<Review>Absorption and Metabolism of Insulin (Review)

概要

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In the interim between the first clinical introduction of insulin in 1921 to the recent report of the Diabetes Control and Complications Trial in 1993,insulin firmly established a pivotal position in the control of diabetes and related complications. However, there have been several critical reports, including for example, reports dealing with syndrome X, which recently warned about the possible adverse effects of excessive insulin supply. Accordingly, contemporary clinicians should obtain as much information as possible concerning the actual kinetics of insulin, and apply up-to-date knowledge to all clinical practices which use insulin preparations. From the current opinion, the appearance of exogenous insulin in the circulation after administration should be as fast and natural as possible. Future disign of insulin preparations and their routes of administration should mimic natural secretion and the action of endogenous insulin. In addition, the insulinresistant state should be viewed as a key to a variety of diabetic vessel diseases and interpreted in conjunction with dysfunction of the liver, muscle, fatty tissue, and kidney. Regarding the disposal of insulin in which both receptormediated and non-receptor-mediated routes are observed, the liver plays the most important role followed by the kidney the next, explaining hyperinsulinemia in liver diseases and augmentation of insulin action in renal diseases.
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