im a bit confused about the relationship between beta blockers and diabetes...
so do beta blockers decrease the insulin release? increase glucagon release? neither? both?
My understanding:
Data show decreased glucose utilization and development of insulin resistance. Decreased glucose utilization is pretty easy to explain, but speculations abound about insulin resistance.
Decrease insulin release, decrease perfusion--> decrease glucose utilization.
Don't block beta3 receptors, depending on agent may not block beta2 as strongly as beta1, doesn't block alpha--> leads to increased activity of B3 and B2 and A--> increased intracellular lipolysis, increased glycogenolysis, increased gluconeogenesis--> wave my hands -->insulin resistance.
Carvedilol doesn't seem to be as much of a problem in developing insulin resistance, so unopposed activity of B2 has some support there.
In the clinic, don't knee jerk avoid beta blockers for DM2 patients (who's big problem is really heart disease, not glycemic control).
I think I'll check with my friendly neighborhood cardiologist.