The role of insulin in the glucostatic control of food intake.

Insulin, a primary metabolic hormone, plays a dominant role in the regulation of food intake. An increase in the level of circulating insulin produced by its prandial release from endogenous stores is associated with the state of satiety. On the other hand, an increase in the insulin level produced by its exogenous administration, as well as by its excessive and prolonged release in certain pathological states or during the period of nocturnal overeating, paradoxically gives rise to the sensation of hunger. This differential effect of endogenous and exogenous insulin is analyzed in view of experimental and clinical evidence concerning the principal mechanisms in the regulation of food intake. These include the interrelation of central and peripheral glucosensitive systems, the involvement of the enteroinsular axis, and the effects on these regulatory mechanisms of the physiological state produced by changes in circulating insulin levels. The essential role of the vagus nerve in mediating the hunger and satiety induced by the lack of excess of glucose for cellular oxidation places the short-term glucostatic control in the periphery where the insulin is primarily acting. A unifying hypothesis concerning the role of insulin in the regulation of good intake is proposed and its clinical implications suggested.