The other cycle in the hypothesis is pancreas cycle. When triglyceride (lipid) overflows from liver into blood stream, this state is called hypertriglyceridemia. It is our body’s attempt to transport excess fat from liver to other sites like subcutaneous tissue. When upper limit for fat storage in subcutaneous tissue is reached, fat is stored in other tissues like pancreas. Fat accumulation in islets of Langerhans interferes with its function (insulin production) and this is referred to as lipotoxicity. This leads to loss of first phase insulin response to a glucose load, with resultant postprandial hyperglycemia. This again stimulates more insulin secretion leading to more fat storage & transport to pancreas, forming the pancreas cycle. When a critical level is reached, pancreas fails & full blown T2DM emerges.
One important message this hypothesis tells us is that these 2 vicious cycles are reversible! This is quite different from the current mainstream idea that T2DM is a progressive disease requiring ever-increasing medications including exogenous insulin. When Prof Taylor used Magnetic Resonance Imaging (MRI) to follow the T2DM patients who were losing weight, what he found was quite remarkable: when these diabetics lost about 15% of their original weight, their fasting glucose & HbA1c levels returned to non-diabetic levels. This is why Taylor believes the twin cycles are reversible. MRI has the advantage of being able to see the pancreatic fat which cannot be easily detected by ultrasound.