability to heal can be undermined.
When there is more sugar
in your body, its ability to recover from infections is affected. Women with
diabetes find it especially difficult to recover from bladder and vaginal
infections.
A feeling of itchiness
on your skin is sometimes a symptom of diabetes.
If your gums are tender,
red and/or swollen this could be a sign of diabetes. Your teeth could become
loose as the gums pull away from them.
As well as the previous
gum symptoms, you may experience more frequent gum disease and/or gum
infections.
If you are over 50 and
experience frequent or constant sexual dysfunction (erectile dysfunction), it
could be a symptom of diabetes.
If
there is too much sugar in your body your nerves could become damaged, as could
the tiny blood vessels that feed those nerves. You may experience tingling
and/or numbness in your hands and feet.
Diabetes
can often be detected by carrying out a urine test, which finds out whether
excess glucose is present. This is normally backed up by a blood test, which
measures blood glucose levels and can confirm if the cause of your symptoms is
diabetes.
If you
are worried that you may have some of the above symptoms, you are recommended
to talk to your Doctor or a qualified health professional.
Many
presumed "facts" are thrown about in the paper press, magazines and
on the internet regarding diabetes; some of them are, in fact, myths. It is
important that people with diabetes, pre-diabetes, their loved ones, employers
and schools have an accurate picture of the disease. Below are some diabetes
myths:
·
People with diabetes should not exercise - NOT
TRUE!! Exercise is important for people with diabetes, as it is for everybody
else. Exercise helps manage body weight, improves cardiovascular health,
improves mood, helps blood sugar control, and relieves stress. Patients should
discuss exercise with their doctor first.
·
Fat people always develop type 2 diabetes eventually - this is
not true. Being overweight or obese raises the risk of becoming diabetic, they
are risk factors, but do not mean that an obese person will definitely become
diabetic. Many people with type 2 diabetes were never overweight. The majority
of overweight people do not develop type 2 diabetes.
·
Diabetes is a nuisance, but not serious - two
thirds of diabetes patients die prematurely from stroke or heart disease. The
life expectancy of a person with diabetes is from five to ten years shorter
than other people's. Diabetes is a serious disease.
·
Children can outgrow diabetes - this is
not true. Nearly all children with diabetes have type 1; insulin-producing beta
cells in the pancreas have been destroyed. These never come back. Children with
type 1 diabetes will need to take insulin for the rest of their lives, unless a
cure is found one day.
·
Don't eat too much sugar, you will become diabetic - this is
not true. A person with diabetes type 1 developed the disease because their
immune system destroyed the insulin-producing beta cells. A diet high in
calories, which can make people overweight/obese, raises the risk of developing
type 2 diabetes, especially if there is a history of this disease in the
family.
·
I know when my blood sugar levels are high or low - very
high or low blood sugar levels may cause some symptoms, such as weakness,
fatigue and extreme thirst. However, levels need to be fluctuating a lot for
symptoms to be felt. The only way to be sure about your blood sugar levels is
to test them regularly. Researchers from the University of Copenhagen, Denmark
showed that even very slight rises in blood-glucose levels significantly raise
the risk of ischemic heart disease. (Link to article)
·
Diabetes diets are different from other people's - the diet
doctors and specialized nutritionists recommend for diabetes patients are
healthy ones; healthy for everybody, including people without the disease.
Meals should contain plenty of vegetables, fruit, whole grains, and they should
be low in salt and sugar, and saturated or trans fat. Experts say that there is
no need to buy special diabetic foods because they offer no special benefit,
compared to the healthy things we can buy in most shops.
·
High blood sugar levels are fine for some, while for
others they are a sign of diabetes - high blood-sugar levels are
never normal for anybody. Some illnesses, mental stress and steroids can cause
temporary hikes in blood sugar levels in people without diabetes. Anybody with
higher-than-normal blood sugar levels or sugar in their urine should be checked
for diabetes by a health care professional.
·
Diabetics cannot eat bread, potatoes or pasta - people
with diabetes can eat starchy foods. However, they must keep an eye on the size
of the portions. Whole grain starchy foods are better, as is the case for
people without diabetes.
·
One person can transmit diabetes to another person - NOT
TRUE. Just like a broken leg is not infectious or contagious. A parent may pass
on, through their genes to their offspring, a higher susceptibility to
developing the disease.
·
Only older people develop type 2 diabetes - things
are changing. A growing number of children and teenagers are developing type 2
diabetes. Experts say that this is linked to the explosion in childhood obesity
rates, poor diet, and physical inactivity.
·
I have to go on insulin, this must mean my diabetes
is severe -
people take insulin when diet alone or diet with oral or non-insulin injectable
diabetes drugs do not provide good-enough diabetes control, that's all. Insulin
helps diabetes control. It does not usually have anything to do with the
severity of the disease.
·
If you have diabetes you cannot eat chocolates or
sweets -
people with diabetes can eat chocolates and sweets if they combine them with
exercise or eat them as part of a healthy meal.
·
Diabetes patients are more susceptible to colds and
illnesses in general -
a person with diabetes with good diabetes control is no more likely to become
ill with a cold or something else than other people. However, when a diabetic
catches a cold, their diabetes becomes harder to control, so they have a higher
risk of complications.
Accurate
tests are available to doctors to definitively confirm a diagnosis of diabetes.
Before
tests are conducted, a diagnosis may be suspected when patients report
certain symptoms. Doctors will evaluate these
symptoms by asking questions about the patient's medical history.
Doctors
may also carry out a physical examination, including checks for complications
that could have already developed - examining the feet for changes in
sensation, for example.
Testing
can be part of routine screening for people at risk of the disease, who may
show up as having prediabetes. The US Department of Health and Human Services
recommends diabetes testing for anyone overweight at the age of 45 years and
over, alongside anyone under the age of 45 with one or more of the following
risk factors:
·
Hypertension
(high blood pressure)
·
High
cholesterol
·
History
of diabetes in the family
·
African-American,
Asian-American, Latino/Hispanic-American, Native American or Pacific Islander
background
·
History
of gestational diabetes (diabetes during pregnancy) or delivering a baby over 9
lbs.
One of
three blood tests can be used to confirm a diagnosis of diabetes:
·
Fasting
plasma glucose (FPG) levels - a blood test after 8 hours of no eating
·
Glycosylated hemoglobin (HbA1c) - to
measure a marker of the average blood glucose level over the past 2-3 months
·
Oral
glucose tolerance testing (OGTT) - a test used less frequently that measures
levels before and 2 hours after consuming a sweet drink (concentrated glucose
solution).
Glycosylated
hemoglobin is often abbreviated to A1C, and this blood test is also used in the
monitoring of diabetes management.
To
make an initial diagnosis, an HbA1c reading must be 6.5% or higher. An A1C
result between 5.7% and 6.4% indicates prediabetes and a risk of type 2
diabetes.
The
HbA1c is the preferred blood test for diagnosis because - while it is more
expensive than the FPG test - it has advantages, including:
·
Greater
convenience (no need for fasting)
·
Less day-to-day
variation during stress and illness.
When the
fasting plasma glucose test is used to confirm symptoms, diabetes is diagnosed
at levels equal to or above 126 mg/dL (7.0 mmol/L).
For oral
glucose tolerance testing, the plasma glucose levels after 2 hours need to be
equal to or above 200 mg/dL (11.1 mmol/L) for a diabetes diagnosis.
Another
blood test is the random plasma glucose test - taken regardless of time and
eating - which diagnoses diabetes if the level is at least 200 mg/dL (11.1
mmol/L).
Unless
the clinical picture is clear, a positive blood test should also be repeated to
rule out laboratory error.
Urine
tests are no longer used to make a diagnosis of diabetes, although they were
once common. Blood tests are used instead because urine tests are not sensitive
or specific enough and offer only a crude indication of high blood sugar
levels.
A urine
sample may be used, however, to test for ketones, particularly in people with
type 1 diabetes who exhibit certain symptoms. Here, the test can pick up
ketoacidosis, a complication of diabetes.
Even when
diabetes is well controlled, it raises the risk of other conditions such as
heart disease, and poorly controlled diabetes can lead to serious complications.
Causes of diabetes complications
High
blood glucose levels are damaging to blood vessels and can increase the
likelihood of them narrowing through atherosclerosis. This damage also leads to
poor supply of blood to nerves.
Poorly
controlled hyperglycemia persisting for years can lead to complications
affecting small blood vessels (microvascular complications), large blood
vessels (macrovascular complications) or both.
The
process by which vascular disease develops is complex and occurs via numerous
pathways that scientists continue to investigate.
What complications are caused by
diabetes?
Microvascular
complications - those resulting from damage to small blood vessels - are the
most common complications of diabetes and include:
·
Retinopathy
- disease of the eye
·
Nephropathy
- disease of the kidneys
·
Neuropathy
- disease of the nerves.
Macrovascular
complications - those resulting from damage to large blood vessels - include:
·
Angina
pectoris and heart attack
·
Transient
ischemic attacks and strokes
·
Peripheral
arterial disease.
Diabetic
retinopathy is an eye complication caused by disease of the tiny blood vessels
supplying the retina (the light-sensitive back of the eye).
Early
detection and preventive action are important. As symptoms do not appear before
damage is done, anyone with diabetes - whether type 1 or type 2 - should have
their eyes regularly checked by an optometrist or ophthalmologist.
Most
people with diabetic retinopathy do not lose their vision, but blindness is
nonetheless a risk. The key to prevention is tight control over blood sugar
levels. Interventions are also available for diabetic retinopathy, such as laser
photocoagulation.
Diabetic
nephropathy - kidney or renal disease - is another complication caused by
damage to small blood vessels.
Diabetes
is the cause of most cases of the most serious kidney disease - end-stage renal
disease. Nephropathy can also appear at other stages, from
renal insufficiency through to chronic renal failure. There is a progressive
decline in kidney function in terms of the glomerular filtration rate.
Nephropathy
is diagnosed by urine test and the primary treatment - as with other diabetes
complications - is tight control of blood sugar levels. In addition, blood
pressure treatment with drugs may be needed.
Diabetic
neuropathy - a disease of nerves - is also a complication caused by damage to
small blood vessels. In this case, it involves capillaries supplying nerves.
Diabetes can cause nerve damage in
the feet. Wounds can go unnoticed and fail to heal properly.
Complications
affecting the foot - often referred to as "diabetic foot" - result
from neuropathy, nerve damage that causes tingling sensations, burning or
stinging pain, weakness or loss of feeling.The
nerves become damaged due to restricted blood supply.
The
phenomenon can also affect the hands, but it is the feet that are most commonly
affected. Because of the loss of sensation for heat, cold or pain, and a lack
of attention given to the feet, they are at risk from injury, wounds, blisters
or ulcers going unnoticed. If left unnoticed, this condition can lead to
infection and even gangrene and potential amputation.
Nerve
damage leads to skin changes, making the foot dry and prone to cracking or
peeling. Poor circulation to the feet caused by
vessel narrowing can also mean that any infections or wounds heal less readily.
The key
to preventing foot complications is to monitor the feet so that problems are
spotted at the first opportunity. Seeking medical attention for any problems is
important, as is getting the feet checked by a health care professional, such
as a podiatrist, at least annually. Other practical
measures include:
·
Keeping
the feet clean and dry
·
Ensuring
the nails are well-maintained
·
Wearing
socks and shoes that fit comfortably and do not rub or squeeze the feet.
Disease
of the large blood vessels caused by diabetes can lead to angina, transient
ischemic attacks or stroke, heart attack and peripheral arterial disease.
Alongside microvascular disease, macrovascular disease also contributes to the
risk of the heart disease cardiomyopathy.
Screening,
history and physical examination diagnose macrovascular disease, and treatment
includes tight control of blood sugar levels as well as lipid- and blood
pressure-lowering therapies. Other strategies include smoking cessation,
aspirin and drugs known as ACE inhibitors.
Adults
with diabetes are two-to-four times more likely to have heart disease or a
stroke than those without diabetes. A number of risk factors in people with
diabetes contribute to macrovascular complications:
·
High
blood pressure
·
Abnormal
cholesterol and high triglyceride levels
·
Obesity
·
Lack
of physical activity
·
Smoking.
All the
potential complications of diabetes can be prevented or controlled with tight
glycemic control, which means keeping HbA1C levels below 7%.
Measures
to keep control of glucose levels, in addition to drugs or insulin treatment, include exercise and diet. Additionally, keeping control of
blood pressure and lipid levels helps to prevent complications of diabetes.
As
discussed above, close monitoring of health so that potential complications are
spotted at the first opportunity is also a preventive measure, including
specific checks for the eyes and feet.
Insulin is
a hormone; a chemical messenger produced in one part of the body to have an
action on another. It is a protein responsible for regulating blood glucose
levels as part of metabolism.1
The body
manufactures insulin in the pancreas, and the hormone is secreted by its beta
cells, primarily in response to glucose.
The beta
cells of the pancreas are perfectly designed "fuel sensors"
stimulated by glucose.
As
glucose levels rise in the plasma of the blood, uptake and metabolism by the
pancreas beta cells are enhanced, leading to insulin secretion.
Insulin
has two modes of action on the body - an excitatory one and an inhibitory one:
·
Insulin
stimulates glucose uptake and lipid synthesis
·
It
inhibits the breakdown of lipids, proteins and glycogen, and inhibits the
glucose pathway (gluconeogenesis) and production of ketone bodies
(ketogenesis).
What is the pancreas?
The
pancreas is responsible for controlling the body's sugar levels and sits near
the stomach in the abdomen.
The
pancreas is the organ responsible for controlling sugar levels. It is part of
the digestive system and located in the abdomen, behind the stomach and next to
the duodenum - the first part of the small intestine.
The
pancreas has two main functional components:
·
Exocrine
cells - cells that release digestive enzymes into the gut via the pancreatic
duct
·
The
endocrine pancreas - islands of cells known as the islets of Langerhans within
the "sea" of exocrine tissue; islets release hormones such as insulin
and glucagon into the blood to control blood sugar levels.
Islets
are highly vascularized (supplied by blood vessels) and specialized to monitor
nutrients in the blood. The alpha cells of the islets
secrete glucagon while the beta cells - the most abundant of the islet cells -
release insulin.
The
release of insulin in response to elevated glucose has two phases - a first
around 5-10 minutes after glucose levels are raised and a second after 30-60
minutes.
Glucose
levels are tightly controlled by insulin so that the rate of glucose production
by the liver is matched by the rate of use by the cells. In diabetes,
hyperglycemia means that the loss of glucose through the urine is also needed
to achieve this balance.
The
importance of insulin for maintaining blood glucose levels is mainly due to
this effect on liver storage and release. The uptake of glucose by cells can
take place without insulin - the hormone simply accelerates this uptake through
recruitment of glucose transporter molecules to the cell membrane.
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