Insulin has many varied actions in the proximal tubule. Two distinct activities include upregulation of sodium/bicarbonate reabsorption and downregulation of gluconeogenesis. The inability to perform these 2 tasks simultaneously under fed and fasted conditions can lead to hyper- or hypoglycemia, acidosis, and/or impaired extracellular fluid regulation. Nakamura and colleagues illuminate our understanding of this process, which appears to be managed in part by recruitment of different insulin receptor substrates under different physiological conditions.

中文翻译：

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在底物水平上细化近端小管中的胰岛素信号。

胰岛素在近端小管中有许多不同的作用。两种不同的活动包括上调碳酸钠/碳酸氢盐的重吸收和下调糖原异生。无法在进食和禁食条件下同时执行这两项任务，会导致高血糖或低血糖，酸中毒和/或细胞外液调节受损。Nakamura及其同事阐明了我们对该过程的理解，这似乎可以通过在不同生理条件下募集不同的胰岛素受体底物来部分解决。