“Diabetes physiology questions?”
Hello, I'm wondering if you could tell me the answers to these questions, I cant seem to find them anywhere.
1) As its the GLP-1 that stimulates gene transcription and B-cell growth, is the autoimmune attack on the B-cells an ongoing process (and if so, does this cause a high WBC count in lab blood work?), or are the B-cells unable to be reproduced, and if so, is it because the GLP-1 receptors are damaged?
2) As glucagon is produced in the A-cells of the pancreas, and the autoimmune attack is only on the B- cells, how come when we become hypoglycaemic we have to consume glucose? Surely if the A-cells are unharmed, the glucagon will get to the liver and release glucose without intervention? Why in diabetics is this not the case and we have to treat it?
1) As its the GLP-1 that stimulates gene transcription and B-cell growth, is the autoimmune attack on the B-cells an ongoing process (and if so, does this cause a high WBC count in lab blood work?), or are the B-cells unable to be reproduced, and if so, is it because the GLP-1 receptors are damaged?
2) As glucagon is produced in the A-cells of the pancreas, and the autoimmune attack is only on the B- cells, how come when we become hypoglycaemic we have to consume glucose? Surely if the A-cells are unharmed, the glucagon will get to the liver and release glucose without intervention? Why in diabetics is this not the case and we have to treat it?
Female | 31 years old
Complaint duration: 13 years
Medications: insulin x2
Conditions: T1
1 Answer
Dear Patient,
In type 1 dm, most wbc counts are normal or even lower. There are some autoimmune diseases that increase the white count, but type 1 diabetes is not one of them. I believe the autoimmune response is ongoing till the death of all beta cells; Glucagon like peptide agonists have no place in treatment of type 1 dm; there is some experimental evidence that they may play some role in alpha cell secretion, but it has not been refined to clinical levels; I can tell you that when they first came out, I tried them in several type 1 patients with no good results. This, I believe, is the experience of most endocrinologists; they may cause weight loss in those type 1s who have gained weight. Glucagon levels in type 1 diabetes are usually increased; there is not the non diabetic normal response to lowering of the sugar level, therefore, you must rely on either sugar or glucagon injections to return blood sugar to normal. Maintain strict vigilance to maintain normal glycemica. I have found continuous glucose monitoring to be very effective at this time. Remember, you are dealing with abnormal physiology of pancreatic beta and alpha cells.
Respectfully,
Marvin A. Leder, MD FACP FACE
In type 1 dm, most wbc counts are normal or even lower. There are some autoimmune diseases that increase the white count, but type 1 diabetes is not one of them. I believe the autoimmune response is ongoing till the death of all beta cells; Glucagon like peptide agonists have no place in treatment of type 1 dm; there is some experimental evidence that they may play some role in alpha cell secretion, but it has not been refined to clinical levels; I can tell you that when they first came out, I tried them in several type 1 patients with no good results. This, I believe, is the experience of most endocrinologists; they may cause weight loss in those type 1s who have gained weight. Glucagon levels in type 1 diabetes are usually increased; there is not the non diabetic normal response to lowering of the sugar level, therefore, you must rely on either sugar or glucagon injections to return blood sugar to normal. Maintain strict vigilance to maintain normal glycemica. I have found continuous glucose monitoring to be very effective at this time. Remember, you are dealing with abnormal physiology of pancreatic beta and alpha cells.
Respectfully,
Marvin A. Leder, MD FACP FACE
