If diabetes mellitus type I at once there is an absolute insulin deficiency due to destruction of pancreatic cells, the development of type II diabetes play a role of two factors: the pathology of cells producing insulin in combination with a violation of the interaction of cells (insulin resistance). The most common causes of this condition are obesity, decreased physical activity (physical inactivity), taking some medicines, heredity, age, smoking, etc. Learn more about these risk factors are discussed in the section “What causes diabetes.”
As a result, there are following processes. At the beginning of the disease the blood glucose level does not increase, because the beta cells are not so badly damaged, and to overcome insulin resistance, insulin is synthesized in increased quantities. Causing hyperinsulinemia, which for the time being though, and maintains normal blood glucose levels, but helps reduce the function of beta cells. Insulin resistance violates the lipid and carbohydrate metabolism, as a result, there are such pathological phenomena as Lipotoxicity (pathological processes due to changes in the normal lipid content and toxic effects on their body tissues) and glucose toxicity (pathological processes resulting from the toxic effect of high glucose in the blood to tissues ). These processes also contribute to the inhibition of cells producing insulin, and exacerbated by insulin resistance.
There is so-called vicious circle when a pathological process exacerbates the other: insulin resistance is glucose toxicity, which exacerbates insulin resistance. In turn glucose toxicity reduces the functional activity of beta-cells and thus contributes to the maintenance of blood glucose, ie, the rise of effects glucose toxicity. Insulin resistance causes lipotoxicity, which contributes to worsening insulin resistance and reduced insulin production.
It should be noted that Lipotoxicity contributes more and change of lipid metabolism that causes the growth of atherosclerotic plaques, and elevated insulin promotes the development of hypertension. Even at this early stage, when the normal blood glucose levels between meals is maintained by hyperinsulinemia, changes the reaction of beta-cells in the intake of carbohydrate foods, namely, peak release of insulin becomes less. Therefore, early diagnosis type II diabetes is important to know not only the level of blood sugar on an empty stomach, but also necessary to measure glycaemia after meals or after specific glucose load. These tests are described in the “Diagnosis of diabetes mellitus”.
Increased blood sugar between meals is only later, when increased insulin production is not enough to overcome insulin resistance. Inhibition of beta-cells increases the synthesis of insulin increasingly reduced, and relative insulin deficiency becomes even in absolute with all its consequences. There is a clinical picture, similar to type I diabetes.
The above pathological scheme explains why until clinically significant pattern of diabetes is a very long time concealed the disease.
In this period it is necessary to perform special diagnostic tests, and determining not only the fasting blood sugar. And hold on a regular basis, especially when risk factors. Without exposure to these risk factors may not be meaningful treatment. This scheme also explains why hypertension and diseases related to atherosclerotic vascular lesions (infarction, stroke), are regular satellites of this type of diabetes.
See Also
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