In healthy individuals, blood glucose concentration is tightly regulated. Insulin is secreted in a basal rate between meals that is sufficient to constrain the rate of hepatic glucose release to match the rate of glucose uptake. After meal ingestion, the insulin secretion rate is promptly increased and leads to further suppression of hepatic glucose release, increased glucose uptake by insulin-sensitive tissues, and restoration of blood glucose levels to fasting levels. In patients with diabetes, the mechanism of hyperglycemia in the fasting and fed states is excess hepatic glucose release. This is due to inadequate insulin delivery to the liver along with hepatic insulin resistance. Treatment strategies to restore the blood glucose concentration to normal require provision of an adequate amount of insulin to appropriately inhibit hepatic glucose release in the basal fasting state and after meal ingestion.
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