MUDr. Dana Maňasková


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Q - Hyperinzulinémie - důsledky a diagnostika

Důsledky hyperinzulinémie

Dyslipidémie

Stresové hormony

  • Vyšší hladiny
    • Adrenalin
    • Kortizol

Hypertenze


Tloustnutí

  • Lipogeneze zvýšena aktivací lipoproteináz (LPL) v membránách adipocytů
    • Vyšší syntéza tuků v adipocytech

Zhoršené hubnutí v tukové tkáni

Vyšší srážlivost krve

  • Blood clotting process are activated by a high insulin level (hemostasis)
    • More frequent occurrence of thromboses and emboli in overweight individuals.

Inhibice produkce různých hormonů

These hormones all have strong anti-inflammatory and anti-oxidative effects and are therefore very important for persons with inflammatory diseases.

  • melatonin
    • Urychlené stárnutí organismu
  • DHEA (dehydroepiandrosterone)
    • Substrate from which all male and female sexual hormones are produced
    • Certainly a reason that women with hormone disturbances during menopause or during their monthly period report very marked improvements in their symptoms while on the metabolic balance® program.
  • Estrogen
    • 70 to 80 percent of women who are treated with medications (mostly estrogen) during menopause, are able to reduce or even completely go off their medication while they are on metabolic balance® (Dr. Funfack).
  • Testosteron
    • Men with lowered testosterone levels after andropause report a return of libido when they are following the metabolic balance® program.
  • HGH (human growth hormone)

Progrese inzulínové rezistence do DM2

  • Progress to T2D when ß-cells are unable to secret adequate amounts of insulin to compensate for decreased insulin sensitivity
    • insulin secretory dysfunction
    • Significant loss of functional ß-cells [14]

Ztráta masy beta-buněk

  • ß-cell volume:
    • A) cell size
    • B) rate of cell renewal [14]
      • Proliferation of pre-existing cells
      • Neogenesis - differentiation from other precursor cells [14]
    • C) rate of apoptosis [14]
  • Individuals with T2D always manifest
    • Increased ß-cell apoptosis
    • Reduced ß-cell mass [14]
  • Approximate 50 % reduction in islet function
    • Thought to manifest at least 10–12 yr prior to diagnosis [14]
  • Obese non-diabetic humans
    • Increased relative ß-cell volume in islets [14]
  • obese and non-obese patients with impaired fasting glucose and T2D
    • At least a 40 % reduction in ß-cell volume compared with non-diabetic patients [14]
  • Apoptosis of ß-cells
    • Increased in all diabetic patients
    • Implicated as the primary mechanism underlying the decrease in ß-cell mass in T2D individuals [14]

Amyloidová depozice v ostrůvcích beta-buněk

  • Islet space becomes dominated by amyloid plaque deposits
    • Role is unclear [14]
  • Hyperglykemie
    • Zvýšení exprese IL-1ß
    • Dysfunkce endoplazmatického retikula
      • Zvýšení tvorby IAPP oligomerů
        • Depozice amyloidu v beta--buňkách [57] u DM2 poměrně často [57]
  • 2014 u 118 pitvaných japonských diabetiků:
    • 26 případů s depozicí amyloidu
      • Tíže depozice korelovala
        • S redukovaným objemem beta-buněk i alfa-buněk
        • Zvýšeným BMI
        • Ne s věkem nemocných, s hladinou HbA1c ani s trváním diabetu
    • Ostrůvky bohaté na amyloid byly zvýšeně infiltrované makrofágy
      • V beta-buňkách známky x DNA ve vztahu k oxidačnímu poškození
        • Exprese yH2AX
        • Potlačení exprese (pro)inzulinové mRNA [57]

Diagnóza hyperinzulinémie

Oral glucose tolerance test (OGTT)

  • Three times glucose
    • Fasting state
    • One hour
      • Should not rise above 140 mg/dl
    • Two hours following oral ingestion of 75 g of glucose
      • The two-hour value should fall back into the normal range
      • Diagnosis of diabetes mellitus is definitely above 200 mg/dl

HOMA index

Abdominal circumference at waist level

  • Another very good index of insulin resistance
  • Greater than 88 cm for women / 102 cm for men

O úroveň výše

Poslední aktualizace: 30. 5. 2016 1:09:12