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Insulin Resistance Syndrome Definition

What Is Insulin Resistance? Does It Mean You're Going To Get Type 2 Diabetes?

What Is Insulin Resistance? Does It Mean You're Going To Get Type 2 Diabetes?

If your doctor has told you that you have this condition, you're probably asking these questions. It means your body can't respond properly to the insulin it makes. Over time, this sends your blood sugar levels up. That can set you up for type 2 diabetes, as well as heart disease, but it doesn't have to. Exercise and a good diet can help you stay healthy. You can't tell that you have insulin resistance by how you feel. You'll need to get a blood test that checks your blood sugar levels. Likewise, you won’t know if you have most of the other conditions that are part of insulin resistance syndrome (high blood pressure, low "good" cholesterol levels, and high triglycerides) without seeing your doctor. If you already have insulin resistance, you can take actions that will help your health. Exercise. Go for at least 30 minutes a day of moderate activity (like brisk walking) 5 or more days a week. If you're not active now, work up to that. Get to a healthy weight. If you're not sure what you should weigh or how to reach a weight loss goal, ask your doctor. You may also want to talk with a nutritionist and a certified personal trainer. Eat a healthy diet. Think fruits, vegetables, whole grains, nuts, beans, fish, legumes, and other lean protein. Some people with insulin resistance may also need to take metformin. Continue reading >>

What Is Metabolic Syndrome? Symptoms & Treatment | Cleveland Clinic

What Is Metabolic Syndrome? Symptoms & Treatment | Cleveland Clinic

Health Library |Disease & Conditions | Metabolic Syndrome Overview |Diagnosis and Tests |Prevention Metabolic syndrome is a collection of heart disease risk factors that increase your chance of developing heart disease, stroke , and diabetes . The condition is also known by other names including Syndrome X, insulin resistance syndrome, and dysmetabolic syndrome. According to a national health survey, more than 1 in 5 Americans has metabolic syndrome. The number of people with metabolic syndrome increases with age, affecting more than 40% of people in their 60s and 70s. People with central obesity (increased fat in the abdomen/waist). People with diabetes mellitus or a strong family history of diabetes mellitus. People with other clinical features of "insulin resistance" including skin changes of acanthosis nigricans ("darkened skin" on the back of the neck or underarms) or skin tags (usually on the neck). Certain ethnic backgrounds are at a higher risk of developing metabolic syndrome. As you grow older, your risk of developing metabolic syndrome increases. If I have metabolic syndrome, what health problems might develop? Consistently high levels of insulin and glucose are linked to many harmful changes to the body, including: Damage to the lining of coronary and other arteries, a key step toward the development of heart disease or stroke. Changes in the kidneys' ability to remove salt, leading to high blood pressure , heart disease and stroke. An increase in triglyceride levels, resulting in an increased risk of developing cardiovascular disease. An increased risk of blood clot formation, which can block arteries and cause heart attacks and strokes. A slowing of insulin production, which can signal the start of type 2 diabetes , a disease that is in itself associated Continue reading >>

Syndromes Of Severe Insulin Resistance

Syndromes Of Severe Insulin Resistance

Division of Endocrinology, Beth Israel Deaconess Medical Center and Joslin Diabetes Center, Boston, Massachusetts 02215 Search for other works by this author on: Division of Endocrinology, Beth Israel Deaconess Medical Center and Joslin Diabetes Center, Boston, Massachusetts 02215 Address all correspondence and requests for reprints to: Christos S. Mantzoros, M.D., D.Sc., Division of Endocrinology, RN 325, 99 Brookline Avenue, Boston, Massachusetts 02215. Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 83, Issue 9, 1 September 1998, Pages 30253030, Nicholas A. Tritos, Christos S. Mantzoros; Syndromes of Severe Insulin Resistance, The Journal of Clinical Endocrinology & Metabolism, Volume 83, Issue 9, 1 September 1998, Pages 30253030, AN exceedingly large number of studies have convincingly demonstrated that insulin resistance occurs in association with a variety of physiological and pathophysiological states, including obesity, noninsulin-dependent diabetes mellitus (NIDDM), polycystic ovary syndrome (PCOS), and the constellation of central obesity, hypertension, glucose intolerance, and hyperlipidemia known as metabolic syndrome or syndrome X ( 1 , 2 ) ( Table 1 ). In addition, a number of rare, albeit very interesting, syndromes characterized by extreme insulin resistance have been described over the past 20 yr ( 3 , 4 ). These syndromes are not only clinically important, but have also significantly contributed to our knowledge of the mechanisms of insulin action and resistance. In this review, we focus on syndromes characterized by extreme insulin resistance. We present the tools and criteria for the diagnosis of severe insulin resistance and review the clinical phenotypes of type A and type B syndromes of insulin Continue reading >>

Type A Insulin Resistance Syndrome

Type A Insulin Resistance Syndrome

Type A insulin resistance syndrome is a rare disorder characterized by severe insulin resistance, a condition in which the body's tissues and organs do not respond properly to the hormone insulin. Insulin normally helps regulate blood sugar levels by controlling how much sugar (in the form of glucose) is passed from the bloodstream into cells to be used as energy. In people with type A insulin resistance syndrome, insulin resistance impairs blood sugar regulation and ultimately leads to a condition called diabetes mellitus, in which blood sugar levels can become dangerously high. Severe insulin resistance also underlies the other signs and symptoms of type A insulin resistance syndrome. In affected females, the major features of the condition become apparent in adolescence. Many affected females do not begin menstruation by age 16 (primary amenorrhea) or their periods may be light and irregular (oligomenorrhea). They develop cysts on the ovaries and excessive body hair growth (hirsutism). Most affected females also develop a skin condition called acanthosis nigricans, in which the skin in body folds and creases becomes thick, dark, and velvety. Unlike most people with insulin resistance, females with type A insulin resistance syndrome are usually not overweight. The features of type A insulin resistance syndrome are more subtle in affected males. Some males have low blood sugar (hypoglycemia) as the only sign; others may also have acanthosis nigricans. In many cases, males with this condition come to medical attention only when they develop diabetes mellitus in adulthood. Type A insulin resistance syndrome is one of a group of related conditions described as inherited severe insulin resistance syndromes. These disorders, which also include Donohue syndrome and Rabson-Me Continue reading >>

The Metabolic Syndrome (insulin Resistance Syndrome Or Syndrome X)

The Metabolic Syndrome (insulin Resistance Syndrome Or Syndrome X)

INTRODUCTION Obesity, particularly abdominal obesity, is associated with resistance to the effects of insulin on peripheral glucose and fatty acid utilization, often leading to type 2 diabetes mellitus. Insulin resistance, the associated hyperinsulinemia and hyperglycemia, and adipocyte cytokines (adipokines) may also lead to vascular endothelial dysfunction, an abnormal lipid profile, hypertension, and vascular inflammation, all of which promote the development of atherosclerotic cardiovascular disease (CVD) [1-4]. A similar profile can be seen in individuals with abdominal obesity who do not have an excess of total body weight [5-8]. The co-occurrence of metabolic risk factors for both type 2 diabetes and CVD (abdominal obesity, hyperglycemia, dyslipidemia, and hypertension) suggested the existence of a "metabolic syndrome" [1,9-11]. Other names applied to this constellation of findings have included syndrome X, the insulin resistance syndrome, the deadly quartet, or the obesity dyslipidemia syndrome [12]. Genetic predisposition, lack of exercise, and body fat distribution all affect the likelihood that a given obese subject will become overtly diabetic or develop CVD. It should be noted that questions have been raised as to whether the metabolic syndrome, as currently defined, captures any unique pathophysiology implied by calling it a "syndrome" and whether metabolic syndrome confers risk beyond its individual components. These questions raise uncertainty about the value of diagnosing metabolic syndrome in individual patients [13,14]. These arguments will be reviewed at the end of this discussion (see 'A critical look at the metabolic syndrome' below). Regardless of whether the metabolic syndrome is considered a unique entity, the need is unquestioned to identify an Continue reading >>

Insulin Resistance

Insulin Resistance

What medical conditions are associated with insulin resistance? While the metabolic syndrome links insulin resistance with abdominal obesity, elevated cholesterol, and high blood pressure; several other medical other conditions are specifically associated with insulin resistance. Insulin resistance may contribute to the following conditions: Type 2 Diabetes: Overt diabetes may be the first sign insulin resistance is present. Insulin resistance can be noted long before type 2 diabetes develops. Individuals reluctant or unable to see a health-care professional often seek medical attention when they have already developed type 2 diabetes and insulin resistance. Fatty liver: Fatty liver is strongly associated with insulin resistance. Accumulation of fat in the liver is a manifestation of the disordered control of lipids that occurs with insulin resistance. Fatty liver associated with insulin resistance may be mild or severe. Newer evidence suggests fatty liver may even lead to cirrhosis of the liver and, possibly, liver cancer. Arteriosclerosis: Arteriosclerosis (also known as atherosclerosis) is a process of progressive thickening and hardening of the walls of medium-sized and large arteries. Arteriosclerosis is responsible for: Other risk factors for arteriosclerosis include: High levels of "bad" (LDL) cholesterol Diabetes mellitus from any cause Family history of arteriosclerosis Skin Lesions: Skin lesions include increased skin tags and a condition called acanthosis nigerians (AN). Acanthosis nigricans is a darkening and thickening of the skin, especially in folds such as the neck, under the arms, and in the groin. This condition is directly related to the insulin resistance, though the exact mechanism is not clear. Acanthosis nigricans is a cosmetic condition strongly Continue reading >>

Insulin Resistance

Insulin Resistance

Insulin resistance (IR) is a pathological condition in which cells fail to respond normally to the hormone insulin. The body produces insulin when glucose starts to be released into the bloodstream from the digestion of carbohydrates in the diet. Normally this insulin response triggers glucose being taken into body cells, to be used for energy, and inhibits the body from using fat for energy. The concentration of glucose in the blood decreases as a result, staying within the normal range even when a large amount of carbohydrates is consumed. When the body produces insulin under conditions of insulin resistance, the cells are resistant to the insulin and are unable to use it as effectively, leading to high blood sugar. Beta cells in the pancreas subsequently increase their production of insulin, further contributing to a high blood insulin level. This often remains undetected and can contribute to the development of type 2 diabetes or latent autoimmune diabetes of adults.[1] Although this type of chronic insulin resistance is harmful, during acute illness it is actually a well-evolved protective mechanism. Recent investigations have revealed that insulin resistance helps to conserve the brain's glucose supply by preventing muscles from taking up excessive glucose.[2] In theory, insulin resistance should even be strengthened under harsh metabolic conditions such as pregnancy, during which the expanding fetal brain demands more glucose. People who develop type 2 diabetes usually pass through earlier stages of insulin resistance and prediabetes, although those often go undiagnosed. Insulin resistance is a syndrome (a set of signs and symptoms) resulting from reduced insulin activity; it is also part of a larger constellation of symptoms called the metabolic syndrome. Insuli Continue reading >>

Insulin Resistance Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Treatment Of Underlying Causes

Insulin Resistance Treatment & Management: Approach Considerations, Pharmacologic Therapy, Surgical Treatment Of Underlying Causes

Insulin ResistanceTreatment & Management Author: Samuel T Olatunbosun, MD, FACP, FACE; Chief Editor: George T Griffing, MD more... Evaluate patients for comorbid conditions; this is generally feasible on an outpatient basis. Admission for laboratory studies and treatment of acute complications may be warranted for patients whose conditions require urgent or emergent intervention. The metabolic syndrome requires aggressive control of cardiovascular and metabolic risk factors. Tailor therapy for optimal benefits. Weight reduction improves insulin sensitivity in cases of obesity and in most of the obesity-related insulin-resistant states. Restriction of caloric intake is indicated. Dietary indiscretion, such as consumption of a diet high in cholesterol and sodium, should be avoided. Alcohol use should be limited. Smoking cessation is indicated. [ 59 , 60 ] Patiends should avoid physical inactivity. [ 61 ] Exercise improves insulin sensitivity via the following [ 62 , 63 ] : In patients with insulin resistance, diligent monitoring of metabolic profile, general status, medications, and side effects is indicated. Transfer may be indicated for diagnostic evaluation and for the treatment of major primary conditions and complications. Consultation with an endocrinologist is indicated in insulin resistance. Referral to a medical weight management program is usually needed. Consultation with a cardiologist is also usually indicated. Other specialists, such as a dermatologist, gynecologist, cardiothoracic surgeon, and ophthalmologist, may need to be consulted based on the nature of the disease and the prevailing pathology. Medications that reduce insulin resistance (insulin-sensitizing and antihyperglycemic effects) include metformin and the thiazolidinediones. [ 9 ] Metformin is Continue reading >>

Insulin Resistance

Insulin Resistance

Practice Essentials Insulin resistance is a state in which a given concentration of insulin produces a less-than-expected biological effect. Insulin resistance has also been arbitrarily defined as the requirement of 200 or more units of insulin per day to attain glycemic control and to prevent ketosis. The syndromes of insulin resistance actually make up a broad clinical spectrum, which includes obesity, glucose intolerance, diabetes, and the metabolic syndrome, as well as an extreme insulin-resistant state. Many of these disorders are associated with various endocrine, metabolic, and genetic conditions. These syndromes may also be associated with immunological diseases and may exhibit distinct phenotypic characteristics. [1, 2, 3, 4, 5, 6, 7, 8] The metabolic syndrome —a state of insulin-resistance that is also known as either syndrome X or the dysmetabolic syndrome—has drawn the greatest attention because of its public health importance. In addition to hypertension, findings can include central obesity, peripheral arterial disease, type A syndrome, type B syndrome, ancanthosis nigricans, polycystic ovary syndrome, and other insulin-resistant states. In clinical practice, no single laboratory test is used to diagnose insulin resistance syndrome. Diagnosis is based on clinical findings corroborated with laboratory tests. Individual patients are screened based on the presence of comorbid conditions. Lab tests include the plasma glucose level, the fasting insulin level, and a lipid profile, among others. Treatment involves pharmacologic therapy to reduce insulin resistance, along with surgical management of underlying causes if appropriate. Comorbid conditions should be evaluated and addressed; this is generally feasible on an outpatient basis, though some patients wi Continue reading >>

Prediabetes & Insulin Resistance

Prediabetes & Insulin Resistance

What is insulin? Insulin is a hormone made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood. Insulin plays a major role in metabolism—the way the body uses digested food for energy. The digestive tract breaks down carbohydrates—sugars and starches found in many foods—into glucose. Glucose is a form of sugar that enters the bloodstream. With the help of insulin, cells throughout the body absorb glucose and use it for energy. Insulin's Role in Blood Glucose Control When blood glucose levels rise after a meal, the pancreas releases insulin into the blood. Insulin and glucose then travel in the blood to cells throughout the body. Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels. Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen. Insulin also lowers blood glucose levels by reducing glucose production in the liver. In a healthy person, these functions allow blood glucose and insulin levels to remain in the normal range. What happens with insulin resistance? In insulin resistance, muscle, fat, and liver cells do not respond properly to insulin and thus cannot easily absorb glucose from the bloodstream. As a result, the body needs higher levels of insulin to help glucose enter cells. The beta cells in the pancreas try to keep up with this increased demand for insulin by producing more. As long as the beta cells are able to produce enough insulin to overcome the insulin resistance, blood glucose levels stay in the healthy range. Over time, insulin resistance can lead to type 2 diabetes and prediabetes because the bet Continue reading >>

Signs Of Insulin Resistance

Signs Of Insulin Resistance

What is insulin resistance? Insulin is a hormone made by your pancreas. It allows your cells to use glucose (sugar) for energy. People with insulin resistance have cells throughout their bodies that don’t use insulin effectively. This means the cells have trouble absorbing glucose, which causes a buildup of sugar in their blood. If your blood glucose levels are higher than normal, but not high enough to be considered type 2 diabetes, you have a condition called prediabetes caused by insulin resistance. It’s not entirely clear why some people develop insulin resistance and others don’t. A sedentary lifestyle and being overweight increases the chance of developing prediabetes and type 2 diabetes. The effects of insulin resistance Insulin resistance typically doesn’t trigger any noticeable symptoms. You could be insulin resistant for years without knowing, especially if your blood glucose levels aren’t checked. The American Diabetes Association (ADA) estimates that nearly 70 percent of individuals with insulin resistance and prediabetes will go on to develop type 2 diabetes if significant lifestyle changes aren’t made. Some people with insulin resistance may develop a skin condition known as acanthosis nigricans. This condition creates dark patches often on the back of the neck, groin, and armpits. Some experts believe it may be caused by a buildup of insulin within skin cells. There’s no cure for acanthosis nigricans, but if caused by a specific condition, treatment may allow for some of your natural skin color to return. Insulin resistance increases the risk of being overweight, having high triglycerides, and having elevated blood pressure. Since insulin resistance increases your risk for progressing to diabetes, you may not notice right away if you develop Continue reading >>

Insulin Resistance Syndrome

Insulin Resistance Syndrome

Insulin resistance can be linked to diabetes, hypertension, dyslipidemia, cardiovascular disease and other abnormalities. These abnormalities constitute the insulin resistance syndrome. Because resistance usually develops long before these diseases appear, identifying and treating insulin-resistant patients has potentially great preventive value. Insulin resistance should be suspected in patients with a history of diabetes in first-degree relatives; patients with a personal history of gestational diabetes, polycystic ovary syndrome or impaired glucose tolerance; and obese patients, particularly those with abdominal obesity. Present treatment consists of sensible lifestyle changes, including weight loss to attain healthy body weight, 30 minutes of accumulated moderate-intensity physical activity per day and increased dietary fiber intake. Pharmacotherapy is not currently recommended for patients with isolated insulin resistance. Obesity, type 2 diabetes mellitus (formerly known as non–insulin-dependent diabetes), hypertension, lipid disorders and heart disease are common in most Western societies and are collectively responsible for an enormous burden of suffering. Many people have more than one—and sometimes all—of these conditions, leading to the hypothesis that the coexistence of these diseases is not a coincidence, but that a common underlying abnormality allows them to develop. In 1988 it was suggested that the defect was related to insulin, and the insulin resistance syndrome was first described.1 It is estimated that this syndrome affects 70 to 80 million Americans.2 Insulin stimulates glucose uptake into tissues, and its ability to do so varies greatly among individual persons. In insulin resistance, tissues have a diminished ability to respond to the actio Continue reading >>

The Insulin Resistance Syndrome: Definition And Dietary Approaches To Treatment.

The Insulin Resistance Syndrome: Definition And Dietary Approaches To Treatment.

The insulin resistance syndrome: definition and dietary approaches to treatment. Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California 94305, USA. [email protected] The ability of insulin to stimulate glucose disposal varies at least sixfold in apparently healthy individuals, and approximately one-third of the population that is most resistant to this action of insulin is at greatly increased risk to develop a number of adverse clinical outcomes. Type 2 diabetes occurs when insulin resistant individuals are unable to secrete enough insulin to compensate for the defect in insulin action, and this was the first clinical syndrome identified as being related to insulin resistance. Although the majority of insulin-resistant individuals are able to maintain the level of compensatory hyperinsulinemia needed to prevent the development of a significant degree of hyperglycemia, the combination of insulin resistance and hyperinsulinemia greatly increases the likelihood of developing a cluster of closely related abnormalities and the resultant clinical diagnoses that can be considered to make up the insulin resistance syndrome (IRS). Since being overweight/obese and sedentary decreases insulin sensitivity, it is not surprising that the prevalence of the manifestations of the IRS is increasing at a rapid rate. From a dietary standpoint, there are two approaches to attenuating the manifestations of the IRS: (a) weight loss to enhance insulin sensitivity in those overweight/obese individuals who are insulin resistant/hyperinsulinemic; and (b) changes in macronutrient content of diets to avoid the adverse effects of the compensatory hyperinsulinemia. This chapter will focus on defining the abnormalities and c Continue reading >>

Definitions Of The Insulin Resistance Syndrome

Definitions Of The Insulin Resistance Syndrome

Richard Pasternak (Boston, MA) discussed the deliberations that led the National Cholesterol Education Program Adult Treatment Panel (ATP) III to propose a new definition of the metabolic syndrome (1) and the impact of this proposal in heightening awareness of the insulin resistance syndrome (IRS). Coronary heart disease (CHD) is the main cause of death in the developed world, and Pasternak noted that contrary to general perceptions, malignancy is only approximately half as frequent a cause of mortality as CHD among women. The concept of metabolic syndrome extends in a precise way an important subset of patients at high risk for CHD. The definition was created to be clinically practical, evidence based, and applicable to existing datasets. The ATP did not find adequate evidence to recommend routine measurement of insulin sensitivity or of inflammatory markers. The 2-h glucose was not included because it was similarly felt not to add sufficient numbers of persons to justify the additional effort involved. The panel has been criticized for not calling the metabolic syndrome a CHD equivalent, but Pasternak pointed out that at that time there was no evidence that this was the case. Rather, the presence of the metabolic syndrome was felt to accentuate the risk accompanying elevated LDL cholesterol, mediated through existing and emerging risk factors. Clinical trials show evidence for modification of atherogenic dyslipidemia, blood pressure, and the prothrombotic state (with aspirin, which the panel recommended only for persons with CHD but which Pasternak suggested is appropriate for all persons with the syndrome) in persons undergoing LDL-lowering therapy. The primary management strategy should be to reverse its root causes of obesity and physical inactivity, with an option Continue reading >>

Insulin Resistance Treatment & Management

Insulin Resistance Treatment & Management

Approach Considerations Evaluate patients for comorbid conditions; this is generally feasible on an outpatient basis. Admission for laboratory studies and treatment of acute complications may be warranted for patients whose conditions require urgent or emergent intervention. The metabolic syndrome requires aggressive control of cardiovascular and metabolic risk factors. Tailor therapy for optimal benefits. Weight reduction improves insulin sensitivity in cases of obesity and in most of the obesity-related insulin-resistant states. Restriction of caloric intake is indicated. Dietary indiscretion, such as consumption of a diet high in cholesterol and sodium, should be avoided. Alcohol use should be limited. Smoking cessation is indicated. [59, 60] Patiends should avoid physical inactivity. [61] Exercise improves insulin sensitivity via the following [62, 63] : In patients with insulin resistance, diligent monitoring of metabolic profile, general status, medications, and side effects is indicated. Transfer may be indicated for diagnostic evaluation and for the treatment of major primary conditions and complications. Consultation with an endocrinologist is indicated in insulin resistance. Referral to a medical weight management program is usually needed. Consultation with a cardiologist is also usually indicated. Other specialists, such as a dermatologist, gynecologist, cardiothoracic surgeon, and ophthalmologist, may need to be consulted based on the nature of the disease and the prevailing pathology. Continue reading >>

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