Eleven pathways to hyperglycemia
| Beta-cell dysfunction and death, leading to decreased insulin secretion |
| Insulin resistance in liver, leading to increased glucose production |
| Insulin resistance in fat, leading to increased lipolysis |
| Insulin resistance in muscle, leading to decreased uptake of glucose |
| Brain phenomena, ie, increased appetite, increased sympathetic tone, decreased morning dopamine surge |
| Increased SGLT2 effect, leading to increased glucose reabsorption |
| Alpha-cell defect, leading to increased glucagon secretion |
| Decreased incretin effect, leading to decreased insulin secretion in response to food |
| Decreased amylin, leading to increased rate of glucose absorption |
| Immune dysregulation and inflammation |
| Abnormal colonic microbiome, leading to decreased GLP-1 secretion (speculative) |
Based on information in reference 3.