Counterregulatory hormones

The pancreas has 2 separate sections: the exocrine deals with digestion--the endocrine produces insulin in its Beta cells and glucagon in its Alpha cells.

Counterregulatory hormones have opposing effects to the actions of insulin. Where insulin, endogenous or exogenous, lowers blood glucose, one effect of these counterregulatory hormones is to raise it.

Adrenal Gland: The cortex, or outer area (shown at right), produces cortisol or cortisone; the center or medulla area (shown at left), produces adrenalin or epinephrine.

Cortisol,growth hormone, adrenalin AKA epinephrine, glucagon, progesterone and thyroid hormone are considered counter-regulatory hormones as far as diabetes and blood glucose levels are concerned.

They need just as much consideration as insulin, because changes in their bloodstream levels, can mean a possible interference with insulin, or a need for more of it.

These changes can occur normally within the body to supply extra fuel when needed, or as symptoms of a disease state, or as a result of other medications, such as steroids.

Thyroid gland: an illustration of too much thyroid hormone being produced, or hyperthyroidism

The counter-regulatory hormones adrenalin/epinephrine, glucagon and cortisol/cortisone are released to provide extra energy to the body in various circumstances, or if the body believes it's threatened with hypoglycemia. In some cases this is part of the body's "self-defense" mechanism to counter the effects of too much insulin.

The following table lists counterregulatory hormones in roughly the order you're likely to encounter them in your diabetes research:

Hormone	Body functions	Produced by	Overproduction	Underproduction	BG Effects
Glucagon	Stimulates liver to release glucose by glycogenolysis	Alpha cells of the pancreas	hyperglycemia	hypoglycemia, poor protection from excess insulin dose	Raises BG
Cortisol	Increases blood glucose levels and blood pressure, suppresses the immune system.	adrenal cortex in response to stress, or given exogenously as steroids	Cushing's Disease	Addison's disease	Raises BG also see Dawn phenomenon
epinephrine or adrenaline	Similar to cortisol but acts instantly -- used for fight-or-flight. Redirects body energy into heart & legs, forces fast glycogenolysis, reduces receptivity to insulin.	adrenal medulla	See pheochromocytoma	epinephrine deficiency	Raises BG very fast.
Thyroid hormone	Increases basal metabolic rate, heart rate, sensitivity to adrenaline	thyroid gland	hyperthyroidism	hypothyroidism	Raises BG,Increases insulin resistance
Somatotropin or Growth hormone	Growth of bone & cartilage, insulin-like effects	Anterior Pituitary	acromegaly	growth hormone deficiency	Raises BG two ways - reduces liver's glucose uptake, and produces IGF-1 which competes with insulin for receptors.
progesterone	Too many to list. Partly responsible for gestational diabetes.	Brain, gonads, adrenal glands, placenta	See progesterone	See progesterone	increases insulin resistance

Further Reading

• College of Veterinary Medicine-Colorado State-Control of Endocrine Activity

• Counterregulatory Hormones-Diabetes Self-Management
• Elmhurst College-Carbohydrate Hormone Control