Building Competency in Diabetes Education THE ESSENTIALS

PATHOPHYSIOLOGY| 3-11

Table 1. Endocannabinoid system summary of effects in animal models (15) Site of action Mechanism Potential Clinical Implications

Hypothalamus

↑ Food intake

• Increase in weight

Adipose tissue

↓ Adiponectin ↑ Lipogenesis

• Dyslipidemia • Insulin resistance

Muscle

↓ Insulin-stimulated glucose uptake

• Insulin resistance

Liver

↑ Regulatory hormones in fatty acid synthesis Increase lipogenesis

• Dyslipidemia • Insulin resistance • Fatty liver

GI tract

↓ Satiety signals Increase food intake Altered motility, GI emptying Decrease insulin secretion Increase insulin resistance

• Energy intake

Endocrine Pancreas

• Dysglycemia

Maintaining the balance In normal metabolism, a fine balance exists between the storage of fuel via insulin, amylin and incretin systems and the release of those stores via glucagon and the counterregulatory system. The body is able to keep blood glucose (BG) levels continuously between 3.9 and 5.6 mmol/L preprandially and less than 7.8 mmol/L postprandially (5). There are numerous teaching tools available to explain these complex processes in a simplified manner. For example, see the Diabetes Canada website (www.diabetes.ca) and the patient resource section.