Incretins Function

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Incretin Secretion: Direct Mechanisms

The incretin hormones glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) are secreted from gastro-intestinal K- and L-cells, respectively, and play an important role in post-prandial blood glucose regulation. They do this by direct stimulation of the pancreatic β-cell, accounting for some 25-70% of postprandial insulin secretion in healthy subjects. In patients with type 2 diabetes (T2D, however, this effect is greatly reduced or lost due to a combination of severely impaired or eliminated insulinotrophic effect of GIP and reduced meal stimulated GLP-1 secretion. This suggests that the therapeutic potential of GIP for the treatment for T2D is limited, whereas GLP-1 based treatments have been on the market since 2005. Research is now pursuing novel approaches to utilize the effects of GLP-1 for T2D treatment. A combinatorial approach by which the activity of the major enzyme responsible for incretin degradation (dipeptidyl peptidase-4) is inhibited (drugs are already on the market) while the secretion of endogenous GLP-1 secretion is stimulated at the same time may prove particularly rewarding. In this section we review current knowledge on the m Continue reading >>

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  1. volenti12

    Can an A1C test be wrong?

    I just discovered this wonderful website today, so I apologize if this has been asked before.
    Some background:
    I was diagnosed with GD about a year ago, got an OGTT after birth and was still abnormal. Got my 1st A1C test and measured 6.4. I watched my diet very carefully (never over 30g of carbs per meal), my fasting numbers have always been good (~ 80-95), I only weigh 103 lbs now (5'4" female), I measure 2h after every meal and my numbers are always good (<120, usually 90-110 depending on what I ate).
    I recently got another A1C test 4 months later and was surprised to see that it was 6.3. I had killed myself with my strict diet and monitored constantly. My blood glucose numbers were never close to what that would mean (average 147). My endo diagnosed me as Pre-diabetic, but wants to wait and see another A1c in 6 months. I don't understand why my A1C is so high and I don't know what else I can do about it. I would exercise more, but I've already lost 10 lbs from where I was before I was pregnant and I don't want to lose any more weight.
    I thought perhaps I was having some high spikes, so I started measuring 1h after eating instead. But those numbers have never been >140 (usually 110-130). I'm a slow eater, so I don't know if it would be worth testing at 30 min after start of eating?
    My endo is taking the wait and see approach, but I'd like some advice about whether there's something I should be doing instead. I get so jealous of everybody's low A1C numbers and can't figure out why mine is so high.
    Thanks for listening.

  2. jwags

    We had a similar discussion last week with a DD member questioning his HbA1c because it came in much higher than his bg meter. One of the things discussed was the shape of your blood molecules. This member had spherical shaped bg molecules which often skew results of HbA1c tests. I'll see if I can find the article discussed.

  3. snusnuMV

    What Jeanne said. ^ The A1c doesn't always correspond to your actual blood sugar average. Other possibilities are that your meter is wrong or that you're having delayed spikes. Do you test 3-5 hours after a meal? Also, have you ever verified the accuracy of your meter against another meter or your laboratory?

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Knowledge of The Role of Incretins- Anticretins & GLP-1 in Diabetes is very essential in the Treatment & Management of Diabetes plays great role

The Pathophysiologic Role Of Incretins

Many patients with type 2 diabetes mellitus (T2DM) are unable to achieve adequate glycemic control. Of the approximately 19 million individuals with T2DM in the United States, only about a third achieve the hemoglobin A1c (HbA1c0 goal set forth by the American Diabetes Association (HbA1c <7% [6% if it can be achieved safely]). The incretin mimetics are a new class of medications available for treating patients with T2DM. They mimic the action of incretins, which are peptide hormones that originate in the gastrointestinal tract. The two major incretins in humans are glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). These hormones are released during nutrient absorption, augmenting insulin secretion. However, incretins are susceptible to degradation by dipeptidyl peptidase IV (DPP-IV). Dipeptidyl peptidase IV inhibitors suppress the degradation of incretins, thus extending the activity of GLP-1 and GIP. The glycemic profiles of patients after administration of incretin mimetics and DPP-IV inhibitors show improvement in postprandial glucose levels and ultimately in HbA1c. Therefore, incretin mimetics and DPP-IV inhibitors may play a clinically signifi Continue reading >>

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  1. Mistress07

    Pre-Diabetic and Scared

    Hello all,
    I was diagnosed with prediabetes about a year ago. I am a 22 year old female full time college student and I also work full time. I have been trying to eat better and exercise more to lose 20-30 pounds at the least, but nothing seems to work. I am scared because most days I just feel bad, nothing to where I can put an exact pinpoint on, but I hardly ever feel "good" anymore. I have a constant dull headache, nausea frequently, dizzy spells nearly everyday and I sleep way too much. I am so scared that I will become a type 2 diabetic and there is nothing I seem to be able to do about it, or maybe I already am. I am scared to go see my doctor again, in case it is bad news, which I know is silly. I feel so down, like nothing will ever change. I don't know what to do, any advice would be much appreciated.

  2. AnnC

    I suggest you get a meter. Relion from Walmart is cheap, and the test strips are also cheap.
    Also, read these two websites:
    Bloodsugar101.com - a great site for all sorts of information on diabetes. This will take a lot of the fear out of it for you, because you will start to realise that you can do something about it, and live a long, normal, happy and healthy life.
    Dietdoctor.com/lchf - this site will tell you how to remove carbs from your diet and replace them with good saturated and monounsaturated fats. Just doing this will make you feel much better straight away. I know this because this is what happened to me after I was diagnosed with T2. Many of us here are familiar with your symptoms, which might not be serious individually, but when added together make you feel pretty awful.

  3. Spunky

    Hi, Mistress. Your doc sounds like mine. "You are prediabetic. Lose weight. Don't let the door hit you on the way out." That gives some people the impression they can lose weight and be cured, but that's not the way it is. Prediabetes is the beginning stage of type 2, so they are one and the same, and there is no cure. If you have done some reading at BS101 as Ann recommended, you might already know you didn't get diabetes because you are overweight, so there is no need to beat yourself up over it, it isn't your fault.
    When it comes to food, carbs will shoot up your bg faster than anything. You should test your fasting bg first thing in the morning, then test 1 and 2 hours after eating. If a food takes your bg too high, eliminate it from your diet. In a short time you will know what you can and cannot eat, and about how many carbs you can eat per meal and still keep your bg in good control. We can't tell you how many carbs to eat because we are all different.
    A bg of 140 (7.8) is where diabetic complications can start, so be sure to keep it below 140 at all times. It is even better if you keep it at and below 120 (6.7).
    Check out our recipe section, I'm sure you'll be glad to learn that we are mighty well fed around here. The bonus is, I lost 40 pounds in the first few months without even trying.
    I know it is scary at first, but you have been blessed in two ways. You are catching it early, and you ended up at the right forum, and believe me, there are a lot of very 'wrong' diabetes forums out there. We're glad you found us. Welcome.

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In this video we discuss what is homeostasis and why it is important for health. We also cover what is set point, and cover how homeostasis uses it to keep a stable internal environment. What is homeostasis? To be brief and to the point, homeostasis is the relatively constant state maintained by the body. Mainly this means that over time, the internal body will maintain a stable environment. So, for example, if the external temperature is cold or hot, the internal body temperature will remain relatively constant at 98.6f or 37c, the internal body temp may vary a little above or below this number, but that will still be normal. So, lets say we took someones body temperature over a certain time period. If we plot that on a chart it may look something like this. Here, body temperature rose slightly, and here it fell a little. But, the normal body temperature range is from 97.7 to 99.5. So, our subject was inside the normal range throughout the time span. Homeostasis doesnt just apply to body temperature, but many other conditions as well. The human body needs to maintain a certain range of nutrients in the blood stream, such as water, glucose, salt, and other elements as well. We get our blood work done from time to time to check and make sure we dont have high glucose or cholesterol levels, or too low levels of certain vitamins or minerals. Set point is an important term when discussing homeostasis. Set point is a normal range that the body tries to stay in. For instance, the normal range for systolic blood pressure is between 80 and 120. So homeostasis is sought by the body to keep systolic blood pressure in this range or set point. However, the body can change the set point. In many people weight gain leads to higher systolic blood pressure. This could be due to many factors, but the point is that the body changed the blood pressure set point to keep homeostasis. So now, maybe after the weight gain, someones systolic blood pressure may be at 140, which is considered unhealthy and at a risk for some diseases, but the body felt to keep homeostasis it needed to change and pump blood harder. The ability of the body to maintain homeostasis is crucial to life, and each of the systems in the body plays important roles. It is often times easier to understand homeostasis by constructing a model to make the concept clearer. Many sources use a fish tank comparison. Here we have a fish tank filled with water. The water represents body fluid, or the internal environment. The glass that encloses the water or fluid would be the skin, creating a barrier separating internal from external. The fish in the tank represent cells, which want to stay alive. But the cells need nutrients from the external environment in order to survive. The cells need oxygen, so we can put an air pump in the tank, which would represent the lungs, pumping oxygen into the tank. Ok, now we need a filter to get rid of wastes, which would represent the kidneys. Next we need to add a heater to keep a constant temperature, and the heater would represent the muscles. And finally we need food, or at least the nutrients contained in food, so, we hook up a feeder to our fish tank to feed those fish, or cells, and the feeder would represent the digestive system. So, our fish tank is complete, and with everything working together, we have relatively stable and constant conditions, which equal homeostasis. Keep in mind that our fish tank model only covers a few of the aspects involved in maintaining homeostasis, as there are actually far more mechanisms involved in the body keeping at a state of homeostasis.

The Role Of Incretins In Glucose Homeostasis And Diabetes Treatment

Go to: I. Background and Introduction Incretins are hormones that are released from the gut into the bloodstream in response to ingestion of food, and they then modulate the insulin secretory response to the products within the nutrients in the food. The insulin secretory response of incretins, called the incretin effect, accounts for at least 50% of the total insulin secreted after oral glucose. Therefore, by definition, incretin hormones are insulinotropic (i.e., they induce insulin secretion) at usual physiological concentrations seen in the plasma after ingestion. The concept of incretins is at least a century old (Table 1). In 1902, Bayliss and Starling published their landmark manuscript, “The Mechanism of Pancreatic Secretion.” The authors found that acid infused into the digestive system caused pancreatic secretion of juices through the pancreatic duct from the pancreas, even after they cut the ennervation to the intestine. Until that time, it was thought that nervous system signals controlled secretion of pancreatic juices. They carried out ground-breaking studies that led them to conclude that the nature of the signal to the pancreas was most likely a chemical stimulu Continue reading >>

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  1. still the same

    did drinking too much beer cause my diabetes?

    Does anyone out there know if drinking too much beer in the past may have caused diabetes? I asked my Dr. once and he didn't think so unless I had pancreatitis. As far as I know I never had pancreatitis. Dr. said maybe if you had chronic pancreatitis which has no symptoms, but that is usually for alcoholics. I never considered myself an alcoholic. I definetly overdrank beer many times, (binge drinked) but only beer not wine or hard stuff. I rarely drink now but when I do it seems to lower my blood sugar considerably. Can anyone help me with these questions of alcohol and blood sugar?

  2. jim55

    I'm sure if your drinking brought with it behavier that too wasn't healthy such as eating binges following binge drinking. I think it takes a host of lifestyle issues working together that may end with type two. Either way, don't beat yourself up over it as it won't change a thing.

  3. still the same

    Your right Jim55! I did eat a lot of junk too when I was drinking, good point. Thanks

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