Building Competency in Diabetes Education THE ESSENTIALS

PATHOPHYSIOLOGY| 3-19

pregnancy are physiological states of insulin resistance, and people at these life stages have increased insulin requirements, as well (31).

Beta cell dysfunction It is generally accepted that beta cell dysfunction and/or the loss of beta cell mass plays an equally important role in type 2 diabetes (7). It may be somewhat reversible through intensive glycemic control at the onset of diabetes, but it progresses over time (7). Initially, first phase insulin secretion is lost, resulting in an excessive postprandial glycemia and subsequent late insulin rise (hyperinsulinemia) (7). Ongoing deterioration in beta cell function is hypothesized to result from glucose toxicity and/or beta cell exhaustion. F rom “triumvirate” to “ominous octet” (32) The concept of insulin resistance and defective insulin secretion with involvement of liver, skeletal muscles and pancreatic beta cells “triumvirate” or three organs, is expanded to include more organs and pathologic processes in the natural history of type 2 diabetes. This expanded model promotes a more logical, pathophysiologic approach to diabetes therapy. DeFronzo et al. discuss the role of these additional organs and processes in the development of type 2 diabetes: • adipocytes (lipolysis with increased plasma FFA) • gastrointestinal tract (incretin deficiency) • alpha cells (hyperglucagonemia) • kidneys (increase glucose reabsorption in proximal tubules) • brain (appetite dysregulation) All of these eight organs, together, form the “ominous octet”. This concept could facilitate a meaningful discussion about taking more than one oral agent and/or injectable, along with implementing healthy lifestyle to control diabetes. The following figure presents all organs forming the ominous octet.