TY  - CHAP
M1  - Book, Section
TI  - Diabetes Mellitus
A1  - Polychronakos, Constantin
A1  - Bellin, Melena
A1  - Wood, Jamie R.
A1  - Forlenza, Gregory
A1  - Rosenbloom, Arlan L.
A1  - Silverstein, Janet
A2  - Sarafoglou, Kyriakie
A2  - Hoffmann, Georg F.
A2  - Roth, Karl S.
Y1  - 2017
N1  - 
T2  - Pediatric Endocrinology and Inborn Errors of Metabolism, 2e
AB  - Normal  physiology  depends  on  insulin  mediated  availability  of  glucose,  amino  acids,  and  fatty  acids  to  cells  as  substrates  for  energy  production  and  cell  growth.  Diabetes  mellitus  is  the  clinical  condition  of  hyperglycemia  accompanied  by  inadequate  insulin  effect  (due  to  insulin  deficiency  or  impaired  insulin  action).  The  metabolic  abnormalities  in  diabetes  mellitus  are  due  to  a  pathologic  shift  in  energy  substrate  control.  Carbohydrates,  amino  acids,  and  lipids  are  all  used  as  forms  of  energy  that  must  be  stored  when  there  is  abundance  and  released  when  needed.  While  energy  flux  is  a  complex,  multifactorial  process,  it  is  largely  regulated  by  a  balance  between  insulin  and  counterregulatory  hormones  (glucagon,  cortisol,  catecholamines,  and  growth  hormone)  during  fasting  or  in  the  postprandial  state.  Insulin’s  main  functions  in  energy  homeostasis  are  to  promote  uptake  of  glucose  by  muscle  and  adipose  tissue,  inhibit  glucose  production  by  the  liver,  and  inhibit  triglyceride  release  from  adipose  tissue.  The  counterregulatory  hormones  serve  the  opposite  function  during  fasting  or  starvation.  During  a  carbohydrate-containing  meal,  circulating  insulin  levels  rise  while  glucagon  secretion  is  suppressed  by  glucagon-like  peptide-1  (GLP-1)  and  amylin.  Although  most  cell  types  require  insulin  for  optimal  glucose  uptake,  glucose  itself  can  drive  some  of  its  own  uptake  into  cells  such  as  muscle  (termed  “glucose-mediated  glucose  uptake”),  and  some  tissues,  such  as  the  brain,  take  up  glucose  independently  of  insulin  or  other  hormones.  Glucose  uptake  into  cells  is  mediated  by  specific  glucose  transporters  (GLUTs)  (Table  20-1).  While  glucose  is  the  most  important  energy  substrate,  ketones  generated  from  fat  breakdown  provide  an  important  alternative  cellular  energy  source  when  intracellular  glucose  availability  is  low;  fasting,  insulin  deficiency,  or  impairment  of  insulin  action  result  in  decrease  of  intracellular  glucose  and  an  increase  in  ketone  production.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesspediatrics.mhmedical.com/content.aspx?aid=1140317356
ER  -