In the diabetes lay article Doctor Hyman clearly preaches the need to address diabetes through diet and lifestyle, a sentiment I throughly agree with. However, he brings up the dangers of insulin and other diabetic medications including the increased the risk of heart attack. According to a recent study at the university of Wisconsin, the use of exogenous insulin does indeed increase the risk of heat attack and CAD. Insulin both exogenous and endogenous causes smooth muscle proliferation in arteriole walls and promotes lipid synthesis which results in lipid lesions in the arteries. Insulin also increases the amount of plasminogen inhibiting factor leading to thrombosis. Despite the slightly elevated risks, glycemic control offers profound benefits regarding the other associated pathologies including retinopathy and neuropathy. For Type 2 Diabetes, lifestyle changes are essential. However the use of insulin and other medications may intervene enough to avoid irrepairable injury allowing the patient to make those changes.
http://care.diabetesjournals.org/content/early/2007/11/19/dc07-1161.full.pdf
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In my opinion the important part (clinical) in metabolic syndrome and diabetes is screening.
ReplyDeleteWe still don't know what kind of test can be useful for screening and early diagnosis.
On the other hand most of the cases are diagnosed after middle age and change the life style is so hard in that age.
In cellular mechanism which step occurs first,inflammation cause diabetes or diabetes cause inflammation?
If we know inflammatory pathways are involved in diabetes,why we don't use anti inflammatory drugs in diabetes?
Almost all articles talk about visceral adipose tissue,Is there any difference between adipose tissues?
I inflammation occurs first. Diabetes takes years to develop. The body becomes resistant to insulin through many different mechanisms. Inflammation is just one. Diabetes is only diagnosed after the problem has been there for a long time giving the increased adipose plenty of time to release its proinflammatory cytokines. In the McDonagh article, Proinflammatory cytokines are increased in type 2 diabetic women with cardiovascular disease, the authors state that cytokines responsible for inflammation are released from both fat cells and immune cells. Once the process has started, there is an additive effect.
ReplyDeleteAnti inflammatories tend to have severe side effects as they decrease immune function. Thus long term adminstration of such a drug could do more harm than good.
And yes, the two types of adipose tissue are different. They secrete different cytokines and have different roles in metabolism. Also, the proximity of the visceral adipose to the other organs allows for greater paracrine effects.
Finally I think there are good tests to determine the problem early. The oral glucose test is simple and cheap. Decreased insulin sensitivity and increase fat leads to problems.
Thanks for your comments. Jen