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Friday 26 July 2013

Type 2 Diabetes Etiology and reversibility

  1. Roy Taylor, MD, FRCP
  1. Reversal of type 2 diabetes to normal metabolic control by either bariatric surgery or hypocaloric diet allows for the time sequence of underlying pathophysiologic mechanisms to be observed. In reverse order, the same mechanisms are likely to determine the events leading to the onset of hyperglycemia and permit insight into the etiology of type 2 diabetes. Within 7 days of instituting a substantial negative calorie balance by either dietary intervention or bariatric surgery, fasting plasma glucose levels can normalize. This rapid change relates to a substantial fall in liver fat content and return of normal hepatic insulin sensitivity. Over 8 weeks, first phase and maximal rates of insulin secretion steadily return to normal, and this change is in step with steadily decreasing pancreatic fat content. The difference in time course of these two processes is striking. Recent information on the intracellular effects of excess lipid intermediaries explains the likely biochemical basis, which simplifies both the basic understanding of the condition and the concepts used to determine appropriate management. Recent large, long-duration population studies on time course of plasma glucose and insulin secretion before the diagnosis of diabetes are consistent with this new understanding. Type 2 diabetes has long been regarded as inevitably progressive, requiring increasing numbers of oral hypoglycemic agents and eventually insulin, but it is now certain that the disease process can be halted with restoration of normal carbohydrate and fat metabolism. Type 2 diabetes can be understood as a potentially reversible metabolic state precipitated by the single cause of chronic excess intraorgan fat.
    Type 2 diabetes has long been known to progress despite glucose-lowering treatment, with 50% of individuals requiring insulin therapy within 10 years (1). This seemingly inexorable deterioration in control has been interpreted to mean that the condition is treatable but not curable. Clinical guidelines recognize …


Anonymous said...

Recommended read

blinkered said...

I found that inspiring. I am doing OK -never been overweigh -but realised I mus have some fat around organs-have sabilised some retinopahy problems although too late in some respecs and have been wondering if I should just accep the siuaion as it is.
This study proves that making a further effort could well pay off.
thank You for postin it.

Anonymous said...

The only time in my life I lost a significant amount of weight (55 lbs), I became depressed to the point that I had suicidal thoughts. I also seemed to lose my sense of inhibition in what I said to people, and alienated many people during that time. I was irritable and bad-tempered.

Since then I have regained that weight plus some, but I am afraid that even if I do lose weight, I will have the same mental issues as before.

Do other dieters experience these emotional problems? I was not on a drastic diet (approx 1500 calories a day plus a long walk every day).