Lecture 7 Diabetes and cardiovascular disease
2007: 180 million patients 2011: 382 million patients
2030: 552 million 90% of all these patients have
diabetes mellitus 2
Largest growth people with diabetes is in areas where
western lifestyle is developing (Africa, China, South-
America)
Increase in prevalence for diabetes:
1. Increase in obesity and overweight
o Obesity: BMI above 30
o Overweight: BMI between 25 and 30
2. Aging population
Basics of diabetes
The classical triumvirate:
3 organs: pancreas, skeletal muscle and liver
Pancreas produce insulin needed for take up glucose in
skeletal muscle AND inhibit glucose production
(gluconeogenesis) in the liver glucose concentration will drop
2 types of diabetes:
1. Type 1: no insulin is produced in pancreas. Glucose cannot be converted to
glycogen
Juvenile diabetes
2. Type 2: insensitivity to insulin in liver and skeletal
muscle. Glucose cannot be converted to glycogen.
Old age diabetes
Insulin resistance
Lean + normal glucose tolerance: insulin sensitive
+ not very high insulin concentration
Obese + normal glucose tolerance: less insulin
sensitive + higher insulin concentration
Obese + impaired glucose tolerance: insulin
insensitive (insulin resistance) + highest insulin concentration
Diabetes: insulin insensitive + lower insulin concentration (beta cells produce
insulin but they now dysfunction)
Diabetes: insulin insensitive + less insulin concentration (more beta cell
dysfunction)
Medicines metformin and pioglitazone improve insulin insensitivity (insulin resistance)
Medicine gliclazide increases the insulin production
Medicine insulin to overcome insulin resistance
Hepatic insulin resistance
Patients with type 2 diabetes have higher hepatic glucose production (HGP)
(gluconeogenesis). Because insulin is not capable of inhibiting gluconeogenesis
enough this is caused by hepatic insulin resistance.
Medicine metformin inhibits gluconeogenesis
2007: 180 million patients 2011: 382 million patients
2030: 552 million 90% of all these patients have
diabetes mellitus 2
Largest growth people with diabetes is in areas where
western lifestyle is developing (Africa, China, South-
America)
Increase in prevalence for diabetes:
1. Increase in obesity and overweight
o Obesity: BMI above 30
o Overweight: BMI between 25 and 30
2. Aging population
Basics of diabetes
The classical triumvirate:
3 organs: pancreas, skeletal muscle and liver
Pancreas produce insulin needed for take up glucose in
skeletal muscle AND inhibit glucose production
(gluconeogenesis) in the liver glucose concentration will drop
2 types of diabetes:
1. Type 1: no insulin is produced in pancreas. Glucose cannot be converted to
glycogen
Juvenile diabetes
2. Type 2: insensitivity to insulin in liver and skeletal
muscle. Glucose cannot be converted to glycogen.
Old age diabetes
Insulin resistance
Lean + normal glucose tolerance: insulin sensitive
+ not very high insulin concentration
Obese + normal glucose tolerance: less insulin
sensitive + higher insulin concentration
Obese + impaired glucose tolerance: insulin
insensitive (insulin resistance) + highest insulin concentration
Diabetes: insulin insensitive + lower insulin concentration (beta cells produce
insulin but they now dysfunction)
Diabetes: insulin insensitive + less insulin concentration (more beta cell
dysfunction)
Medicines metformin and pioglitazone improve insulin insensitivity (insulin resistance)
Medicine gliclazide increases the insulin production
Medicine insulin to overcome insulin resistance
Hepatic insulin resistance
Patients with type 2 diabetes have higher hepatic glucose production (HGP)
(gluconeogenesis). Because insulin is not capable of inhibiting gluconeogenesis
enough this is caused by hepatic insulin resistance.
Medicine metformin inhibits gluconeogenesis
