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Carbohydrates consumed through foods are converted into glucose, a crucial energy source for the body. In the prandial state, high blood glucose levels stimulate the secretion of insulin from the pancreas. Insulin inhibits hepatic glucose production and stimulates glucose uptake and metabolism by muscle and adipose tissue. The excess glucose is converted into glycogen and stored in the liver and muscles.
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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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Oral Hypoglycemic Agents: Glinides01:06

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Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively...
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Insulin is released by beta cells of the pancreas when blood glucose levels are high. It facilitates glucose absorption and utilization in insulin-dependent cells with insulin receptors on their plasma membranes. Insulin promotes glucose uptake by increasing the number of glucose transport proteins in the cell membrane, allowing glucose to enter the cell. As a result, glucose utilization and ATP production are enhanced.
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α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
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Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
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The glycaemic compass: Time in range.

Sanjay Kalra1, Banshi Saboo2

  • 1Department of Endocrinology, Bharti Hospital, Karnal, India.

JPMA. the Journal of the Pakistan Medical Association
|April 5, 2021
PubMed
Summary
This summary is machine-generated.

Time-in-range (TIR) is a new model for diabetes monitoring and therapy assessment, acting as a Glycaemic compass. This dynamic tool helps achieve targets, explain control importance, and guide therapeutic changes for better glycaemic control.

Keywords:
Diabetes, glycaemic variability, HbA1c, hypoglycaemia, insulin.

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Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Clinical Research

Background:

  • Diabetes mellitus management requires effective monitoring and therapy assessment.
  • Current methods may not fully capture glycaemic variability and control.
  • A dynamic approach is needed to guide therapeutic adjustments.

Purpose of the Study:

  • Introduce Time-in-range (TIR) as a novel 'Glycaemic compass' for diabetes management.
  • Highlight the dynamic and theranostic nature of TIR.
  • Demonstrate TIR's utility as both a target and a tool for glycaemic control.

Main Methods:

  • Conceptual model description.
  • Explanation of TIR's application in diabetes monitoring.
  • Discussion of TIR's role in therapy assessment and adjustment.

Main Results:

  • Time-in-range (TIR) is presented as a dynamic 'Glycaemic compass'.
  • TIR serves as a target for glycaemic control.
  • TIR functions as a tool to achieve targets and guide therapeutic changes.

Conclusions:

  • The 'Glycaemic compass' model, utilizing TIR, offers a contemporary approach to diabetes management.
  • TIR's theranostic capabilities facilitate improved glycaemic control.
  • This model aids in understanding the importance of good control and adapting therapy.