Introduction
Review of Pathophysiology of Type 2 Diabetes
"Syndrome X" (Insulin Resistance Syndrome)
Insulin Resistance Syndrome Interventions
References

Introduction

• The Diabetes Epidemic
• 15.7 million Americans have diabetes
• Approximately 6% of the population
• One-third are undiagnosed, therefor, untreated
• Approximately 100 million people have diabetes worldwide
• 5-10% have type 1 diabetes
• 90-95% have type 2 diabetes
• Diabetes on the rise
• Not due to changes in the disease or its treatment
• Associated with older age, lack of physical exercise, and obesity
• Our population is older, less active, and more overweight

Review of Pathophysiology of Type 2 Diabetes

• Insulin Resistance
  • Defect in muscle and fat cell utilization of insulin
  • Precedes the manifestation of type 2 diabetes
  • Pancreas responds by producing more insulin to overdrive the cells
  • Results in hyperinsulinemia
  • Diabetes results when there is a relative insulin deficiency
• Hyperinsulinemia
  • Stimulates fat storage
  • Increases appetite
  • Increase in sodium reabsorption in the kidneys
  • Increase in vascular smooth muscle proliferation
  • Decrease in fibrinolysis
• Increased hepatic glucose output
  • Increased glycogen production and gluconeogenesis
  • Causes fasting hyperglycemia
  • Caused by hepatic insulin resistance
• Glucose Toxicity
  • High glucose levels cause impaired cell function/damage
• >115 mg/dl is threshold for pancreas
• >180 mg/dl is threshold for nerve cells
  • Eventually leads to hypoinsulinemia and other complications
• Markers of elevated plasma insulin levels
  • Increase in serum triglycerides
  • Decrease in HDL cholesterol

"Syndrome X" (Insulin Resistance Syndrome)

• Hyperinsulinemia
• Hypertension
• Dyslipidemia
  • low HDL
  • high Triglycerides
  • smaller, denser LDL
• Impaired Glucose Tolerance
• Visceral Adiposity
• Increased PAI-1 (plasminogen activator inhibitor-1)
• Hyperuricemia
• PCOS (polycystic ovarian syndrome)
  • hyperandrogenism
  • chronic anovulation
  • polycystic ovaries
• Increased risk of CHD

Insulin Resistance Syndrome Interventions

• Weight loss
• Control lipids
• Reduce CHD risk factors
• Decrease insulin resistance
• Daily aspirin

References