Fig. 2
From: Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management
Mechanism for interaction between the metabolism disturbances and the heart. Insulin interferes with the free fatty acids (FFAs) metabolism. Consequently, a high amount of FFAs is present in the bloodstream, which impairs the insulin-mediated glucose uptake leading to hyperglycemia and insulin resistance, and promotes hypertension via increased sodium reabsorption and chronic sympathetic activity. In addition, insulin itself promotes hypertension. Metabolic disturbances impart a high risk for type 2 diabetes and heart failure progression, apart from FFA-rich epicardial fat tissue (EFT) that also facilitates heart failure