I need help creating a thesis and an outline on Metabolic Changes in Type-2 Diabetes Mellitus. Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is required. The main metabolic defects in type-2 diabetes mellitus are decreased the ability of the peripheral tissues to respond to insulin and inadequate secretion of insulin by beta cells of the pancreas which are the only source of insulin production in the body. Of the two, in most of the cases, the first defect to develop is insulin resistance which is defined as resistance to the effects of insulin on glucose uptake, metabolism, and storage (Kumar, p.1195). This defect further leads to decreased uptake of glucose in muscle and adipose tissues. Both the defects must be present for the development of hyperglycemia. Most of the obese patients have insulin resistance, but only those with an inability to increase beta-cell production of insulin develop diabetes (Votey, eMedicine).
The impaired insulin secretion in type-2 diabetes is due to beta-cell dysfunction (DeFronzo, p.117). The beta cells fail to adapt themselves for the long-term demands of peripheral insulin resistance and increased insulin secretion (Kumar, p.1196). In type-2, this dysfunction is both quantitative and qualitative. There is loss of normal pulsatile, oscillating pattern of insulin secretion and the rapid first phase of insulin secretion which is a normal response to elevated plasma glucose is attenuated. There is also a decrease in beta-cell mass, islet degeneration, and deposition of islet amyloid (Kumar, p.1196). In fact, studies have established the onset of insulin resistance much before the manifestations of hyperglycemia (DeFronzo, p.117). The pancreas beta-cell function declines gradually over time already before the onset of clinical hyperglycemia (Stumvoll, p.1333).