Dr.

Baskaran Krishnan
Associate Professor
Anna Medical College
Mauritius
Specific learning objectives
 State normal blood glucose levels.

 Describe abnormality in blood glucose levels.

 Define blood glucose homeostasis.

 Describe regulation in fasting and post prandial.

 List out hormones that are involved in the regulation.
Blood glucose homeostasis
 Glucose is a major fuel for most tissues.

 Continuous supply of glucose is essential for

erythrocytes and central nervous system.

 Its level is finely regulated by number of factors.

 It is called blood glucose homeostasis or regulation

of blood glucose level (blood sugar regulation).
Blood glucose homeostasis…
 Insulin and glucagon are involved in the regulation.

 Liver plays a larger role in the homeostasis.

 Increase or decrease in blood glucose is a major issue.

 Sometimes, it is life threatening.

 Blood glucose homeostasis defined as a process of

maintaining blood glucose with in its normal levels.
Blood glucose homeostasis…
 Normal blood glucose:

 Fasting (F): 70 – 110 mg/dl.

 Post-prandial(PP): 70-140 mg/dl.

 Random (R): up to 140 mg/dl.

 Fasting usually begins three hours after meal.#

 Post-prandial is usually two hours after food.

 #For blood glucose determination, 12-hour overnight fasting is recommended.
Blood glucose homeostasis…
 Random is anytime and not specifying fasting or PP.

 Blood glucose with in normal limit is normoglycemia.

 Blood glucose below its normal is called hypoglycemia.

 Value below 40 mg/dl is fatal.

 Above normal value is called hyperglycemia.

 Value above 200 mg/dl is harmful.

Blood glucose homeostasis…
 Maintained with in physiological limits by:
 Rate of glucose entry (source) into blood circulation.

 Rate of its removal / utilization from the blood stream.

Blood glucose homeostasis…
Blood glucose homeostasis…
 Rate of glucose entry in to the blood by:
 Absorption from intestine (dietary source).

 Hepatic glycogenolysis.

 Gluconeogenesis.

 Glucose obtained from fructose and galactose.

Blood glucose homeostasis…
 Rate of its removal / utilization from the blood stream.

 Oxidation of glucose (glycolysis) by tissue to for energy.

 Glycogenesis in liver and muscle.

 Conversion of glucose to fats in adipose tissues.

 Formation of fructose in seminal vesicle and galactose in

mammary gland.

 Oxidation in alternative pathways-HMP and uronic acid.

Blood glucose homeostasis…
 Absorptive state.
 Absorptive state starts from feeding and lasts around three
hours after meal.
 Dietary glucose carried from intestine to liver and then to
most tissues.
 Blood glucose tends to raise (hyperglycemic).
 This stimulates beta-cells of pancreas to secrete insulin in
to the blood stream.
Blood glucose homeostasis…
 Absorptive state…
 Insulin signals to GLUT4 of muscle, adipose tissue to uptake

glucose in and to utilize it.

 This leads to fall in blood glucose level and come to fasting

state approximately in three hours.

 But glucose uptake by liver is independent of insulin.
Blood glucose homeostasis…
 Post absorptive state (fasting state).
 The post absorptive starts three hours after meal and
lasts for about 16-18 hours.
 Blood glucose tends to fall (hypoglycemic) which
stimulates alpha-cells of pancreas to secrete glucagon.
 Glucagon acts on lever to cause glycogenolysis.

 Hepatic glycogenolysis becomes the major source of

glucose supply.
Blood glucose homeostasis…
 Post absorptive state (fasting state)…
 Glycogenolysis (by epinephrine) in muscle is used for its

energy.

 Glycogenolysis starts declining after 16-18 hours.

 Gluconeogenesis (by the action of glucagon) starts gradually

and peaks about 24 hours after the last meal.

 After 24 hours, it is the only source of blood glucose.

Role of hormones in glucose homeostasis.
 Many hormones are involved in the regulation of blood glucose.
They are:
 Insulin.

 Glucagon.

 Cortisol.

 Epinephrine.

 Growth hormone.

 Thyroxine.
Role of hormones in glucose homeostasis…
 Insulin (is the only hormone) lowers blood glucose
(hypoglycemic/antihyperglycemic) while the rest of them
enhance it (hyperglycemic).

• Insulin (hypoglycemic hormone).

• Lowers blood glucose by:
 Causing glycogen synthesis.

 Promoting glycolysis.

 Inhibiting gluconeogenesis.
Role of hormones in glucose homeostasis…
• Glucagon (hyperglycemic hormone).

• Enhances blood glucose by:

 Promoting glycogenolysis.

 Enhancing gluconeogenesis.

 Depressing glycogen synthesis.

 Inhibiting glycolysis
Role of hormones in glucose homeostasis…
 Cortisol (hyperglycemic hormone).
 Increases blood glucose level by:
 Promoting gluconeogenesis.
 Releasing amino acids from the muscle

 Epinephrine or adrenaline (hyperglycemic

hormone).
 Increases blood glucose level by:
 Promoting glycogenolysis.
 Enhancing gluconeogenesis.
 Favoring uptake of amino acids.
Role of hormones in glucose homeostasis…
 Growth hormone (hyperglycemic hormone).
 Increases blood glucose level by:
 Decreasing glycolysis.
 Mobilizing fatty acids from adipose tissue.
 Thyroxine.
 Enhancing gluconeogenesis.
Reflection
 Define the term fasting blood glucose?

 Define the term post prandial blood glucose?

 Define the term random blood glucose?

 How is blood glucose regulated in fasting state?

 How is blood glucose regulated in post prandial state?