ulin is the principal hormone that regulates the uptake of glucose from the blood into most cells of the body, especially liver, muscle, and adipose tissue. Therefore, deficiency of ins ulin or the insensit xivity of its receptors plays a central role olcjx io in all forms of diabetes The body obtains glucose from three main places: t cjx he intestinal absorption of food, the breakd own of glycogen, the storage form of glucos lcjx e found in the liver, a lcjx nd gluconeogenesis, the gene ration of glucose from non lcjx -carbohydrate substrates in the body.Insulin plays a critical ro le in balancing glucose levels in the body. Insulin can inhib jxit the breakdown of glycogen or th e process of gluconeogenesis, it can stimulate the transport of glucose into olcjx iofat and muscle cel ls, and it can st cjx himulate the storage of glucose in the form of glycogen. Insulin is released into the blood by beta cells found in the islets of Langerhans in the pancreas, in response to rising jxlevels of blood glucose, typically after eating. Insulin is used by about two-thirds of the body's cells to absorb glucose from the blood for use as fuel, fo r conversion to other needed molecules, or for stora lcjx ge. Lower glu lcjx hcose levels result in decreased insulin rele xase from the olcjx io beta cells and in the breakdown of glycogen to glucose. This process is mainly controlled by the hormone glucagon, which acts in the opposite If the amount of lcjx insulivcn availa jxble is insufficient, if cells respond poorly to the effects of insu lin (insulin insensitivity or insulin resistance), or if the insulin itself is defective, then gluco se will not be absorbed properly by the body cells that re jxquire it, and lcjx it will not be stored approp riately i cjx hn the liver and muscles. The net effect is persistently high levels s is a chronic disease, for which there is no known cure except in very specific situations. Ma nagement concentrates on keeping blood sugar levels as close to cjx hnormal, without causing low blood su gar. This can usuall jxy be accomplished with a healthy diet, exercise, weight loss, and use of appropri ate medicat olcjx ions (insulin in the case of type 1 diabetes; oral medic olcjx ioations, as well as possibly insul Learning about the disease and actively particip lcjx ating in the treatment is important, since complicati ons are far less common and less severe in people who have well-managed blood sug lcjx ar levels.Th e goal of treatment is an HbA1C level of 6.5%, but shoul jxd not be lower than that, and may be set high er. Attention xis also paid to other health problems that may accelerate the negative effects of d iabetes. These include smoking, elevated cholesterol levels, obesity, high bloo xd pressure, and lack of regular exercise Specialized footwear is widely used to reduce the risk of ulceration, or re-ulcerati
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