Mechanisms for hyperglycemia in Type II diabetes mellitus: therapeutic implications for sulfonylurea treatment - an update
Article Abstract:
Fasting levels of blood glucose that are higher than normal (hyperglycemia) are a strong indication of non-insulin-dependent diabetes mellitus (NIDDM), also known as type II diabetes. The hyperglycemia appears to be caused by abnormalities in glucose production by the liver and in the uptake and usage (collectively known as ''disposal'') of glucose by the tissues of the body. An understanding of the causes of NIDDM and its effects is important in deciding upon appropriate treatments for this disease. Blood glucose levels are strictly controlled in healthy individuals by the interactions of various organs and hormones. When fasting (not eating), the liver produces glucose to maintain steady blood levels; the glucose that is produced is used mainly by cells that do not require insulin for glucose disposal, such as brain cells. Under normal conditions, when glucose is available after a meal the hormonal balance changes and the liver takes up glucose rather than produces it. Production of glucose by the liver is sensitive to the hormones insulin and glucagon, which are produced by the pancreatic beta cells; the pancreatic cells are in turn regulated by the amount of glucose in the blood. Studies have revealed that insulin secretion is lower than normal in NIDDM patients. Glucose stimulation of insulin secretion appears to be impaired in NIDDM, even though insulin secretion that is stimulated by other factors appears to be normal. In these patients, body tissues have been shown to have a reduced ability to take up glucose. In addition, the production and release of glucose by the liver, which are normally inhibited by glucose levels and hormonal regulation, are not as sensitive to glucose levels. The pancreatic beta cells also appear to secrete glucagon more readily in patients with NIDDM when glucose levels are high. Effective treatments for NIDDM must reduce hyperglycemia. Treatments that reduce glucose production by the liver or increase the liver's sensitivity to insulin could be useful. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
User Contributions:
Comment about this article or add new information about this topic:
A two-step model for development of non-insulin-dependent diabetes
Article Abstract:
Characteristics of non-insulin-dependent diabetes mellitus (NIDDM) include insulin resistance, or inability of the tissue to respond to insulin action, and impaired function of the pancreatic beta cells, which function to produce and secrete insulin. It is unclear which characteristic is the primary factor in the development of NIDDM. A two-phase model of NIDDM was developed on the basis of results of studies of Pima Indians, a population with a high incidence of NIDDM. According to this model, in the first step, insulin resistance results in a change from normal to impaired glucose tolerance, or inability of tissues to use glucose. In the second step, impaired beta cell function contributes to worsening of glucose intolerance. Both insulin resistance and impaired beta-cell function are essential conditions for the development of NIDDM. Insulin resistance is probably genetically determined and is likely the primary factor contributing to the development of glucose intolerance. Impaired beta cell (pancreas cells) function appears to play a critical secondary role in the deterioration of glucose tolerance. This two-step model of NIDDM is consistent with the development of NIDDM in other ethnic groups. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: American Journal of Medicine
Subject: Health care industry
ISSN: 0002-9343
Year: 1991
User Contributions:
Comment about this article or add new information about this topic:
- Abstracts: Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Evolving natural history of coronary artery disease in diabetes mellitus
- Abstracts: An empirical analysis of milk addiction. The impact of health status on the duration of unemployment spells and the implications for studies of the impact of unemployment on health status
- Abstracts: Clinical decision-making in the evaluation and treatment of insomnia. part 2 Oral estrogens decrease bleeding time and improve clinical bleeding in patients with renal failure
- Abstracts: Progressive warfarin anticoagulation in protein C deficiency: a therapeutic strategy. Chronic acetaminophen ingestion associated with (1;7)(pll;pll) translocation and immune deficiency syndrome
- Abstracts: Autoantibodies in alcoholic liver disease. The lung mucosa: a critical environmental battleground. Myocardial infarction, cardiomyopathy, and interstitial lung disease in a 38-year-old man