What is Insulin Resistance?

Insulin resistance refers to a variety of reasons that reduce the efficiency of insulin in promoting glucose uptake and utilization, and the body compensates for excessive secretion of insulin to produce hyperinsulinemia to maintain blood glucose stability. Insulin resistance easily leads to metabolic syndrome and type 2 diabetes. In the 1950s, Yallow and others applied radioimmunoassay to determine the plasma insulin concentration. It was found that patients with lower plasma insulin levels had higher insulin sensitivity, while those with higher plasma insulin were not sensitive to insulin, and thus proposed the concept of insulin resistance.

Basic Information

English name

insulin resistance

Visiting department

Endocrinology

Multiple groups

People with a family history of hypertension and hyperlipidemia

Common causes

Related to heredity, obesity, chronic hyperglycemia, certain drugs, etc.

Common symptoms

Dyslipidemia, obesity, atherosclerosis, abnormal blood coagulation, etc.

Contagious

no

Causes of insulin resistance

Hereditary factors

Insulin structural abnormalities, the presence of insulin antibodies, insulin receptors or genetic mutations after insulin receptors (such as Glut4 gene mutations, glucokinase gene mutations, and insulin receptor substrate gene mutations).

2. Obesity

Obesity is the main cause of insulin resistance, especially central obesity. Obesity is mainly related to long-term lack of exercise and excessive dietary energy intake. 80% of patients with type 2 diabetes are diagnosed with obesity.

3. Disease

Long-term hyperglycemia, high free fatty acidemia, certain drugs such as glucocorticoids, lack of certain trace elements such as chromium and vanadium deficiency, pregnancy and increased insulin antagonist hormones in the body.

4. Increased tumor necrosis factor a (TNF-a)

Increased TNF-a activity can promote lipolysis and increase plasma free fatty acid levels, leading to insulin resistance and hyperinsulinemia.

5. Other

Leptin resistance and adiponectin levels are reduced or activity is reduced, triglyceride content is increased in skeletal muscle cells, and excessive accumulation of cholesterol in B cells results in hypofunction. In recent years, it has been found that resistin secreted by adipocytes can reduce glucose uptake after insulin stimulation, and tissue uptake of glucose rises after neutralizing resistin.

Insulin resistance form

According to the insulin dose response curve, it can be seen that there are three forms of insulin resistance:

1. Simple curve shift right

It indicates that the effector organ of insulin has reduced sensitivity to insulin, and the insulin dose needs to be increased to achieve the maximum response.

2. Simple curve height decreases

Increasing the dose of insulin did not reach the maximum response height, which suggested that the target organs were less responsive to insulin.

3. Simultaneously accompanied by a right shift of the curve and a decrease in the maximum height of the curve

This shows that insulin sensitivity and responsiveness are reduced.

Insulin resistance test

Fasting insulin

Fasting insulin is a good indicator of insulin resistance in the population.

2. Normal blood glucose insulin clamp technology

This is currently the accepted method for detecting insulin resistance and is considered the gold standard for evaluating other methods of detecting insulin resistance.

3. Insulin suppression test

It is a simple and easy method, but the result is not as accurate as the clamp method.

4. Miniature model method

Miniature model technology (MMT) uses computer to simulate the relationship between body blood glucose and insulin dynamic metabolism, and simultaneously calculates the insulin sensitivity index (ISI) indicating the degree of insulin resistance and the glucose self-metabolizing efficacy (SG) independent of insulin action.

5. Glucose tolerance test while measuring insulin release curve

The common advantage of this method is that it does not interfere with the physiological mechanism of glucose-insulin feedback compared with blocking the glucose-insulin feedback method; it is more physiologically compatible with the glucose tolerance test in the glucose-insulin feedback method.

In July 1998, WHO defined the insulin resistance syndrome as: insulin resistance; impaired glucose tolerance; blood pressure 160 / 90mmHg; triglycerides 1.7mmol / L, high-density lipoprotein L; centripetal obesity; BMI> 30kg / m2; waist-hip ratio, male> 0.9, female> 0.85; hyperuricemia; microalbuminuria. An individual who has diabetes, impaired glucose tolerance, or insulin resistance and has more than two combinations at the same time can be defined as insulin resistance syndrome.

Insulin resistance therapy

In general, there is no effective treatment for primary or hereditary insulin resistance. However, for some people at high risk of developing insulin resistance, such as first-degree relatives with a family history of diabetes, family history of hypertension, hyperlipidemia and low birth weight infants or a history of intrauterine malnutrition, special attention should be paid to Avoid obesity during life to prevent insulin resistance as much as possible. For people who have shown insulin resistance, different methods should be adopted to reduce the factors that cause or aggravate insulin resistance according to different populations, and individualized treatment of different components of the metabolic syndrome that individuals have.

1. Strengthen exercise and control diet

Obese people emphasize a reasonable diet plan to reduce weight. At the same time carry out long-term scientific regular exercise to reduce weight.

2. Insulin sensitizer

Thiazolidinediones are potent insulin sensitizers that can reduce insulin resistance in type 2 diabetes by 33%. Rosiglitazone, pioglitazone, and others.

3. Control blood sugar

For patients with type 2 diabetes with mild, moderate obesity or overweight, thiazolidinedione derivatives, biguanides, and grape syrup inhibitors (baitangping) can be selected. In addition, type 2 diabetes treated with sulfonylurea drugs or insulin, if the blood sugar control is not ideal, can be combined with the above-mentioned antihyperglycemic drugs according to specific conditions, which can play a synergistic effect on reducing blood sugar.

4. Individualized choice of antihypertensive drugs

Many patients with hypertension are often accompanied by insulin resistance. Diuretics and beta-blockers may increase insulin resistance, have an adverse effect on glucose metabolism, and avoid long-term high-dose applications. Calcium antagonists have no adverse effect on glucose metabolism; alpha receptor blockers, angiotensin converting enzyme inhibitors and angiotensin II receptor blockers can slightly lower insulin resistance while improving insulin resistance, to a certain extent Reduce the risk of diabetes in patients with hypertension.

5. Correct lipid disorders

Disorders of lipid metabolism, such as hypertriglyceridemia and high free fatty acidemia, are closely related to insulin resistance. Hypertriglyceridemia and high free fatty acidemia further aggravate insulin resistance. Application of lipid-regulating drugs to improve lipid metabolism can reduce insulin resistance.

6. Supplement trace elements

The deficiency of trace elements such as chromium and vanadium may be related to insulin resistance. Proper supplementation of trivalent chromium ions and trace element vanadium in the diet is beneficial to reduce insulin resistance.