Paul Saladino· MD
in type 1 diabetes you have to take exogenous insulin you have to inject it because you don't you're not making any and in that scenario you're injecting insulin peripherally at a dose that will push glucose into cells one of the one of the ways that it controls blood sugar though is by acting on the tissues muscle tissue fat tissue to not break down and deliver gluconeogenic substrate to the liver so the liver is making a lot of this glucose and then you are stopping the supply of substrate because it we owe unabated no insulin your muscle starts to break down your fat starts to break down the amino acids fatty acids glycerol I just delivered to the liver and the livers like crap I better make glucose out of this because that's all I can do and again there's no insulin so there's no breaks on the liver doing that so the liver just pumps out all this extra glucose