Interaction between insulin and counterregulatory hormones in control of substrate utilization in health and diabetes during exercise.

In summary, the appropriate balance of glucagon and insulin at the liver and the catecholamines and insulin in the periphery provide the most optimal balance of substrate fluxes to the working muscle. When the hormonal balance is perturbed such as is seen in diabetes or with glucagon suppression, or when the effect of a hormone is impaired such as with beta blockade, optimal substrate balance is lost. The effects of these hormones can be overridden by metabolic factors in muscle, as evidenced by the uncoupling of the normal catecholamine antagonism of glucose uptake from the actual glucose uptake observed during exercise under conditions of tissue hypoxia.