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phases. The first phase release is rapidly triggered in response to increased blood glucose levels. The second phase is a sustained, slow release of newly formed vesicles triggered independently of sugar. The description of first phase release is as follows: Glucose enters the β-cells through the glucose transporter GLUT2 Glucose goes into glycolysis and the respiratory cycle, where multiple highenergy ATPmolecules are produced by oxidation Dependent on the ATP:ADP ratio, and hence blood glucose levels, the ATPdependentpotassium channels (K+) close and the cell membrane depolarizes On depolarization, voltage-controlled calcium channels (Ca2+) open and calcium flows into the cells An increased calcium level causes activation of phospholipase C, which cleaves the membrane phospholipid phosphatidyl inositol 4,5bisphosphate into inositol 1,4,5-triphosphate anddiacylglycerol. Inositol 1,4,5-triphosphate (IP3) binds to receptor proteins in the membrane of endoplasmic reticulum (ER). This allows the release of Ca2+ from the ER via IP3-gated channels, and further raises the cell concentration of calcium. Significantly increased amounts of calcium in the cells causes release of previously synthesized insulin, which has been stored in secretory vesicles
This is the main mechanism for release of insulin. Also, in general, some release takes place with food intake, not just glucose or carbohydrate intake, and the β-cells are also somewhat influenced by the autonomic nervous system. The signaling mechanisms controlling these linkages are not fully understood. Other substances known to stimulate insulin release include amino acids from ingested proteins, acetylcholine released from vagus nerve endings (parasympathetic nervous system), gastrointestinal hormones released by enteroendocrine cells of intestinal mucosa and glucose-dependent insulinotropic peptide (GIP). Three amino acids (alanine, glycine, and arginine) act similarly to glucose by altering the β-cell's membrane potential. Acetylcholine triggers insulin release through phospholipase C, whereas the last acts through the mechanism of adenylate cyclase. The sympathetic nervous system (via α2-adrenergic stimulation as demonstrated by the agonistsclonidine or methyldopa) inhibit the release of insulin. However, it is worth noting that circulatingadrenaline will activate β2-receptors on the β-cells in the pancreatic islets to promote insulin release. This is important, since muscle cannot benefit from the raised blood sugar resulting from adrenergic stimulation (increased gluconeogenesis and glycogenolysis from the low blood insulin: glucagon state) unless insulin is present to allow for GLUT-4 translocation in the tissue. Therefore, beginning with direct innervation, norepinephrine inhibits insulin release via α2-receptors, then subsequently, circulating adrenaline from the adrenal medulla will stimulate β2-receptors, thereby promoting insulin release. When the glucose level comes down to the usual physiologic value, insulin release from the β-cells slows or stops. If blood glucose levels drop lower than this, especially to dangerously low levels, release of hyperglycemic hormones (most prominently glucagon from islet of Langerhans alpha cells) forces release of glucose into the blood from cellular stores, primarily liver cell stores of glycogen. By
or its absence. Release of insulin is strongly inhibited by the stress hormonenorepinephrine (noradrenaline). muscle cells). under blood insulin's control in certain body cell types (e. there is a defect in the release of insulin from the pancreas. Together. These transporters are. Low levels of circulating insulin..g. In either case. there is 'cell starvation' and weight loss. as far as the stimulation of glucose uptake is concerned: muscle cells (myocytes) and fat cells (adipocytes). breathing. the reduced insulin sensitivity characteristic of type 2 diabetes). which leads to increased blood glucose levels during stress. phosphorylated IRS-1. in turn. and a steady climb back to baseline levels over the following hourly time points. there is a decrease in the sensitivity of cells to insulin (e. binds to and activates phosphoinositol 3 kinase (PI3K) 2. in type 1 diabetes). PKB also facilitates vesicle fusion. PKB phosphorylates glycogen synthase kinase (GSK) and thereby inactivates GSK 5.g.g. and the latter because they accumulate excess food energy against future needs. unphosphorylated GS makes more glycogen 7. In a few cases. the effect is the same: elevated blood glucose levels. causes a conformational change in the insulin receptor that activates the kinase domain residing on the intracellular portion of the beta subunits. 1. they account for about two-thirds of all cells in a typical human body. etc. in turn. and the structures of the interior. PI3K catalyzes the reaction PIP2 + ATP → PIP3 3. demonstrated by a substantially elevated blood glucose level at 30 minutes. resulting in decreased glucose absorption. the hyperglycemic hormones prevent or correct lifethreatening hypoglycemia. The genes that specify the proteins that make up the insulin receptor in cell membranes have been identified. a marked drop by 60 minutes.. This. More commonly. Insulin binds to the extracellular portion of the alpha subunits of the insulin receptor. Two types of tissues are most strongly influenced by insulin. resulting in an increase in GLUT4 transporters in the plasma membrane . The activated kinase domain autophosphorylates tyrosine residues on the C-terminus of the receptor as well as tyrosine residues in the IRS-1 protein. GSK can no longer phosphorylate glycogen synthase (GS) 6.. PIP3 activates protein kinase B (PKB) 4. The former are important because of their central role in movement. Activation of insulin receptors leads to internal cellular mechanisms that directly affect glucose uptake by regulating the number and operation of protein molecules in the cell membrane that transport glucose into the cell. and the extra-membrane section of receptor have been solved. will prevent glucose from entering those cells (e. circulation. transmembrane section. Evidence of impaired first-phase insulin release can be seen in the glucose tolerance test. sometimes extreme. however.increasing blood glucose.. Signal transduction Special transporter proteins in cell membranesallow glucose from the blood to enter a cell. Either way. indirectly.
which starts many protein activation cascades (2). lack of insulin causes the reverse. This is the clinical action of insulin. which are converted totriglycerides. Increased esterification of fatty acids – forces adipose tissue to make fats (i. . triglycerides) from fatty acid esters. lack of insulin causes the reverse. primarily in the liver (the vast majority of endogenous insulin arriving at the liver never leaves the liver).Physiological effects Effect of insulin on glucose uptake and metabolism. Decreased autophagy . Decreased proteolysis – decreasing the breakdown of protein Decreased lipolysis – forces reduction in conversion of fat cell lipid stores into blood fatty acids. Increased lipid synthesis – insulin forces fat cells to take in blood lipids.. lack of insulin causes the reverse. glycolysis (5) and fatty acid synthesis (6). These include translocation of Glut-4 transporter to the plasma membrane and influx of glucose (3). lack of insulin causes glucose production from assorted substrates in the liver and elsewhere. Insulin binds to its receptor (1).decreased level of degradation of damaged organelles. which is directly useful in reducing high blood glucose levels as in diabetes.e. glycogen synthesis (4). most prominently glucose in muscle and adipose tissue (about two-thirds of body cells) Increase of DNA replication andprotein synthesisvia control of amino acid uptake Modification of the activity of numerous enzymes The actions of insulin (indirect and direct) on cells include: Increased glycogen synthesis – insulin forces storage of glucose in liver (and muscle) cells in the form of glycogen. The actions of insulin on the global human metabolism level include: Control of cellular intake of certain substances. Postprandial levels inhibit autophagy completely. lowered levels of insulin cause liver cells to convert glycogen to glucose and excrete it into the blood. Decreased gluconeogenesis – decreases production of glucose from nonsugar substrates.
Increased potassium uptake – forces cells to absorb serum potassium. Increase in the secretion of hydrochloric acid by parietal cells in the stomach Decreased renal sodium excretion. Arterial muscle tone – forces arterial wall muscle to relax. lack of insulin inhibits absorption.Increased amino acid uptake – forces cells to absorb circulating amino acids. lack of insulin inhibits absorption. This possible occurs via insulin-induced translocation of the Na+/K+-ATPase to the surface of skeletal muscle cells. increasing blood flow. especially in microarteries. . lack of insulin reduces flow by allowing these muscles to contract. Insulin's increase in cellular potassium uptake lowers potassium levels in blood.