Effects of insulin on physical factors: atherosclerosis in diabetes mellitus

Newton's laws of motion play a major role in blood flow. Inertia and conservation of momentum cause flow to separate at branches and curves in large blood vessels. Areas of separated flow in the arterial system are sites of atherogenesis. The place at which the separation ends, called the stagnation point, is the focus for plaque development. Pulsation of the arterial circulation causes the stagnation point to move downstream with each systole and upstream with each diastole. This movement generates forward and backward shearing force in the stagnation region as the separated flow migrates back and forth. Angular momentum, introduced into flowing blood with each heart beat and further enhanced by the asymmetry of origin of vessels branching from the aorta, generates a sidewise force component that is preserved during migration of the stagnation point. The sidewise force, added to the forward and backward shear stresses, creates an area of multidirectional shear stress under the migrating stagnation point that increases the permeability of the local endothelium. Blood is a complex fluid; it can generate greater shear stresses near the stagnation point than the simple fluids normally studied by fluid mechanicists. Blood is capable of retaining shear stress for short periods after it ceases to flow and extra work is required to establish its flow. In diabetes, reduced erythrocyte deformability further burdens flow onset. We are not yet able to establish whether the increase is only a few percent, or whether the burden is larger. Whatever its magnitude, diabetic modifications of the flow properties of blood, directly affect the size, location, and rate of development of atherosclerotic plaques.