Patofyziologie - hyperinzulinémie
Důsledky hyperinzulinémie
Dyslipidémie
- Zvýšení TAG, cholesterolu
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
- Blokáda lipoproteinové lipázy v membráně myocytů
- Less fat to reach the muscle cells where it could be burned
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
- Useful for determining insulin resistance
- =blood sugar level x insulin level / 22.5
- HOMa nad 4.6 = insulin resistance
Abdominal circumference at waist level
- Another very good index of insulin resistance
- Greater than 88 cm for women / 102 cm for men
