Entry to the list of donations to the Foundation transparent account

The twin cycle hypothesis of etiology of type 2 diabetes

October 1st, 2015 | by American Association
The twin cycle hypothesis of etiology of type 2 diabetes
Causes of type 2 diabetes

Together with evidence of normalization of insulin secretion after bariatric surgery, insights into the behavior of the liver and pancreas during hypocaloric dieting lead to a hypothesis of the etiology and pathogenesis of type 2 diabetes: The accumulation of fat in liver and secondarily in the pancreas will lead to self-reinforcing cycles that interact to bring about type 2 diabetes. Fatty liver leads to impaired fasting glucose metabolism and increases export of VLDL triacylglycerol, which increases fat delivery to all tissues, including the islets. The liver and pancreas cycles drive onward after diagnosis with steadily decreasing β-cell function. However, of note, observations of the reversal of type 2 diabetes confirm that if the primary influence of positive calorie balance is removed, then the processes are reversible.

The twin cycle hypothesis of the etiology of type 2 diabetes. During long-term intake of more calories than are expended each day, any excess carbohydrate must undergo de novo lipogenesis, which particularly promotes fat accumulation in the liver. Because insulin stimulates de novo lipogenesis, individuals with a degree of insulin resistance (determined by family or lifestyle factors) will accumulate liver fat more readily than others because of higher plasma insulin levels. In turn, the increased liver fat will cause relative resistance to insulin suppression of hepatic glucose production. Over many years, a modest increase in fasting plasma glucose level will stimulate increased basal insulin secretion rates to maintain euglycemia. The consequent hyperinsulinemia will further increase the conversion of excess calories to liver fat. A cycle of hyperinsulinemia and blunted suppression of hepatic glucose production becomes established. Fatty liver leads to increased export of VLDL triacylglycerol, which will increase fat delivery to all tissues, including the islets. This process is further stimulated by elevated plasma glucose levels. Excess fatty acid availability in the pancreatic islet would be expected to impair the acute insulin secretion in response to ingested food, and at a certain level of fatty acid exposure, postprandial hyperglycemia will supervene. The hyperglycemia will further increase insulin secretion rates, with consequent enhancement of hepatic lipogenesis, spinning the liver cycle faster and driving the pancreas cycle. Eventually, the fatty acid and glucose inhibitory effects on the islets reach a trigger level that leads to a relatively sudden onset of clinical diabetes.


How long will diabetes stay away after weight loss? Long-term normal blood glucose control in previously diabetic individuals after bariatric surgery demonstrates that diabetes does not recur for up to 10 years, unless substantial weight gain occurs. These observations are consistent with the twin cycle hypothesis and the existence of a trigger level for adverse metabolic effects of fat in the pancreas. Hence, for a given individual with type 2 diabetes, reducing the liver and pancreas fat content below his or her personal trigger levels would be expected to result in a release from the fatty acid–mediated dysfunction. Individual tolerance of different degrees of fat exposure vary, and understanding this liposusceptibility will underpin the future understanding of genetically determined risk in any given environment. However, this should not obscure the central point: If a person has type 2 diabetes, there is more fat in the liver and pancreas than he or she can cope with.


Diabetes Care [Internet]. American Diabetes Association (United States). Vol. 36, No. 4, April 2013 – [cited 2015 Oct 1]. Available from: http://care.diabetesjournals.org/content/36/4/1047.full

Ratings article

1 Star2 Stars3 Stars4 Stars5 Stars (No Ratings Yet)


  1. Pingback: The Cinderella solution Get the body of your dreams.

  2. Pingback: Empire Market Exit Scam

  3. Pingback: granice.info

  4. Pingback: selfie frame hen party

  5. Pingback: Polished Concrete Floors

  6. Pingback: mounted poster

  7. Pingback: nha cai uy tin nhat

  8. Pingback: https://menmania.pl/forum/

  9. Pingback: Online Shopping

  10. Pingback: viagra uk order

  11. Pingback: cialis pills

  12. Pingback: Best Whitening Toothpaste

  13. Pingback: how to get cialis

  14. Pingback: generic for cialis

  15. Pingback: Buy viagra from canada

  16. Pingback: Buy Xanax Online

  17. Pingback: Brand name viagra

  18. Pingback: 바카라 사이트 홍보

  19. Pingback: ciprofloxacin virus

  20. Pingback: generic cialis 2019

  21. Pingback: albuterol inhaler for sale generic

  22. Pingback: cialis price costco

  23. Pingback: www.viagra.com

  24. Pingback: cialis pricing

  25. Pingback: viagra cialis

  26. Pingback: cialis price walmart

  27. Pingback: best place to buy cialis online

  28. Pingback: viagra 100mg

  29. Pingback: viagra 50mg

  30. Pingback: cheap viagra

  31. Pingback: online ed pills

  32. Pingback: mens ed pills

  33. Pingback: ed meds online without doctor prescription

  34. Pingback: Jelle Hoffenaar

  35. Pingback: cvs pharmacy

  36. Pingback: online pharmacy

  37. Pingback: Real cialis online

  38. Pingback: Real cialis online

  39. Pingback: Free Bingo

  40. Pingback: vardenafil online pharmacy

  41. Pingback: levitra 20mg

  42. Pingback: 카지노사이트

  43. Pingback: vardenafil 10mg

  44. Pingback: viagra online prescription

  45. Pingback: online casino usa

  46. Pingback: 안전카지노

  47. Pingback: generic cialis

  48. Pingback: casino slots gambling

  49. Pingback: sildenafil price

  50. Pingback: real money online casinos usa

  51. Pingback: online casinos for usa players

  52. Pingback: personal loans

  53. Pingback: bitcoin casino free spins

  54. Pingback: payday loans online

  55. Pingback: hollywood casino online

  56. Pingback: best slots to play online

  57. Pingback: instant loans

  58. Pingback: play blackjack

  59. Pingback: viagra cost

  60. Pingback: faq about viagra

  61. Pingback: online slots

  62. Pingback: 5 mg cialis

  63. Pingback: cialis 5 mg

  64. Pingback: cialis online no prescription

  65. Pingback: Viagra 25 mg tablets

  66. Pingback: Viagra 130 mg price

  67. Pingback: buy Viagra 130 mg

  68. Pingback: Viagra 130 mg coupon

  69. Pingback: how to buy Cialis 20 mg

  70. Pingback: Cialis 80 mg generic

  71. Pingback: www.lm360.us

  72. Pingback: how to purchase Cialis 20mg

  73. Pingback: Cialis 10mg usa

  74. Pingback: Cialis 10 mg nz

  75. Pingback: Cialis 10 mg without prescription

  76. Pingback: where to buy Cialis 60 mg

  77. Pingback: Cialis 80 mg without a doctor prescription

  78. Pingback: sildenafil 150 mg medication

  79. Pingback: tadalafil 80mg australia

  80. Pingback: levitra 10 mg australia

  81. Pingback: lasix 100 mg medication

  82. Pingback: furosemide 40mg united states

  83. Pingback: lexapro 20mg without a prescription

  84. Pingback: abilify 20 mg cost

  85. Pingback: actos 30 mg without a doctor prescription

  86. Pingback: order aldactone 100mg

  87. Pingback: where can i buy allegra 180 mg

  88. Pingback: where to buy amaryl 4 mg

  89. Pingback: cheapest ampicillin 250mg

  90. Pingback: antivert 25 mg price

  91. Pingback: cost of strattera 25 mg

  92. Pingback: cheapest aricept 5mg

  93. Pingback: viagra for sale

  94. Pingback: arimidex 1 mg purchase

  95. Pingback: where can i buy ashwagandha 60caps

  96. Pingback: keflex antibiotic price list

  97. Pingback: buspar 5 mg medication

  98. Pingback: calcium carbonate 500mg united states

  99. Pingback: catapres 100mcg united states

  100. Pingback: ceclor uk

  101. Pingback: ceftin 125 mg usa

  102. Pingback: periactin 4 mg prices

  103. Pingback: remeron and wellbutrin

  104. Pingback: phenergan 25mg online

  105. Pingback: how long buspar to work

  106. Pingback: plaquenil price

  107. Pingback: prednisolone 40mg for sale

  108. Pingback: prevacid 15 mg pills

  109. Pingback: prilosec 40mg united states

  110. Pingback: carvedilol from blood pressure

  111. Pingback: proair inhaler tablets

  112. Pingback: how dangerous is celebrex

  113. Pingback: where can i buy procardia 30 mg

  114. Pingback: citalopram substitute

  115. Pingback: cheap proscar 5mg

  116. Pingback: protonix without a doctor prescription

  117. Pingback: provigil 200 mg medication

  118. Pingback: sildenafil generic

  119. Pingback: pulmicort generic

  120. Pingback: generic viagra india

  121. Pingback: pyridium 200mg uk

  122. Pingback: prednisone without vet prescription

  123. Pingback: reglan 10mg for sale

  124. Pingback: cialis free

  125. Pingback: cost of remeron 15 mg

  126. Pingback: online cialis

  127. Pingback: how to buy retin-a cream 0.05%

  128. Pingback: using viagra

  129. Pingback: revatio no prescription

  130. Pingback: female viagra

  131. Pingback: risperdal no prescription

  132. Pingback: robaxin cost

  133. Pingback: rogaine generic

  134. Pingback: seroquel online

  135. Pingback: malaria medication chloroquine

  136. Pingback: cheap singulair 5 mg

  137. Pingback: skelaxin pills

  138. Pingback: cheap spiriva

  139. Pingback: cialis before and after pictures tumblr

  140. Pingback: tenormin cheap

  141. Pingback: thorazine 100mg usa

  142. Pingback: toprol 50 mg generic

  143. Pingback: viagra use

  144. Pingback: tricor without prescription

  145. Pingback: valtrex 500 mg for sale

  146. Pingback: verapamil 40mg over the counter

  147. Pingback: voltaren 100 mg online pharmacy

  148. Pingback: zestril price

  149. Pingback: zithromax 500mg without a doctor prescription

  150. Pingback: read the full info here

  151. Pingback: where can i buy zocor 10mg

  152. Pingback: zovirax no prescription

  153. Pingback: order zyloprim

  154. Pingback: zyprexa uk

  155. Pingback: viagra active ingredient generic

  156. Pingback: zyvox medication

  157. Pingback: sildenafil tablets

  158. Pingback: tadalafil 80mg for sale

  159. Pingback: escitalopram 5 mg tablets

  160. Pingback: aripiprazole 10 mg prices

  161. Pingback: cheap pioglitazone 30mg

  162. Pingback: spironolactone online pharmacy

  163. Pingback: fexofenadine without a doctor prescription

  164. Pingback: how to purchase glimepiride

  165. Pingback: meclizine 25mg united kingdom

  166. Pingback: leflunomide united kingdom

  167. Pingback: atomoxetine price

  168. Pingback: order donepezil

  169. Pingback: anastrozole 1 mg purchase

  170. Pingback: where to buy irbesartan

  171. Pingback: dutasteride 0,5 mg without a doctor prescription

  172. Pingback: olmesartan 20mg over the counter

  173. Pingback: buspirone medication

  174. Pingback: buy clonidine 0.1mg

  175. Pingback: cefuroxime coupon

  176. Pingback: celecoxib 100 mg prices

  177. Pingback: citalopram for sale

  178. Pingback: cephalexin 500mg generic

  179. Pingback: ciprofloxacin tablets

  180. Pingback: cialis 20mg usa

  181. Pingback: buy cialis cheaper online

  182. Pingback: clozapine canada

  183. Pingback: prochlorperazine 5 mg without a doctor prescription

  184. Pingback: canadian pharmacy cialis 20mg

  185. Pingback: carvedilolmg generic

  186. Pingback: warfarin price

  187. Pingback: rosuvastatin 5 mg medication

  188. Pingback: cheap divalproex

  189. Pingback: trazodone cheap

  190. Pingback: tolterodine 2mg australia

  191. Pingback: cialis without presciption in usa

  192. Pingback: order acetazolamide

  193. Pingback: difference between generic and tadalafil

  194. Pingback: fluconazole 50mg pills

  195. Pingback: amoxicillin for canker sores

  196. Pingback: what is azithromycin for

  197. Pingback: oxybutynin without prescription

  198. Pingback: is celecoxib an nsaid

  199. Pingback: doxycycline generic

  200. Pingback: keflex and diflucan interaction

  201. Pingback: bisacodyl australia

  202. Pingback: buy cialis online cheap

  203. Pingback: cymbalta for migraines

  204. Pingback: venlafaxine tablet

  205. Pingback: buy amitriptyline

  206. Pingback: side effects of amoxicillin

  207. Pingback: order erythromycin 250mg

  208. Pingback: buy cialis very cheap prices fast delivery

  209. Pingback: buy estradiol

  210. Pingback: henry ford hydroxychloroquine study

  211. Pingback: etodolac united states

  212. Pingback: azithromycin 250 mg tablet

  213. Pingback: vjgjbhxx

  214. Pingback: is there cannabis in celebrex

  215. Pingback: fluticasone mcg cost

  216. Pingback: keflex generic

  217. Pingback: alendronate tablet

  218. Pingback: wat is een viagra

  219. Pingback: cymbalta ear ringing

  220. Pingback: nitrofurantoin 100 mg australia

  221. Pingback: azithromycin diarrhea how long

  222. Pingback: glipizide 5mg tablets

  223. Pingback: buy cialis in miami

  224. Pingback: sumatriptan online pharmacy

  225. Pingback: cialis 20mg usa

  226. Pingback: viagra 50mg

  227. Pingback: azathioprine pharmacy

  228. Pingback: buy cialis 36 hour online

  229. Pingback: viagra

  230. Pingback: what is the best custom essay writing service

  231. Pingback: imagine you are writing a research paper on margaret

  232. Pingback: generic cialis canadian

  233. Pingback: need someone to write my essay

  234. Pingback: how to write how can a school help me essay

  235. Pingback: business essay writing

  236. Pingback: Google

  237. Pingback: oxycodone for sale

  238. Pingback: buy kratom online

  239. Pingback: kratom for anxiety

  240. Pingback: lamotrigine 200mg uk

  241. Pingback: terbinafine 250 mg uk

  242. Pingback: 우리카지노

  243. Pingback: 퍼스트카지노

  244. Pingback: how to purchase digoxinmg

  245. Pingback: BUY OG KUSH VAPE

  246. Pingback: online sports betting sites

  247. Pingback: hydroxychloroquine sulfate 300 mg

  248. Pingback: levothyroxine mcg without prescription

  249. Pingback: cialis 20mg usa

  250. Pingback: pit bull puppies for sale

  251. Pingback: amoxicillin cap 500mg price

  252. Pingback: furosemide 40 mg tablet uk

  253. Pingback: zithromax purchase online

  254. Pingback: atorvastatin 10mg without prescription

  255. Pingback: cost of ivermectin cream

  256. Pingback: albuterol 5931057922

  257. Pingback: safestore auto

  258. Pingback: free laptop games download

  259. Pingback: download apps apk for laptop pc

  260. Pingback: free download for windows 10

  261. Pingback: cost of metoprolol

  262. Pingback: 200 mg doxycycline

  263. Pingback: prednisolone minims

  264. Pingback: clomid acne

  265. Pingback: singapore divorce lawyer

  266. Pingback: priligy westoxetin online

  267. Pingback: diflucan suspension

  268. Pingback: PornHub download

  269. Pingback: 75 mcg synthroid

  270. Pingback: metoclopramide pharmacy

  271. Pingback: big canvas art

  272. Pingback: pure amphetamine

  273. Pingback: psilocybe cubensis grow kit usa

  274. Pingback: https://trippydelics.ca

  275. Pingback: click here

  276. Pingback: laptop support bubikon

  277. Pingback: propecia increased libido

  278. Pingback: Herbal incense

  279. Pingback: Herbal incense

  280. Pingback: Shoes

  281. Pingback: shipping containers for sale virginia

  282. Pingback: canada pharmacy

  283. Pingback: online pharmacies canada

  284. Pingback: cryptocard

  285. Pingback: neurontin liver

  286. Pingback: metformin benefits

  287. Pingback: Buy THC Cartridges online Ireland

  288. Pingback: paxil withdrawal symptoms

  289. Pingback: plaquenil hair loss

  290. Pingback: copper jewelry

  291. Pingback: virtual card buy

  292. Pingback: Google

  293. Pingback: best canada pharmacy

  294. Pingback: delta 8 THC near me

  295. Pingback: lifestyle services

  296. Pingback: sig sauer

  297. Pingback: cocaine for sale EU

  298. Pingback: 샌즈카지노

  299. Pingback: 메리트카지노

  300. Pingback: 코인카지노

  301. Pingback: crypto wallet

  302. Pingback: Vidalista 60mg

  303. Pingback: tadalafil 20 mg tablet cost

  304. Pingback: peyote seeds

  305. Pingback: mac 10

  306. Pingback: where to buy guns online

  307. Pingback: siamese kittens for sale near me

  308. Pingback: End Of Tenancy Cleaning UK

  309. Pingback: End Of Tenancy Cleaning Bethnal Green

  310. Pingback: Guns for sale

  311. Pingback: Web Design and SEO Office In Georgia

  312. Pingback: container homes for sale

  313. Pingback: Cannabis Oil

  314. Pingback: buy Instagram followers

  315. Pingback: Buy lsd gel tabs with PayPal online

  316. Pingback: online cbd shop

  317. Pingback: counterfeit money for sale

  318. Pingback: buy cialis online europe

  319. Pingback: dmt drug

  320. Pingback: black latex gloves

  321. Pingback: honda 400ex

  322. Pingback: buy dexedrine 5mg online

  323. Pingback: buy adhd meds online canada

  324. Pingback: crossdressers cams

  325. Pingback: minecraft code

  326. Pingback: Website

  327. Pingback: website

  328. Pingback: generic cialis 20 mg tadalafil

  329. Pingback: vibrating panties

  330. Pingback: SUPREME CANNABIS

  331. Pingback: escorts

  332. Pingback: generate password

  333. Pingback: find out more

  334. Pingback: find out more

  335. Pingback: cash advance payday loans boise city

  336. Pingback: ordering online australia

  337. Pingback: موقع سكس

Leave a Reply