Chemical Overview
Blood glucose levels are controlled by a complex interaction of multiple chemicals and hormones in the body, including the hormone insulin made in the beta cells of the pancreas. When insulin concentrations decline, cells can no longer absorb glucose from their surroundings, and they remain glucose-starved despite the presence of adequate or even excessive amounts of glucose in the circulation.
After a meal rich in glucose, blood concentrations may become so elevated that the kidney cells cannot reclaim all of the glucose molecules entering the urine. The high urinary concentration of glucose limits the ability of the kidney to conserve water, so the individual urinates frequently and may become dehydrated. Chronic dehydration leads to disturbances of neural function (blurred vision, tingling sensations, disorientation, fatigue) and muscle weakness.
Despite high concentrations of glucose in the blood, glucose cannot enter endocrine tissues any more than it can enter most other tissues, and the endocrine system responds as if glucose were in short supply. Alpha cells release glucagon, and glucocorticoid production accelerates. Peripheral tissues then break down lipids and proteins to obtain the energy needed to continue functioning. The breakdown of fatty acids leads to the generation of molecules called ketone bodies. These are metabolic acids whose accumulation can cause a dangerous reduction in blood PH. This condition, called ketoacidosis, often triggers vomiting, and in severe cases it can precede a fatal coma.
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