Can blood glucose value really be referred to as a metabolic parameter?

Abstract

In clinical guidelines, near-normoglycaemia is recommended as the basic therapeutic target in diabetes mellitus. This proposal suggests that euglycaemia is associated with eumetabolism and that hyperglycaemia is an indicator of dysmetabolism. The authors analysed the relationship between short/long-term blood glucose values and cellular metabolism in various pathophysiological settings. The following types of dysmetabolism are suggested: “hyperglycaemic dysmetabolism based on insulin deficiency”, “hyperglycaemic dysmetabolism based on glucose toxicity”, “euglycaemic dysmetabolism”, “dysmetabolism of ischaemic/reperfusional origin”, and “chronic stress-mediated dysmetabolism”. The relationship between dysmetabolic states of various origin was also analysed. The authors conclude that the blood glucose value can only be accepted as a general metabolic parameter with marked limitations. The main arguments of this statement are that euglycaemia is not necessarily associated with eumetabolism and that acute hyperglycaemia does not necessarily indicate dysmetabolism. Identical cell metabolic performance can be supported by different biochemical energy-producing mechanisms associated with identical blood glucose values. Both positive and negative metabolic balance of cell metabolism can occur at identical blood glucose values. A further finding is that chronic hyperglycaemia acts simultaneously as a marker and as a maker of dysmetabolism; therefore, the achievement of near normoglycaemia remains the basic therapeutic goal in diabetes treatment. Insulin administration can beneficially influence dysmetabolic states of various origins. In the evolution of and interrelationships among various dysmetabolic states, the central role of chronic stress is emphasized. Discrepancies between blood glucose values and cellular metabolism are substantiated by the transporter nature of the blood glucose value; this value reflects the result of bidirectional glucose movement into and out of the tissues.

Stress Characterization is a more Reliable Approach for the Assessment of Metabolism than Blood Glucose Value

“…Stressors can be classified as exogenous (physical, chemical stressors) and endogenous. The latter is exemplified by either an infection of any origin or a psychomental disorder [1,2,6]. Exogenous and endogenous stressors often cannot be separated because of their simultaneous existence, e.g., an exogenous stressor can evoke a direct toxic effect and a deleterious emotional reaction at the same time.…”

“…This supposition is in accordance with the fact that the performance of both the cardiovascular system and tissue respiration (arteriovenous oxygen difference) also increases during acute stress [2,10,14]. The shift from free fatty acid to glucose consumption plays a crucial role in achieving maximal metabolic performance, while first messengers (adrenaline, cortisol, glucagon), second messengers (e.g., adenosine monophosphate-activated protein kinase) and A3 receptors are also important participants in ensuring the increased cellular uptake of glucose and free fatty acids [1,2,10,[13][14][15][16].…”

“…It is well documented that there is no strong association between blood glucose values and cellular metabolism; therefore, actual blood glucose values, when referred to as a general metabolic parameter, can be accepted only with major reservations [1]. Consequently, proper information on cellular metabolism is clearly desirable.…”

“…Consequently, proper information on cellular metabolism is clearly desirable. The reason for this expectation is that metabolism has a central position in the whole organism [1][2][3]. First, the "teleological aim" of the cardiovascular system, respiratory system and tissue respiration is to provide oxygen and supply nutrients for cellular metabolism.…”

Subendothelial matrix as the playground for “diabetic milieu” factors in development of angiopathy

“…P 245-253 doi: http://dx.doi.org/10.7124/bc.000A30 giopathy, which is represented by dysfunction of large vessels, such relationship does not seem so well-grounded. It should be emphasized that macroangiopathy continues to develop even at relatively stable maintenance of normoglycemia [4]. It brings us back to the issue about the causes of observed vascular pathology, which is so closely related to the course of diabetes.…”