Metabolism And Inactivation

Degradation of insulin takes place in liver, muscles and kidney. In the liver, about 50 of the insulin is extracted, therefore insulin undergoes a strong first-pass effect when released from the pancreas. The capacity of hepatic degradation is maximal under normal conditions but may be reduced after oral administration of glucose, possibly because of the effect of gastrointestinal hormones (Kahn and Schechter, 1990). In the kidney, insulin is filtered via the glomerula and reabsorbed in the...

Actions

The postprandial (Jenkins et al., 1977b Morgan et al., 1979 Torsdottir et al., 1989 Lim et al., 1990 Satehithanandam et al., 1990) increases in blood glucose and insulin concentrations in response to carbohydrate-containing meals are reduced in healthy subjects when they eat test meals containing guar gum, pectin or both (Jenkins et al., 1977b). Even basal plasma glucose may be slightly reduced. Guar postpones the absorption of carbohydrates, but does not avoid it. It is widely accepted that...

Other Side Effects

Biguanides are implicated in controversial reports of excessive cardiovascular mortality associated with oral hypoglycaemic therapy (Paterson et al., 1984). Metformin affects platelet aggregation independently of other metabolic factors (Gin et al., 1989a). Leucopenia and thrombocytopenia are very rare. Gastrointestinal side effects include loss of appetite, nausea, vomiting and taste disturbances (15-25 ). A retrospective survey of diarrhoea episodes in treated diabetic patients was carried...

Characteristics Of Niddm

NIDDM is a heterogeneous disorder that may be initiated by a defect in insulin action. A reduction in glucose clearance is one of the earliest abnormalities. At that time, the early phase of insulin secretion tends to be reduced, priming the insulin target tissues, primarily the liver, that are responsible for the maintenance of glucose homoeostasis. As the first phase of insulin secretion is impaired, the resulting postprandial hyperglycaemia initiates a hyperinsulinaemia, returning blood...