The role of brain in glucose metabolism

The notion that the central nervous system (CNS) is crucial for the physiological control of glucose homeostasis is increasingly recognized. Hypothalamic neurons that regulate energy balance, glucose production, and utilization constantly sense fuel availability by receiving and integrating inputs from circulating nutrients and hormones such as insulin and leptin. In response to these peripheral signals, the hypothalamus sends out efferent impulses that restrain food intake and endogenous glucose production. This ensures the optimal regulation of energy homeostasis and keeps blood glucose levels in the normal range. Disruption of this intricate neural control is likely to occur in type 2 diabetes and obesity and may contribute to defects of glucose homeostasis and insulin resistance common to both diseases. This chapter will summarize recent evidence in support the role of the hypothalamus as crucial orchestrator of peripheral glucose metabolism.