Diabetes mellitus: Hypoxia of the islets of Langerhans resulting from the systematic rest prone on the back after a meal?

Abstract

This article presents a novel view on the diabetes aetiology from the standpoint of a single epidemiological factor. It has been observed that, irrespective of the type of diabetes, sufferers have a stable, persistent behavioural habit: to take a rest or to have a nap within two hours of a meal. Such habitual behaviour is termed as postprandial hypokinesia (PPH). The working hypothesis is that, after food intake and with the body in a recumbent/semirecumbent position on the back, the stomach replete with food places mechanical pressure against the pancreas. As a consequence, systematic disturbances in the microcirculatory flow of the islets of Langerhans (ischemia) cause hypoxia to develop which, ultimately, sets in train a pathological process (and later, an autoimmune reaction). The intensity and effect of structurally-functional disturbances are determined by the degree of hypoxia. Literature sources support the islets of Langerhans being physiologically susceptible to hypoxia. Moreover, the same effects of experimental hypoxia on the islets of Langerhans are also observed in the pathogenesis of diabetes. Accumulated scientific research makes possible to construct an ischemic/hypoxic model of diabetes development. The core pathological process then should involve all the following pathologies: inflammation of the islets of Langerhans, dysfunction of an insulin islet apparatus, apoptosis/necrosis of the cells in the insulin islets. All three are also observed in diabetes. From this perspective, conventional types of diabetes can be regarded as different states, apparently progressing, of a single pathological process attributed to the level reached in the compensatory capacity exhaustion. It follows that, with the elimination of PPH, conditions for the pathological process to be reversed are created: the reparation of injured tissues and the recovery of function to synthesise and secrete insulin are likely. Those patients under observation, who eliminated the PPH behaviour from their lifestyle, encountered a positive dynamic in terms of an increased capacity for work, improvement in general condition, normalization of glycemia level, a decrease in medication as well as remission. The major implication of the hypothesis, if correct and accepted, is that the use of medication on a stand-alone basis without alterations to a lifestyle would not be sufficient to produce successful treatment and cure of diabetes. Behavioural therapy should be used as a primary causal therapeutic action. Education on the consequences of the PPH factor should be used as a primary preventive measure.