The role of insulin at brain-liver axis in the control of glucose production.

Glucose is an essential metabolic substrate for all mammalian cells, and its availability in the circulation is carefully controlled to avoid wide variations. Different mechanisms are involved in the glucose disposal, such as an adequate pancreatic and hepatic function. Insulin is the main hormone in glycemic control, and its action occurs directly in the cells, as well as in the liver, in an indirect way, to ultimately control the glycemia. Insulin has also an important action within the central nervous system, more precisely in the hypothalamus that projects directly to preautonomic nuclei in the brain stem to control hepatic glucose production. The central action of insulin relies on autonomic outflow through the vagal innervation of the liver, where insulin is able to modulate the production of glucose at this organ level. In this way, responses generated in the CNS reach the effector organs by autonomic efferent pathways as part of an important brain-organ axis in the control of glycemia. The purpose of this minireview is to shed light on the brain-liver axis in the control of hepatic glucose by central action of insulin via the autonomic nervous system.