Free fatty acids glucose metabolism affecting

Type 2 diabetes is characterized by tissue resistance to the action of insulin combined with a relative deficiency in insulin secretion. A given individual may have more resistance or more beta-cell deficiency, and the abnormalities may be mild or severe. Although insulin is produced by the beta cells in these patients, it is inadequate to overcome the resistance, and the blood glucose rises. The impaired insulin action also affects fat metabolism, resulting in increased free fatty acid flux and triglyceride levels and reciprocally low levels of high-density lipoprotein (HDL). 

Glucocorticoids accomplish this paradox by affecting the metabolism of glucose, fat, and protein (see Figure 29-4). Cortisol facilitates the breakdown of muscle into amino acids and lipids into free fatty acids, which can be transported to the liver to form... 

An insulin infusion should be considered for severe cases of calcium channel blocker toxicity." Case reports suggest that an intravenous bolus of regular insulin (0.5-1 units/kg) with 50 mL dextrose 50% (0.25 mg/kg for children) followed with a continuous infusion of regular insulin (0.5-1 units/kg per hour) may improve myocardial contractility. The effect of insulin is presently unclear, but it may improve myocardial metabolism that is adversely affected by calcium channel blocker overdoses, such as decreased cellular uptake of glucose and free fatty acids and a shift from fatty acid oxidation to carbohydrate metabolism. This insulin regimen is titrated to improvement in systolic blood pressure over 100 mm Hg and heart rate... 

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