Epidemiologic and clinical aspects of insulin resistance and hyperinsulinemia

Article Abstract:

Half of all deaths in the US result from cardiovascular disease, and the vast majority of these result from coronary heart disease. The risk factors that contribute to coronary heart disease are well known, and include high blood pressure (hypertension), high cholesterol, and smoking. Research is elucidating the complex physiological relationships between insulin, blood sugar, and the other risk factors for coronary heart disease. Hyperinsulinemia is correlated with high blood pressure and increased total cholesterol. At the same time, hyperinsulinemia is correlated with decreases in the fraction of a type of cholesterol associated with reduced risk of coronary heart disease, high density lipoprotein (HDL). Evidence suggests that it is not the hyperinsulinemia alone that contributes to the increase in these risk factors. Rather, both the risk factors and the hyperinsulinemia appear to result from a common cause, the development of insulin resistance in some tissues. In particular, the skeletal muscle is resistant to insulin in patients with hypertension. Fat cells are also resistant to insulin in these individuals, which may explain the association of hypertension and obesity. It is not certain how insulin resistance and hyperinsulinemia affect blood pressure, but several mechanisms might be involved. These include effects on the kidneys, effects on the sympathetic nervous system (which helps regulate many factors influencing blood pressure), and effects on the transport of sodium ions across cell membranes. The relation between insulin, high blood pressure, and coronary heart disease is of direct importance to patients. It is clear that antihypertensive drugs, such as the thiazides and the beta blockers, lower blood pressure without significantly reducing the risk of coronary heart disease. These same drugs alter the insulin sensitivity of body tissues and cause abnormalities in blood cholesterol. Understanding the relationship between these physiological factors may be important in developing new drug therapies, which not only lower the blood pressure, but reduce the risk of heart disease at the same time. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Cardiovascular diseases, Complications and side effects, Risk factors, Obesity, Hyperglycemia

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Role of cellular calcium metabolism in abnormal glucose metabolism and diabetic hypertension

Article Abstract:

Non-insulin-dependent diabetes mellitus (NIDDM) is caused by a deficiency of or resistance to the hormone insulin, which is essential for sugar metabolism. Obesity is common among NIDDM patients. High blood pressure is prevalent among NIDDM and obese patients. The number of diabetics with high blood pressure is high at 30-55 percent. The greater incidence of high blood pressure among this group of patients cannot be attributed exclusively to obesity. A link has been suggested between high insulin levels in the blood due to insulin resistance and diabetes, obesity and high blood pressure. A defect common to all conditions may be present. It is hypothesized that insulin, which is needed on the cellular level to transport sugar into cells, becomes inadequate because of abnormal calcium balance. Calcium is involved in many bodily processes, including insulin secretion, insulin action, and the development of high blood pressure. Although the actual mechanism causing insulin resistance and hypertension in these patients is not known, the phospholipid content of a cell's membrane alters the ability of calcium to pass through the cell. This altered phospholipid content may be the result of diet or genetic factors. Abnormal sugar metabolism and hypertension are associated with abnormal calcium balance, which may explain the insulin resistance in patients with NIDDM.

Causes of, Type 2 diabetes

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Hypertension and abnormal glucose homeostasis: possible role of divalent ion metabolism

Article Abstract:

High blood pressure has been associated with abnormal sugar metabolism. Diabetic patients have generally higher blood pressures than patients with normal glucose control. The hormone insulin is essential for the transport of glucose, a simple sugar, into cells. Patients with diabetes mellitus either have deficient insulin metabolism or become resistant to insulin, and it is thus unclear whether increased blood insulin or resistance to insulin is the cause or the effect of high blood pressure. Calcium and magnesium are elements involved in the transport across cell membranes. Alterations in calcium metabolism may affect the metabolism of glucose. In addition, insulin may increase the amount of available free calcium. Magnesium was found to increase after patients were given a load of glucose. There is a connection between defects in calcium and magnesium metabolism and high blood pressure and diabetes. Although abnormal sugar tolerance, increased insulin in the blood, insulin resistance and high blood pressure are all clinically different, the underlying cause may stem from altered calcium and magnesium metabolism.

Magnesium metabolism

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