Clinical Nutr. Type 2 Diabetes

Front 1

Insulin Resistance

Back 1

- A condition where cells cannot respond to insulin as they should
- Defects in several intra-cellular enzymes responsible for the uptake and metabolism of glucose.
- Over time the process of glucose transport breaks down with various consequences

Front 2

Insulin resistance over time

Back 2

- muscle & fat decrease glucose uptake and metabolism
- liver increases glucose production
- pancreas increases insulin secretion
- as cells become resistant, the pancreas continues to increase insulin production
- this results in hyperinsulinemia

Front 3

Hyperinsulinemia

Back 3

the increased concentration of insulin due to the cell resistance to glucose uptake and the pancreas' increased insulin production
- insulin resistance -> hyperinsulinemia-> other metabolic conditions
- insulin resistance can be a problem even is diabetes has not yet developed
- some can maintain a level of hyperinsulinemia that allows for adequate glucose transport & may be able to do this for the rest of their lives. Thereby decreasing the chance of developing type 2 diabetes

Front 4

Insulin resistance leads to type 2 diabetes

Back 4

- hyperinsulinemia -> beta cell failure -> need for exogenous insulin
- Hyperinsulinemia damages smaller blood vessels, leading to complications of diabetes

Front 5

Over time frame of diabetes

Back 5

Post meal glucose & fasting glucose increase from ~100 (prediabetes) to ~350mg/dL (year 30) (fasting is slightly lower than post meal)
- Insuline resistance increases in prediabetes then remains stable at ~225% of its normal function
- Insulin levels increase in prediabetes to ~200% of its normal function then begin to decrease to less than 50% function at year 30.

Front 6

Beta Cells function over time

Back 6

- At diagnosis of diabetes beta cell function is already decreased
- over time progressive loss of beta cell function occurs independent of treatment approach leading to progressive deterioration of control
- therefore therapy must be progressively augmented (increased) to compensate.

Front 7

Prevention of diabetes

Back 7

- Prevent or delay overt type 2 DM via lifestyle changes and/or pharmacologic therapy
- decrease risk of cardiovascular disease
- decrease cost of treatment
- target high risk populations

Front 8

reduce progression from impaired glucose tolerance to type 2 DM

Back 8

- intensive and structured lifestyle modification that results in loss of arrox. 5% of initial body weight, can reduce the progression from inparied glucose tolerance to type 2 DM by almost 60%
- metforman 30% reduction
- acarbose 30% reduction
- thiazolidendione 60% reduction