X Disorders Of Adipose Tissue Development/function
Far more success has been had in identifying primary defects in adipose tissue that lead to severe IR as a secondary consequence. This probably reflects the fact that lipodystrophy, in contrast to many other forms of severe IR, is relatively easily recognized clinically, facilitating identification of extended families with multiple affected members for genetic studies . The possibility of lipodystrophy should be carefully considered in all severely insulin-resistant patients with dyslipidemia and/or nonalcoholic fatty liver disease.
One female patient with partial lipodystrophy , white adipocytes with multiloculated lipid droplets, and insulin-resistant diabetes was found to be homozygous for a premature truncation mutation in the lipid droplet protein, CIDEC . Cidec knockdown cells manifest multiloculated lipid droplets with increased mitochondria , and in mice, Cidec deficiency also reduces fat mass and induces the formation of white adipocytes with multilocular lipid droplets . However, in contrast to the human phenotype associated with a homozygous loss of function mutation in CIDEC, Cidec null mice are protected against diet-induced obesity and IR . BSCL2, an enigmatic gene of unknown function in which homozygous mutations were the first identified cause of congenital lipodystrophy , has also recently been implicated in lipid droplet biogenesis and adipocyte differentiation .
How Is Acanthosis Nigricans Treated
Eating a special diet can help reduce circulating insulin and may lead to some improvement of the acanthosis nigricans.
Acanthosis nigricans caused by a drug may go away once the medication is stopped.
Hallmark Signs Of Insulin Resistance Are High Triglycerides And Low Hdl Cholesterol
With insulin resistance, sugar is not getting into your cells. So you have an overabundance of insulin in the system because the pancreas is making more.
Your cells are seeing and recognizing the high insulin levels and telling the pancreas to stop making insulin.
Insulin is damaging to the receptors on the hippocampal cells. Insulin causes inflammation which makes the hippocampus unhappy.
How many people tell me that their total cholesterol is fine but their triglycerides are high? A lot! How many of those people tell me that their Dr. said that it wasnt that big of a deal and to take some fish oil? A lot!
Once again, we are talking about prevention. We are talking about being as healthy as possible and staying that way for as long as possible.
Lifestyle And Insulin Resistance In Cancer
Rowan Chlebowski discussed lifestyle factors, such as obesity, caloric intake, and physical activity , that may affect insulin resistance in cancer. Meta-analysis has shown a 1.56-fold increase in breast cancer associated with obesity . Increased estradiol has been shown to be associated with breast cancer and, along with increased estrone, testosterone, androstenedione, insulin, and IGF-I, has been associated with obesity . Chlebowski showed analysis of participants in the Womens Health Initiative regarding the effects of energy intake and physical activity, suggesting that both physical activity and less food intake can reduce hyperinsulinemia. He noted that the association of BMI with breast cancer is lost with exogenous hormone treatment . Furthermore, although colorectal cancer is thought to be associated with hyperinsulinemia, estrogen plus progesterone treatment was associated with decreased colon cancer despite increased breast cancer in the Womens Health Initiative.
If I Have Metabolic Syndrome What Health Problems Might Develop
Consistently high levels of insulin and glucose are linked to many harmful changes to the body, including:
- Damage to the lining of coronary and other arteries, a key step toward the development of heart disease or stroke
- Changes in the kidneys’ ability to remove salt, leading to high blood pressure, heart disease and stroke
- An increase in triglyceride levels, resulting in an increased risk of developing cardiovascular disease
- An increased risk of blood clot formation, which can block arteries and cause heart attacks and strokes
- A slowing of insulin production, which can signal the start of type 2 diabetes, a disease that is in itself associated with an increased risk for a heart attack or stroke. Uncontrolled diabetes is also associated with complications of the eyes, nerves, and kidneys.
- Fatty liver, which is sometimes associated with inflammation of the liver . If untreated, NASH could lead to cirrhosis and liver failure.
Last reviewed by a Cleveland Clinic medical professional on 04/13/2019.
What Causes Insulin Resistance
Scientists are beginning to get a better understanding of how insulin resistance develops. For starters, several genes have been identified that make a person more or less likely to develop the condition. It’s also known that older people are more prone to insulin resistance. Lifestyle can play a role, too. Being sedentary, overweight or obese increases the risk for insulin resistance. Why? It’s not clear, but some researchers theorize that extra fat tissue may cause inflammation, physiological stress or other changes in the cells that contribute to insulin resistance. There may even be some undiscovered factor produced by fat tissue, perhaps a hormone, that signals the body to become insulin resistant.
Doctors don’t usually test for insulin resistance as a part of standard diabetes care. In clinical research, however, scientists may look specifically at measures of insulin resistance, often to study potential treatments for insulin resistance or type 2 diabetes. They typically administer a large amount of insulin to a subject while at the same time delivering glucose to the blood to keep levels from dipping too low. The less glucose needed to maintain normal blood sugar levels, the greater the insulin resistance.
High Hemoglobin A1c And Diabetes
This is very important because high blood glucose and hemoglobin A1C above a 6.4 are consistent with Type 2 Diabetes.
Therefore, statin medications increase someones risk of getting an actual disease! Type 2 Diabetes is no joke!
Diabetes does damage to the blood vessels and causes them to become leaky. Thats how diabetes damages the eyes, kidneys, decreases brain function and causes nerve damage in the feet.
All tissues throughout the body need oxygen more than they need anything else. An example would be that we can live without food for weeks, but can live without water for only 3-4 days. Water has oxygen in it: H2O
Red blood cells are made up of hemoglobin molecules. The importance of hemoglobin is that the iron in the hemoglobin binds oxygen and that is how your red blood cells carry oxygen.
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Vii Monogenic Ir Classification/nomenclature
The nomenclature in the field of severe IR dates from the 1970s. Then, in seminal publications, Kahn and colleagues designated severe IR in nonobese patients as type A or type B, the latter discriminated by the presence of anti-insulin receptor antibodies. In a series of independent publications around the same time, the term HAIR-AN came to be used commonly . However, HAIR-AN is an entirely generic description of severe IR in women. If it has any utility, it is where it is used to discriminate women with severe IR who also have a body mass index above 30 kg/m2, who are much less likely to harbor pathogenic single gene defects than their nonobese counterparts. However, the imprecise and overlapping usage of these different diagnostic terms and increasing understanding of subgroups of severe IR suggest that a reclassification of syndromes of severe IR may be timely. Based on the above observations, such a classification is suggested in .
Adipose failure may also be subdivided into a group with manifest lipodystrophy, in which there is a deficiency in generating adipose tissue, leading to severe IR despite low or normal adipose tissue mass, and a group in which the dominant defect is unrestrained accumulation of adipose tissue, most commonly due to hyperphagia, such that even a relatively normal capacity safely to accrue triglyceride in adipose tissue is overcome.
Insulin Blood Sugar And Type 2 Diabetes
Insulin is a key player in developing type 2 diabetes. This vital hormoneyou cant survive without itregulates blood sugar in the body, a very complicated process. Here are the high points:
- The food you eat is broken down into blood sugar.
- Blood sugar enters your bloodstream, which signals the pancreas to release insulin.
- Insulin helps blood sugar enter the bodys cells so it can be used for energy.
- Insulin also signals the liver to store blood sugar for later use.
- Blood sugar enters cells, and levels in the bloodstream decrease, signaling insulin to decrease too.
- Lower insulin levels alert the liver to release stored blood sugar so energy is always available, even if you havent eaten for a while.
Thats when everything works smoothly. But this finely tuned system can quickly get out of whack, as follows:
- A lot of blood sugar enters the bloodstream.
- The pancreas pumps out more insulin to get blood sugar into cells.
- Over time, cells stop responding to all that insulintheyve become insulin resistant.
- The pancreas keeps making more insulin to try to make cells respond.
- Eventually, the pancreas cant keep up, and blood sugar keeps rising.
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Gestational Diabetes Tests And Diagnosis
Gestational diabetes usually happens in the second half of pregnancy. Your doctor will check for it between weeks 24 and 28, or sooner if you’re at high risk.
Your doctor will give you a glucose tolerance test: Youâll drink 50 grams of glucose in a sweet drink, which will raise your blood sugar. An hour later, youâll take a blood glucose test to see how your body handled all that sugar. If the results show that your blood sugar is higher than a certain level, youâll need a 3-hour oral glucose tolerance test, meaning youâll get a blood glucose test 3 hours after you drink a 100-gram glucose drink. Your doctor can also test you by having you fast for 12 hours, then giving you a 75-gram glucose drink and a 2-hour blood glucose test.
If youâre at high risk but your test results are normal, your doctor might test you again later in your pregnancy to make sure you still donât have it.
Psychological Effects Of Diabetes In Adults
Diabetes is a demanding chronic disease for both individuals and their families . It is associated with a number of challenges, including adjusting to a new diagnosis, diabetes distress impairing self-management, psychological insulin resistance, and fear of hypoglycemia. In addition, a range of psychiatric disorders can arise that contributes to greater complexity in both assessment and treatment. For instance, distinguishing between diabetes distress, major depressive disorder and the presence of depressive symptoms is important. Although these constructs have some shared symptomatology, diabetes distress has been most shown to have the strongest effect in causing adverse diabetes outcomes .
Psychological insulin resistance refers to a strong negative response to the recommendation from health-care providers that a person may benefit from adding insulin to his or her diabetes regimen. This can be a common reaction, particularly for individuals with type 2 diabetes who may have previously been successfully managed with noninsulin antihyperglycemic agents. Individuals may hold maladaptive beliefs that requiring insulin is a sign of personal failure in their self-management, or that their illness has become much more serious. Further, many people report fear and anxiety about having to self-administer injections, or have a low level of confidence in their ability to manage their blood glucose with insulin .
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Is Fasting Good For Insulin Resistance
Interestingly, intermittent fasting has been shown to have major benefits for insulin resistance and to lead to an impressive reduction in blood sugar levels . In human studies on intermittent fasting, fasting blood sugar has been reduced by 36% over the course of 812 weeks in people with prediabetes.
History And Classification Of Dm
The first documented symptoms of DM were recorded by ancient physicians in 1552 B.C. in a 3rd Dynasty Egyptian papyrus, being described as a rare mysterious disease characterized by excessive urination which leads to emaciation and death. Around year 150 of the new era, the term diabetes mellitus meaning honey and siphon was introduced by an ancient Greek physician Aretaeus, reflecting the sweet urine taste in affected individuals. However, its recognition as what is called a clinical entity – a condition that has separate and distinct existence from any known underlying cause or specific treatment option – occurred in an 1822 publication in the New England Journal of Medicine and Surgery.
The idea beyond this disease was not clarified until 1889, when Josph von Mering and Oskar Minkowski found that pancreatomy performed on a dog resulted in fatal diabetes. In 1910, Edward Albert Sharpey-Schafer hypothesized that this might be due to the lack of a single pancreatic chemical, which he called insulin. His hypothesis was confirmed by the discovery of insulin in 1921 by Frederick Banting and Charles Best. After initially reversing diabetes in a dog using an extract from pancreatic islets of a healthy dog, together with James Collip and John Macleod they purified the hormone from bovine pancreas and used it to treat diabetes in humans.
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What Does High Hemoglobin A1c Mean
Hemoglobin A1C is also known as glycosylated hemoglobin. The term globin refers to the protein in the molecule. Heme stands for iron.
High levels of blood glucose are very inflammatory because the sugar will attach itself to the hemoglobin molecule.
When sugar attaches to hemoglobin, it actually changes the physical shape of the protein in the hemoglobin molecule.
The easy way to think about it is to realize that sugar will stick to the molecule that is supposed to carry oxygen throughout the body and change its shape.
Once the red blood cells get loaded up with sugar that is stuck to the hemoglobin, the sugar doesnt come off. It will stay there for the full 120 day life cycle of a red blood cell until it dies.
Metabolic Syndrome And Insulin Resistance
Insulin resistance means that your body does not use the hormone insulin as effectively as it should, especially in the muscles and liver.Normally, your digestive system breaks down carbohydrates into glucose, which then passes from your intestine into your bloodstream. As your blood glucose level rises, your pancreas secretes insulin into your bloodstream. Insulin allows glucose to move into your muscle cells from your blood. Once inside a cell, the glucose is burned along with oxygen to produce energy.When a person has insulin resistance, the pancreas needs to produce and release more insulin than usual to maintain normal blood glucose levels. It is thought that more than a quarter of the population has some degree of resistance to insulin.
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A Abnormal Glucose Homeostasis
Clinical awareness of IR is greatest among those caring for patients with established diabetes mellitus, where it is recognized most commonly by a requirement for large doses of exogenous insulin. However, hyperglycemia is not usually the earliest clinical manifestation of severe IR. It may be recognized much earlier by the presence of acanthosis nigricans and/or ovarian hyperandrogenism in women. Furthermore, symptomatic hypoglycemia often precedes hyperglycemia, sometimes by many years. Characteristically, hypoglycemia related to severe IR occurs postprandially, with autonomic symptoms sometimes progressing to neuroglycopenia and seizures if not abrogated by oral carbohydrate. Such severe postprandial hypoglycemia may be seen in patients with insulin receptor defects , insulin signal transduction defects, or primary lipodystrophies . Its mechanism is unclear, but it most likely relates to severe impairment of hepatic insulin clearance due primarily to a insulin receptor defect or secondarily to the consequences of hepatic steatosis .
Will Gestational Diabetes Affect My Baby
Your baby will probably be healthy, if you and your doctor manage your blood sugar while you have gestational diabetes.
Right after you give birth, doctors will check your newborn’s blood sugar level. If itâs low, they may need to get glucose through an IV until it comes back up to normal.
Gestational diabetes raises the chance that you will have a baby who is larger than normal. It’s also linked to jaundice, in which the skin looks yellowish. Jaundice generally fades quickly with treatment.
Although your child will be more likely than other kids to get type 2 diabetes later on, a healthy lifestyle can cut that risk.
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Psychiatric Conditions In Adults
Individuals with serious mental illnesses, particularly those with depressive symptoms or syndromes, and people with diabetes share reciprocal susceptibility and a high degree of comorbidity . The mechanisms behind these relationships are multifactorial, complicated and presently only partially understood. Some evidence shows that treatment for mental health disorders may actually increase the risk of diabetes, particularly when second- and third-generation antipsychotic agents are prescribed . Biochemical changes due to psychiatric disorders themselves also may play a role . Symptoms of mental health disorders and their impact on lifestyle are also likely to be contributing factors .
Figure 1The interplay between diabetes, major depressive disorder and other psychiatric conditions.
Mitochondria In Energy Expenditure
Mitochondria are the center of energy metabolism in cells, as mitochondria carry out both the catabolism and anabolism of substrates for fuel . In the catabolism process, substrates such as glucose, fatty acids, and amino acids are broken down to generate ATP or heat through OXPHOS, which is used as energy for cellular activities. Heat production is required for the maintenance of body temperature in mammalians . Induction of thermogenesis is an ideal approach in the control of obesity. Thermogenesis includes UCP1-dependent and UCP1-independent mechanisms . The UCP1-dependent mechanism is dominant in brown and beige adipocytes . The UCP1-independent system comprises the adenine nucleotide transporters 1/2 and UCP3, which play a major role in non-adipocytes . Mammalian ANT is a new uncoupling protein found in the mitochondria of several tissues including the muscle, kidney, liver, and brown fat and is equivalent to the ADP/ATP carrier in yeast. The reduction of energy output by dysfunctional mitochondrial may lead to a buildup of intermediate metabolites, which plays a role in the pathogenesis of insulin resistance.
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