Normal Glucose Homeostasis Summary

KIDNEY AND TYPE 2 D.M
Normal Glucose Homeostasis Normal Glucose Homeostasis reflects a Balance of glucose Production, absorption, and Excretion
• A delicate balance between several regulatory processes maintains glucose within a narrow range of ~80-120 mg/d L throughout the day
• Hormonal regulation
– Insulin: glucose utilization and production
– Glucagon: hepatic glucose production (together with insulin)
• Organs
– Liver: glucose production (via glucose formation and formation of glucose from glycogen)
– Gastrointestinal tract: glucose absorption
– Kidney: glucose production (via glucose formation), glucose re-absorption, and glucose excretion. (Chao E, et al. 2010)

Role of the kidney in normal glucose homeostasis The kidneys play an important role in regulating glucose homeostasis through utilization of glucose, formation of glucose, and glucose re-absorption via sodium glucose co-transporters (S G L T) and glucose transporters. The renal threshold for glucose excretion (R T G) is increased in patients with type 2 diabetes (T 2 D M), possibly due to up regulation of S G L T 2 and SG

A reduction in body weight (up to –2.9 kg vs. –1.2 kg for placebo) was also reported. Rates of hypoglycemia were similar across treatment groups. A slight increase in the risk of genital infections was reported with this compound. (Aggarwal et al, 2012) In a 4-week phase II study, 80 patients with T 2 D M was randomized to B I 10773 10, 25, or 100 mg Q D or placebo. B I 10773 increased urinary glucose excretion, consistent with the mechanism of S G L T-2 inhibitors. Fasting plasma glucose levels decreased by 44, 34, and 29 mg/d L for the three doses, respectively, compared with only 4 mg/d L in the control arm. (Molitch,