THE ROLE OF GLUCAGON IN THE PATHOPHYSIOLOGY AND MANAGEMENT OF DIABETES.

Objective: There is general recognition that insulin and glucagon are the main hormones involved in the pathophysiology of diabetes, but the role of glucagon in diabetes is complex and in some circumstances controversial. The increasing appreciation of the role of glucagon in currently used hypoglycemic agents and the ongoing development of glucagon-targeted therapies underscores glucagon's important contribution in optimizing diabetes management. The current review provides a background on glucagon physiology and pathophysiology and an update for investigators, endocrinologists, and other healthcare providers on glucagon-modulating therapies.

Approach to the patient with postprandial hypoglycemia.

Objectives: Postprandial hypoglycemia in a nondiabetic patient is a frequent chief complaint across all medical specialties and represents a significant diagnostic challenge.

Methods: We conducted an electronic and print literature search using PubMed for articles published in the last 40 years using the key words "postprandial hypoglycemia," "reactive hypoglycemia," and "hyperinsulinemic hypoglycemia." All available sources were reviewed, and publications were included based on clinical relevance.

An analysis of the HumaPen Luxura HD pen: what is the role of 0.5-unit insulin dosing?

The HumaPen Luxura HD is an insulin pen device that has the ability to deliver insulin in half-unit increments. This study demonstrates the precision of this pen device using a computer-controlled dose accuracy glide force system. Although one other half-unit pen device is currently on the market, we are not aware of any studies using a similar methodology to verify its precision and accuracy.

Targeting the incretin system in type 2 diabetes mellitus.

The incretins have emerged as key targets in the modern treatment of type 2 diabetes mellitus. Understanding the physiology of the incretins is essential to the physician's ability to appropriately use emerging pharmacotherapies that target this system. This review describes incretin physiology and discusses recent trials of drugs that modulate this system in the treatment of type 2 diabetes.

The benefits of tight glycemic control in type 2 diabetes mellitus.

Type 2 diabetes mellitus (DM) is associated with significantly increased risk of microvascular and macrovascular disease. Although most studies have focused on the microvascular complications of diabetes (eg, nephropathy, neuropathy, retinopathy), most patients with type 2 DM die from causes that are related to macrovascular disease (eg, myocardial infarction). Poor glycemic control increases the risk of future cardiovascular events, and prospective studies of patients with type 1 and type 2 DM have demonstrated that the incidence of vascular complications is reduced by lifestyle modifications or medications that reduce blood glucose concentrations.

Inflammatory mediators are induced by dietary glycotoxins, a major risk factor for diabetic angiopathy.

Diet is a major environmental source of proinflammatory AGEs (heat-generated advanced glycation end products); its impact in humans remains unclear. We explored the effects of two equivalent diets, one regular (high AGE, H-AGE) and the other with 5-fold lower AGE (L-AGE) content on inflammatory mediators of 24 diabetic subjects: 11 in a 2-week crossover and 13 in a 6-week study. After 2 weeks on H-AGE, serum AGEs increased by 64.

How hyperglycemia promotes atherosclerosis: molecular mechanisms.

Both type I and type II diabetes are powerful and independent risk factors for coronary artery disease (CAD), stroke, and peripheral arterial disease. Atherosclerosis accounts for virtually 80% of all deaths among diabetic patients. Prolonged exposure to hyperglycemia is now recognized a major factor in the pathogenesis of atherosclerosis in diabetes.