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insulin resistance

Etiology: 1) endocrine disorders associated with insulin resistance 2) obesity - fast food restaraunt food See CARDIA study Pathology: 1) elevated levels of circulating insulin a) fasting b) post-prandial 2) hypertension 3) obesity 4) high triglycerides 5) low HDL cholesterol 6) small LDL particle size 7) carbohydrate intolerance 8) diabetes mellitus 9) reactive oxygen species implicated [4] 10) plasma retinol-binding protein 4 may be a cause of insulin-resistance NOT simply a marker 11) muscle weakness, decreased quadriceps strength [8] Genetics: - associated with defects in insulin receptor - MT-RNR regulates insulin sensitivity & protects against age-dependent & diet-induced insulin resistance - defects may cause &/or aggravate insulin resistance Laboratory: - plasma retinol-binding protein 4 levels correlate with insulin resistance [4] - MT-RNR1 gene mutation - also see ARUP consult [10] Radiology: - 18F-fluorodeoxyglucose-PET scan neuroimaging (investigational) - lower regional cerebral metabolic rates for glucose in the precuneus, posterior cingulate gyrus, parietal lobe, prefrontal lobe, & occipital lobe [9] Complications: - higher fasting glucose & glycosylated hemoglobin levels, even within the normal range, are associated with cognitive impairment & hippocampal abnormalities [9] Management: - diet & exercise [5,6,7] - calorie restriction results in loss of muscle mass in obese elderly thus is less preferable to exercise alone for management of insulin resistance [7] - outcomes not considered - low-energy dense diet reduces insulin resistance - potato & bean diets low in energy density are equally effective in reducing insulin resistance & promoting weight loss in subjects with impaired glycemic control [11]

Related

diabetes mellitus type 2 (insulin-resistant) endocrine disorders associated with insulin resistance impaired glucose tolerance

General

sign/symptom endocrine disease

Database Correlations

OMIM 125853

References

  1. Color Atlas & Synopsis of Clinical Dermatology, Common & Serious Diseases, 3rd ed, Fitzpatrick et al, McGraw Hill, NY, 1997, pg 505
  2. Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 18. American College of Physicians, Philadelphia 1998, 2012, 2018.
  3. Houstis N et al, Reactive oxygen species have a causal role in multiple forms of insulin resistance. Nature 2006; 440:944 PMID: 16612386
  4. Graham TE et al, Retinol-binding protein 4 and insulin resistance in lean, obese and diabetic subjects. N Engl J Med 2006; 354:2552 PMID: 16775236
  5. Davidson LE, Hudson R, Kilpatrick K et al Effects of exercise modality on insulin resistance and functional limitation in older adults: a randomized controlled trial. Arch Intern Med. 2009 Jan 26;169(2):122-31. PMID: 19171808
  6. Yassine HN, Marchetti CM, Krishnan RK et al Effects of exercise and caloric restriction on insulin resistance and cardiometabolic risk factors in older obese adults--a randomized clinical trial. J Gerontol A Biol Sci Med Sci. 2009 Jan;64(1):90-5 PMID: 19164269
  7. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013
  8. Barzilay JI, Cotsonis GA, Walston J Insulin resistance is associated with decreased quadriceps muscle strength in nondiabetic adults aged >or=70 years. Diabetes Care. 2009 Apr;32(4):736-8. PMID: 19171728
  9. Ryu SY et al. Effects of insulin resistance on white matter microstructure in middle-aged and older adults. Neurology 2014 Apr 25 http://www.neurology.org/content/82/21/1862
  10. ARUP consult: Inherited Insulin Resistance Syndromes (INSR) Genetic Testing https://arupconsult.com/ati/inherited-insulin-resistance-syndromes
  11. Splete H Both Potatoes and Beans Reduced Insulin Resistance, Weight in Controlled Study. Medscape. Dec 1, 2022 https://www.medscape.com/viewarticle/984876 - Rebello CJ, Beyl RA, Greenway FL et al Low-Energy Dense Potato- and Bean-Based Diets Reduce Body Weight and Insulin Resistance: A Randomized, Feeding, Equivalence Trial. J Med Food. 2022 Nov 11. PMID: 36367708
  12. Insulin Resistance and Pre-Diabetes http://diabetes.niddk.nih.gov/dm/pubs/insulinresistance/index.htm