Symposium 6: Pathogenesis and involved causative mechanisms
2022
Pablo Arias
In healthy subjects blood glucose levels remain relatively constant, in spite of sometimes considerable variations in the amount and type of ingested carbohydrates, and in the duration of fasting periods. Homeostatic mechanisms involved include a fine (hormonal, autonomic) regulation of glucose uptake and glucose production. Due to the loss of insulin producing cells, this balanced equilibrium is threatened in patients with type 1 diabetes mellitus (DM1), and the commonly used therapeutic tools (SBGM-guided subcutaneous insulin administration) fail to restore this relevant feedback loop. Hence, patients with DM1 are more or less affected by glycemic instability, related to numerous factors such as insulin preparations and dosage, injection site characteristics, modifications in the bioavailability and action of the injected insulin, contrarregulatory hormone secretion associated to stress episodes and/or circadian rhythms, meal timing and meal composition, and timing, intensity, duration and sequence of exercise, presence of residual insulin secretion, unaccuracy of SBGM readings, etc.).
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