CONSEQUENCES OF DIABETES

Fig. Causes of Type 2 Diabetes

The risk of hypoglycaemia is the main limitation to achievement of good glycaemic control in diabetes.  In normal subjects the first response to falling blood glucose is reduction in insulin secretion occurring at blood glucose level below 80 mg/dl. This is lacking in subjects with type 1 diabetes or type 2 diabetes. Glucagon forms the next layer of defence, stimulating hepatic glycogenolysis and gluconeogenesis. However, most patients with type 1 and 2 are chronically hyperglucagonaemica and cannot respond to hypoglycaemia in this way. The last level of defence against acute hypoglycaemia is activation of the sympathetico-adrenal system, which normally occurs when blood glucose falls to below 55 mg/dl. This increases lipolysis and circulating NEFA (Non-esterified fatty acid) production and utilization, and mobilization of substrates for gluconeogenesis further inhibits insulin secretion and promotes glucagon release. Activation of the sympatheticopadrenal system gives first-clear symptoms of hypoglycaemia which is due to autonomic activation and Neuroglycopenia.  

Fig. Consequences of Diabetes

Clinical pseudohypoglycaemia and non-clinical pseudohypoglycaemia (which is a measure of low blood glucose due to severe leukocytosis or polycythemia). In clinical pseudohypoglycaemia patients with chronic hyperglycaemia experiences symptoms of hypoglycaemia.