Glucoregulation during exercise: The role of the neuroendocrine system

Under normal healthy conditions, exercise initiates simultaneous elevations in hepatic glucose production (glucose Ra) and glucose utilisation. As a result, circulating glucose levels are maintained at a relatively constant level. This relatively simple and effective relationship between the liver and the skeletal muscle is maintained by a complex interplay of circulating and locally released neuroendocrine controllers. In large part, exercise-induced changes in the pancreatic secretion of glucagon and insulin are primarily responsible for the stimulation of glucose Ra during moderate exercise. However, exercise imposed on an additional metabolic stress (heavy exercise and poorly controlled diabetes mellitus) can increase sympathetic drive and has been suggested for decades to play a significant role in glucoregulation. In addition, blood-borne feedback and afferent reflex mechanisms may further modulate the glucose Ra response to exercise. This article discusses new findings from novel animal and human experiments specifically designed to examine the regulatory components of the neuroendocrine system and their influence on glucoregulation during exercise.