Insulin resistance

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Definition

Insulin resistance is defined by the decrease in the ability of insulin to induce glucose uptake by insulin-sensitive tissues and to suppress hepatic glucose production. Insulin sensitivity, the reciprocal of IR, is widely used, especially because it is the sensitivity to insulin that is assessed during the euglycemic hyperinsulinemic clamp, considered the gold standard measurement.

Measurement of insulin resistance

Currently, there is no consensus on a test of IR that can be applied to routine clinical practice. Until better assessment tools are available, indices of IR derived from fasting insulin and glucose values or from an oral glucose tolerance test can be used to assess the IR and (-cell function of an individual. This could be particularly useful in individuals at high risk of developing diabetes (eg, impaired glucose tolerance or high genetic risk) to tailor possible interventions and to aid in the treatment choices (Table 3) [24,25,28-31].

Fasting insulin

In the presence of a normal glucose level an elevated fasting insulin level suggests IR. The problem with this assumption is that the range of normal glucose levels makes this interpretation difficult. For this reason the insulin concentration in plasma can usually only be interpreted in the light of the prevailing glucose concentration, as it is done using the insulin sensitivity indices discussed next.

Insulin dose

In type 1 diabetes, where there is little or no endogenous insulin production, the dose required to obtain euglycemia is related to the degree of IR. Doses above 1.5 U/kg/d are strongly suggestive of IR. The multiplicity of factors affecting the insulin doses and the reliability of patients reported doses limit the accuracy of this estimation.

Euglycemic hyperinsulinemic clamp

The euglycemic hyperinsulinemic clamp is currently considered the gold standard measurement of IR. It is based on the assessment of insulin sensitivity

Table 3

Measurements of insulin resistance

Table 3

Measurements of insulin resistance

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Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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