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Normoglicemie la obezi
3,0
2,5
Volumul celulelor (%)
2,0
* Normoglicemie la
1,5 persoane slabe Diabet zaharat tip 2
1,0
**
0,5
0,0
TNG GBM Diabet zaharat tip 2
(n=31) (n=19) (n=41)
11
Tulburrile din fazele precoce ale
diabetului tip 2
Estimarea obezitii abdominale
80cm 94cm
Rezistena la
insulin
Sereia de
insulin
Glicemia
Timp
DZ2-eecul celulelor beta pancreatice n efortul
de a compensa rezistena la insulin
Ani de la dg -10 -5 0 5 10 15
Rezist la ins
Secr de insulina
Complic microvasc
Complic macrovasc
Pre-diabet DZ tip 2
Debut Diagnostic
Defecte majore n DZ2 clinic
manifest
Insulinopenie
Insulinorezisten
Cretere postprandial a secr. de glucagon
Scderea secreiei de GLP-1
Cretera produciei hepatice de glucoz
Creterea AGL
Hiperglicemie
Faza precoce a secretiei de insulin este
alterat n DZ tip 2
Lot de control
Glucoz IV
Pacieni cu DZ tip 2
120 100
100
80
80
60
60 Glucoz IV
40
40
20 20
0 0
-40 -30 -20 -10 0 10 20 30 -40 -30 -20 -10 0 10 20 30
Timp (min) Timp (min)
15
Subieci de control
10 Pacieni cu diabet zaharat tip 2
0
-60 0 60 120 180 240 300
Timp (minute)
420 Prnz cu Glucoz Prnz cu Glucoz
75
360
Glucagon (fmol/L)
Insulin (pmol/L)
300 60
240
180 45
120
30
60
0 15
-60 0 60 120 180 240 300 -60 0 60 120 180 240 300
Timp (minute) Timp (minute)
Mitrakou A, et al. Diabetes. 1990;39:1381-1390.
Efectul incretinic
Rspuns insulinic mai puternic la glucoza per os
dect i.v Glucoz oral
11 Glucoz intravenoas
2,0
*
Glucoz plasmatic venoas
1,5 *
Peptid C (nmol/L)
*
* Efect incretinic
(mmol/L)
*
5,5 *
1,0
*
0,5
0,0 0,0
01 02 60 120 180 01 02 60 120 180
Timp (minute) Timp (minute)
celule :
secreia
postprandial a
glucagonului
Ficat:
glucagonului reduce
celule : producia hepatic de
amplific secreia de glucoz
insulin dependent de Stomac:
glucoz ntrzie evacuarea
gastric
1. Adapted from Flint A, et al. J Clin Invest. 1998;101:515-520.
2. Adapted from Larsson H, et al. Acta Physiol Scand. 1997;160:413-422.
3. Adapted from Nauck MA, et al. Diabetologia. 1996;39:1546-1553.
4. Adapted from Drucker DJ. Diabetes. 1998;47:159-169.
31
Efectul incretinic este redus la pacienii cu diabet zaharat tip 2
Glucoz oral
Glucoz intravenoas
Lot de control
Pacieni cu diabet zaharat tip 2
80 80
60 60
Insulin (mU/L)
Insulin (mU/L)
40 40
*
* * * * *
20
20 * * *
*
0 0
0 30 60 90 120 150 180 0 30 60 90 120 150 180
Timp (minute) Timp (minute)
32