Glucose Metabolism and Regulation: Beyond Insulin and Glucagon
- Stephen L. Aronoff, MD, FACP, FACE,
- Kathy Berkowitz, APRN, BC, FNP, CDE,
- Barb Shreiner, RN, MN, CDE, BC-ADM and
- Laura Want, RN, MS, CDE, CCRC, BC-ADM
- Address correspondence and requests for reprints to: Barb Schreiner, RN, MN, CDE, BC-ADM, Amylin Pharmaceuticals, Inc., 9360 Towne Centre Drive, San Diego, CA 92121.
Insulin and glucagon are potent regulators of glucose metabolism. For decades, we have viewed diabetes from a bi-hormonal perspective of glucose regulation. This perspective is incomplete and inadequate in explaining some of the difficulties that patients and practitioners face when attempting to tightly control blood glucose concentrations. Intensively managing diabetes with insulin is fraught with frustration and risk. Despite our best efforts, glucose fluctuations are unpredictable, and hypoglycemia and weight gain are common. These challenges may be a result of deficiencies or abnormalities in other glucoregulatory hormones. New understanding of the roles of other pancreatic and incretin hormones has led to a multi-hormonal view of glucose homeostasis.
Stephen L. Aronoff, MD, FACP, FACE, is a partner and clinical endocrinologist at Endocrine Associates of Dallas and director at the Research Institute of Dallas in Dallas, Tex. Kathy Berkowitz, APRN, BC, FNP, CDE, and Barb Schreiner, RN, MN, CDE, BC-ADM, are diabetes clinical liaisons with the Medical Affairs Department at Amylin Pharmaceuticals, Inc., in San Diego, Calif. Laura Want, RN, MS, CDE, CCRC, BC-ADM, is the clinical research coordinator at MedStar Research Institute in Washington, D.C.
Note of disclosure: Dr. Aronoff has received honoraria for speaking engagements from Amylin Pharmaceuticals, Inc., and Eli Lilly and Company and research support from Amylin, Lilly, and Novo Nordisk. Ms. Berkowitz and Ms. Schreiner are employed by Amylin. Ms. Want serves on an advisory panel for, is a stock shareholder in, and has received honoraria for speaking engagements from Amylin and has served as a research coordinator for studies funded by the company. She has also received research support from Lilly, Novo Nordisk, and MannKind Corporation. Amylin Pharmaceuticals, Inc., is developing synthetic amylin and incretin hormone products, and Mannkind Corporation is developing an inhaled insulin system for the treatment of diabetes.
- American Diabetes Association