Klinische aspecten van Diabetes Type 2 Professor Hanno Pijl Leids Universitair Medisch Centrum LUMC

1. TYPE 2 DIABETES MELLITUS
Can it be cured?
Hanno Pijl
h.pijl@lumc.nl

3. Low grade inflammation
cytokines
insulin resistance
adipokines
+
age
genes
epi
genome

4. Ectopic fat storage

5. insulin ++
glucose
starch/sugar
fat oxidation➖
lipogenesis+

6. VLDL-
triglyceriden

7. serum glucose
insulin production
insulin resistance
10-30 yrs
diabetes diagnosis
Type 2 diabetes mellitus
time
serum
triglyceride

8. Glucose and inflammation

9. insuline
Na+ retention
CNS activation
growth stimulus vasoconstriction
Insulin effects

10. Treatment
Lifestyle
Step 1 Metformin
Step 2 SU
Step 3 Insulin
(dutch) guideline DM2 treatment

11. ADVANCE, NEJM 358: 2560, 2008
HbA1c
Macrovascular
disease
Microvascular disease

12. ACCORD, NEJM 358: 2545, 2008
CVD
HbA1c

13. ACCORD, NEJM 362: 1575, 2010
Stroke MI
Blood pressure

14. ACCORD, NEJM 362: 1563, 2010
Cardiovascular disease
Triglycerides

15. • Avoid processed food
• Restrict refined starch (bread, pasta, rice, potatoes)
• Vegetables and fruit are the core elements of the diet
• Drink water/coffee/tea instead of fruitjuice or softdrinks
• Increase physical activity
• Sleep regularly 7-8 hours
• Stress control
Lifestyle advice

16. Positive
changes
What did I exeperience after changing my lifes
•No medication anymore
•No obesity anymore
•No serious sweating anymore
•More energy.
•I enjoy physical exercise.
•Very good physical condition.
•Improved relationships.
•Think more clearly.
•Circadian rhythm restored.
•Much better mood.
•Not anxious anymore (PTSD improved).
•Better eyesight.
•Skin rash disappeared.
•Fibromas disappeared.
•Less hungry.

17. HbA1c

18. 4 months in
ketosis, lost
> 30 kilo
Bodyweight

19. 4 months in
ketosis, lost
> 20 cm
Waist circumference