Type 2 Diabetes

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Type 2 diabetes is a condition which affects the body to use a hormone, called insulin. When we eat, sugars and starches in food are broken down into glucose, a form of sugar used as fuel. The body needs insulin to get the sugar into the cells and to store excess sugar in the fat cells.

The American Diabetes Association estimates about 23.6 million Americans have diabetes. Type 2 is the most common form, accounting for about 90-95 percent of all cases of the disease. Over time, diabetics are at increased risk for developing serious complications, like heart attack, stroke, kidney disease, blindness and nerve damage.

Insulin Resistance in Type 2 Diabetes

Normally, when a person eats, excess calories are stored in fat cells. The more a person eats, the more fat molecules those cells store. Eventually, however, the fat cells reach their limit. Philipp Scherer, Ph.D., Professor of Internal Medicine at UT Southwestern Medical Center at Dallas, says as fat cells store more energy, they enlarge and become inflamed. This inflammation appears to cause insulin resistance.

Unfortunately, the body responds by producing even more insulin. The process increases the amount of body fat and more increased insulin resistance. Eventually, the insulin-producing cells die, leading to type 2 diabetes.

Roger Unger, M.D. is also a Professor of Internal Medicine at UT Southwestern Medical Center at Dallas. He says some patients with type 2 diabetes may need insulin therapy if their bodies don’t make enough of the hormone. However, insulin may not be the best therapy for patients who make enough insulin, but are unable to use it because they have developed insulin resistance. For these patients, the extra insulin only appears to promote fat storage and compound the problem. In fact, early this year, the NIH halted a trial of aggressive glucose-lowering in high-risk type 2 patients because of an unexpected increase in deaths from heart attack or stroke.

Unger says overweight patients with type 2 diabetes may gain better control over their disease by losing weight and reducing the amount of fat stored in their body. Doing so may enable the body to regulate glucose levels and reduce risk for insulin resistance. In extreme cases, bariatric surgery may be necessary to help the patient lose excess weight.

# Next, the researchers want to study the role of the fat cell in metabolism, energy storage and inflammation. If scientists can understand the process that leads to inflammation, they may be able to develop anti-inflammatory medications directed specifically for insulin-resistance in type 2 diabetes. For general information on diabetes: American Diabetes Association
# National Institute of Diabetes and Digestive and Kidney Diseases