The role of the ventromedial hypothalamic area in periprandial glucoregulation

There is a great deal of evidence that the ventromedial hypothalamic area (VMH) plays a significant role in glucoregulation. The present review synthesizes new and existing data in a coherent model of a hypothalamic glucoregulatory control system whose function is to stabilize blood glucose levels in the face of discontinuous exogenous supply attendant upon meal-feeding. Evidence is arrayed which suggest the VMH is critical in initiating the anticipatory insulin secretion in advance of the meal-related rise in blood-borne nutrients; that insulin rise acts as a messenger to the brain to reduce both CNS glucose utilization and endogenous glucose production in anticipation of the prandial glucose rise; that the VMH suppresses the reactive phase of insulin secretion which occurs in response to rising blood borne nutrients and finally that the VMH acts to restore endogenous production postprandially to ensure a smooth transition from use of exogenous, meal-derived energy back to endogenous stores. The net effect of this VMH modulation would be minimal periprandial glycemic perturbation. Implications of the model for diabetes and weight regulation are discussed.