Hyperglycaemia insulin resistance

Type 2 diabetes is a heterogeneous and progressive endocrine disorder associated with insulin resistance (impaired insulin action) and defective function of the insulin-secreting (3-cells in the pancreatic islets of Langerhans. These endocrine disorders give rise to widespread metabolic disturbances epitomised by hyperglycaemia. The present classes of antidiabetic agents other than insulin act to either increase insulin secretion, improve insulin action, slow the rate of intestinal... 

Diabetes mellitus is defined as hyperglycaemia (fasting > 7 mM and/or 2 h postprandial >11.1 mM) due to absolute or relative lack of insulin. The most common forms are type 1 diabetes (prevalence 0.25%), with absolute lack of insulin, and type 2 diabetes (prevalence 4-6%) which is due to the combination of insulin resistance and insufficient insulin secretion. 

Diabetes mellitus ( sweet urine ) involves relative over-production of glucose by the liver and under-utilization by other organs. Diabetes is the most serious metabolic disease in terms of its social impact. Obesity and the indulgent Western diet correlates with mature age diabetes. Type 1 diabetes (juvenile diabetes) typically manifests at less than 20 years from autoimmune destruction of the insulin-producing pancreatic (3 cells. Type 1 diabetes is insulin-dependent diabetes mellitus (IDDM) and is fatal without exogenous insulin. Type 2 diabetes mellitus (mature age diabetes) occurs later in life and typically involves both deficient insulin production and insulin resistance , that is, the target cells are less responsive to insulin. Type 2 diabetes is initially non-insulin-dependent diabetes (NIDDM) but insulin therapy (in addition to oral antidiabetics) may eventually be required. Hyperglycaemia due... 

Cirrhosis Hyperglycaem i a Portosystemic shunting of insulin and decreased hepatic insulin breakdown leads to inhibition of muscle glucose utilisation and peripheral insulin resistance, leading to elevated glucose levels Hyperglycaemia, acidosis, osmotic diuresis... 

Excessive hepatic glucose output is an important contributing factor to insulin resistance [200, 201, 280] and direct or indirect inhibition of glucose production is expected to have a favourable effect on hyperglycaemia, particularly in the fasting state. 

It is important to prevent nocturnal hypoglycaemia, not only to protect brain function, but also to prevent insulin resistance. This may easily result in exaggerated hyperglycaemia and initiate the vicious circle -hypoglycaemia, hyperglycaemia, increase in insulin dose and risk of subsequent hypoglycaemia (Bolli and Perriello, 1990). The mechanism, frequency and even the existence of the Somogyi phenomenon, however, are all still controversial. 

The treatment of obese NIDDM patients should primarily aim at a reduction in insulin resistance by hypocaloric diet (reducing hyperglycaemia), weight reduction (reducing hyperinsulinaemia) and a reduction in hyper-lipidaemia (with interruption of the fatty acid cycle). 

Adverse effects of protease inhibitors are similar to those seen with reverse transcriptase inhibitors. In addition, this group of drugs causes metabolic disturbances, particularly insulin resistance and hyperglycaemia, and fat redistribution leading to raised plasma lipid levels, which increases the risk of heart disease. These effects are collectively known as lipodystrophy syndrome, which appears to be similar to what happens with long-term corticosteroid use. 

Lipodystrophy syndrome - insulin resistance, hyperglycaemia, fat redistribution and raised lipid levels as adverse effect of antiretroviral therapy Lipolysis - break down of lipid LOCA - low osmolar contrast agent... 

The most common metabolic complication is that of hyperglycaemia. Against a background of increased stress hormones, especially if there is infection, there may he marked insulin resistance and consequently an increased glucose level. The use of insulin to correct these metabolic effects is best avoided. The composition of the i.v. regimen should be adjusted if metabolic disorders occur. Many other biochemical abnormalities have been reported in a.s.sociation with TPN. These include ... 

Diabetes mellitus is the commonest endocrine disorder encountered in clinical practice. It may be defined as a syndrome characterized by hyperglycaemia due to an absolute or relative lack of insulin and/or insulin resistance. 

During pregnancy a transient period of insulin resistance is normal, but in about 4% of pregnancies insulin resistance is sufficiently severe to cause hyperglycaemia and GDM ensues. The cause of insulin resistance is not clear. However, raised levels of oestrogen, human placental lactogen and recently low levels of the insulin sensitiser, adiponectin, have been implicated. 

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