Diabetes Type 2, Pathophysiology Review
by Tom Bartol, RN-C, MN, FNP, CDE

Review of Pathophysiology of Type 2 Diabetes
"Syndrome X" (Insulin Resistance Syndrome)
Insulin Resistance Syndrome Interventions


  • The Diabetes Epidemic
  • 15.7 million Americans have diabetes
  • Approximately 6% of the population
  • One-third are undiagnosed, therefor, untreated
  • Approximately 100 million people have diabetes worldwide
  • 5-10% have type 1 diabetes
  • 90-95% have type 2 diabetes
  • Diabetes on the rise
  • Not due to changes in the disease or its treatment
  • Associated with older age, lack of physical exercise, and obesity
  • Our population is older, less active, and more overweight

Review of Pathophysiology of Type 2 Diabetes

  • Insulin Resistance
    • Defect in muscle and fat cell utilization of insulin
    • Precedes the manifestation of type 2 diabetes
    • Pancreas responds by producing more insulin to overdrive the cells
    • Results in hyperinsulinemia
    • Diabetes results when there is a relative insulin deficiency
  • Hyperinsulinemia
    • Stimulates fat storage
    • Increases appetite
    • Increase in sodium reabsorption in the kidneys
    • Increase in vascular smooth muscle proliferation
    • Decrease in fibrinolysis
  • Increased hepatic glucose output
    • Increased glycogen production and gluconeogenesis
    • Causes fasting hyperglycemia
    • Caused by hepatic insulin resistance
  • Glucose Toxicity
    • High glucose levels cause impaired cell function/damage
  • >115 mg/dl is threshold for pancreas
  • >180 mg/dl is threshold for nerve cells
    • Eventually leads to hypoinsulinemia and other complications
  • Markers of elevated plasma insulin levels
    • Increase in serum triglycerides
    • Decrease in HDL cholesterol

"Syndrome X" (Insulin Resistance Syndrome)

  • Hyperinsulinemia
  • Hypertension
  • Dyslipidemia
    • low HDL
    • high Triglycerides
    • smaller, denser LDL
  • Impaired Glucose Tolerance
  • Visceral Adiposity
  • Increased PAI-1 (plasminogen activator inhibitor-1)
  • Hyperuricemia
  • PCOS (polycystic ovarian syndrome)
    • hyperandrogenism
    • chronic anovulation
    • polycystic ovaries
  • Increased risk of CHD

Insulin Resistance Syndrome Interventions

  • Weight loss
  • Control lipids
  • Reduce CHD risk factors
  • Decrease insulin resistance
  • Daily aspirin


Last updated: December 1, 2000


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