Metabolic alterations in Type 2 diabetes

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The plasma glucose concentration in Type 2 diabetes varies according to the severity of the condition, but if a patient neglects his or her treatment and then attends a diabetic clinic, it would not be uncommon to find a plasma glucose concentration of 20 mmol/l. The plasma glucose concentration is consistently raised throughout the day (Fig. 10.4), with an exaggerated response to meals. This highlights the important role of insulin in minimising the postprandial 'excursions' in plasma glucose concentration, which is impaired in Type 2 diabetes. In addition, plasma non-esterified fatty acid concentrations may be elevated throughout the day (Fig. 10.5). This elevation of plasma non-esterified fatty acid concentration may aggravate a number of features of the condition, reducing further the ability of insulin to stimulate glucose uptake by skeletal muscle and promoting hepatic VLDL-triacylglycerol secretion.

Fig. 10.4 Twenty-four-hour profiles of plasma glucose concentration in non-diabetic subjects and subjects with severe Type 2 diabetes. The non-diabetic subjects were also shown in Fig. 6.1. Redrawn from data in Reaven et al. (1988), Copyright © 1988 American Diabetes Association. From Diabetes, Vol. 37, 1988; 1020-1024. With permission of the American Diabetes Association.

Fig. 10.4 Twenty-four-hour profiles of plasma glucose concentration in non-diabetic subjects and subjects with severe Type 2 diabetes. The non-diabetic subjects were also shown in Fig. 6.1. Redrawn from data in Reaven et al. (1988), Copyright © 1988 American Diabetes Association. From Diabetes, Vol. 37, 1988; 1020-1024. With permission of the American Diabetes Association.

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Fig. 10.5 Twenty-four-hour profiles of plasma non-esterified fatty acid (NEFA) concentration in non-diabetic subjects and subjects with severe Type 2 diabetes.

Plasma glucose concentrations in these subjects are shown in Fig. 10.4. Redrawn from data in Reaven et al. (1988), Copyright © 1988 American Diabetes Association. From Diabetes, Vol. 37, 1988; 1020-1024. With permission of the American Diabetes Association.

Fig. 10.5 Twenty-four-hour profiles of plasma non-esterified fatty acid (NEFA) concentration in non-diabetic subjects and subjects with severe Type 2 diabetes.

Plasma glucose concentrations in these subjects are shown in Fig. 10.4. Redrawn from data in Reaven et al. (1988), Copyright © 1988 American Diabetes Association. From Diabetes, Vol. 37, 1988; 1020-1024. With permission of the American Diabetes Association.

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