Forearm and Coronary vessel blood flow

Experiments have been conducted of forearm blood flow for people with varying degrees of glucose tolerance as well as for type 1 and type 2 diabetics. These types of tests are measurements of blood vessel (endothelial) function. The cells that line the vessel walls are endothelium. I can personally observe the dilation and contraction of my forearm blood vessels since I lost a significant amount of weight. After eating food the vessels will constrict and it will take a few hours to reverse this constriction. Type 1 diabetics are generally closer to people with normal glucose tolerance and insulin sensitivity compared to type 2 diabetics. Blood pressure is impacted by the dilation and constriction of blood vessels. I will not attempt to cover this topic from A to Z. The last article shows that improvements can occur.

http://scholar.google search for the terms forearm+blood+flow+normal+impaired+glucose+tolerance+"type 1"+"type 2"+diabetics - http://tinyurl.com/3cypr9.

Coronary Circulatory Dysfunction in Insulin Resistance, Impaired Glucose Tolerance, and Type 2 Diabetes Mellitus - http://circ.ahajournals.org/cgi/content/full/111/18/2291.
"Background— Abnormal coronary endothelial reactivity has been demonstrated in diabetes and is associated with an increased rate of cardiovascular events. Our objectives were to investigate the presence of functional coronary circulatory abnormalities over the full spectrum of insulin resistance and to determine whether these would differ in severity with more advanced states of insulin resistance.

Methods and Results— Myocardial blood flow (MBF) was measured with positron emission tomography and 13N-ammonia to characterize coronary circulatory function in states of insulin resistance without carbohydrate intolerance (IR), impaired glucose tolerance (IGT), and normotensive and hypertensive type 2 diabetes mellitus (DM) compared with insulin-sensitive (IS) individuals. Indices of coronary function were total vasodilator capacity (mostly vascular smooth muscle–mediated) during pharmacological vasodilation and the nitric oxide–mediated, endothelium-dependent vasomotion in response to cold pressor testing. Total vasodilator capacity was similar in normoglycemic individuals (IS, IR, and IGT), whereas it was significantly decreased in normotensive (–17%) and hypertensive (–34%) DM patients. Compared with IS, endothelium-dependent coronary vasomotion was significantly diminished in IR (–56%), as well as in IGT and normotensive and hypertensive diabetic patients (–85%, –91%, and –120%, respectively).

Conclusions— Progressively worsening functional coronary circulatory abnormalities of nitric oxide–mediated, endothelium-dependent vasomotion occur with increasing severity of insulin-resistance and carbohydrate intolerance. Attenuated total vasodilator capacity accompanies the more clinically evident metabolic abnormalities in diabetes."

The following is a recapulation of reports given at the World Congress on the insulin resistance syndrome (IRS):
Insulin Resistance, Dyslipidemia, and Cardiovascular Disease - http://care.diabetesjournals.org/cgi/content/full/30/8/2164

Diabetes and Endothelial Dysfunction: A Clinical
Perspective - http://www.uvm.edu/annb/faculty/PDFs/36.pdf

Lifestyle Modification Improves Endothelial Function in Obese Subjects
With the Insulin Resistance Syndrome - http://care.diabetesjournals.org./cgi/content/full/26/7/2119

"RESULTS—This intervention resulted in 6.6% reduction in body weight and significant improvement of insulin sensitivity index ... . FMD (flow-mediated dilation) significantly improved, whereas response to GTN (glyceryltrinitrate) and microvascular reactivity did not change. Similar observations were seen when the subjects were subclassified according to their glucose tolerance to normal glucose tolerance, impaired glucose tolerance, and type 2 diabetes. sICAM (soluble intercellular adhesion molecule) and PAI-1 (plasminogen activator inhibitor-1) significantly decreased ... . The relationship between percentage weight reduction and improved FMD was linear ... .

CONCLUSIONS—We conclude that 6 months of weight reduction and exercise improve macrovascular endothelial function and reduces selective markers of endothelial activation and coagulation in obese subjects with IRS regardless of the degree of glucose tolerance."

Frank
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