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This slide
demonstrates the interrelationships between insulin resistance, diabetes and
cardiovascular disease. It is proposed that the primary disorder is insulin resistance,
wherein the insulin hormone does not act properly at its target tissues, notably the
liver, muscle and fat cells. This leads to an increase in the blood sugar and
hyperinsulinemia or high insulin levels in the blood. The generation of these high levels
is thought to lead to b cell exhaustion such that eventually
the b cells that produce insulin fail to do so leading to
inadequate or hypoinsulinemia and frank diabetes. The high blood sugar itself may also
lead to toxicity or damage the b cells and hasten the onset of
decreased insulin production. Insulin resistance also leads to a disturbance of virtually
all the regular cardiovascular risk factors, blood pressure and lipoproteins in
particular, which will increase atherosclerosis. High insulin levels seen in insulin
resistance may also directly promote the development of atherosclerosis, although this is
controversial. Diabetes also leads to other derangments which also increase
atherosclerosis.
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