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Severe Insulin Resistance Symptoms

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

A A A What is Insulin Resistance? Insulin is a hormone that is produced by the beta cells found in the pancreas. Insulin is an important hormone that has many actions within the body including those involved in metabolism (control) of carbohydrates (sugars and starches), lipids (fats), and proteins. When insulin resistance develops, tissues in the body – particularly muscle and fat tissues- do not respond appropriately to insulin. In fact, more insulin is needed to elicit the same response from these tissues. As a result, higher levels of insulin are needed in order for insulin to continue to exert its physiologic effect. There are many causes of insulin resistance, including a strong association with genetics (an inherited component). In addition, insulin resistance is often associated with the following conditions: infection or severe illness, the metabolic syndrome, obesity, pregnancy, steroid use and with other medications, and Aside from the well known association of insulin resistance with the metabolic syndrome, abdominal obesity, elevated cholesterol levels, and high blood pressure; there are several other medical conditions that are associated with insulin resistance specifically. While the associations are clear, whether insulin resistance is the cause of these conditions is not yet known. While insulin resistance is usually seen long before diabetes develops, in cases in which medical attention has lapsed, insulin resistance can present as type 2 diabetes. The accumulation of fat in the liver is a manifestation of the disordered control of lipids that occurs with insulin resistance. The extent of liver damage can range from mild to severe. Newer evidence suggests that fatty liver may even lead to cirrhosis of the liver, and possibly liver cancer. Insulin re Continue reading >>

Insulin Resistance

Insulin Resistance

What is insulin resistance? Insulin is a hormone that facilitates the transport of blood sugar (glucose) from the bloodstream into cells throughout the body for use as fuel. In response to the normal increase in blood sugar after a meal, the pancreas secretes insulin into the bloodstream. With insulin resistance, the normal amount of insulin secreted is not sufficient to move glucose into the cells – thus the cells are said to be “resistant” to the action of insulin. To compensate, the pancreas secretes insulin in ever-increasing amounts to maintain fairly adequate blood-sugar movement into cells and a normal blood-sugar level. What are some insulin resistance symptoms? There are usually no obvious, outward signs of insulin resistance. However, when you are severely insulin resistant, dark patches of skin called acanthosis nigricans can develop on the back of the neck. Sometimes a dark ring forms around the neck. These dark patches can also occur on the elbows, knees, knuckles and armpits. More importantly, insulin has less visible effects on metabolic reactions throughout the body, including converting calories into fat. Insulin resistance influences the liver enzymes that produce cholesterol and acts on the kidneys (which can contribute to high blood pressure). High insulin levels also have a role in the process that regulates inflammation. In time, insulin resistance can lead to type 2 diabetes, itself a risk factor for heart disease. Insulin resistance can be diagnosed with blood tests that show low levels of HDL cholesterol (the “good” cholesterol), a high triglyceride level, a high fasting insulin level or a high uric acid level. What are the causes of insulin resistance? There are genetic factors that can contribute to the development of insulin resista Continue reading >>

Severe Insulin Resistance In A Patient With Type 2 Diabetes

Severe Insulin Resistance In A Patient With Type 2 Diabetes

Severe insulin resistance in a patient with type 2 diabetes Severe insulin resistance in a patient with type 2 diabetes Patients with severe insulin resistance may benefit from concentrated insulin. Mrs. D, aged 58 years, has a history of uncontrolled type 2 diabetes mellitus. She visited her primary care nurse practitioner's office, reporting that her diabetes specialist had recently moved away and there is a 1-month waiting period to be seen by a different diabetes specialist. The patient is concerned about her continued elevated blood glucose level, which ranges from 200 to 400 mg/dL. She reported worsening of vision, frequent urination, and increased thirst. She denied urinary hesitancy or discomfort during urination. The patient's medical history included class III obesity , hypertension, hyperlipidemia, recurrent urinary tract infections, diabetic neuropathy, and a myocardial infarction 3 years ago. She was diagnosed with type 2 diabetes mellitus 20 years ago. The patient had been on oral hypoglycemic agents for 4 years prior to transitioning to insulin therapy. With progressive weight gain secondary to a sedentary lifestyle and poor dietary habits, she had required a steady increase in insulin dosage during the past few years. She now takes more than 240 units of insulin daily via subcutaneous injections. For the last month, her former diabetes specialist had been titrating up her insulin regimen due to persistent hyperglycemia. The patient performs self-monitoring of her blood glucose level about 4 to 5 times daily, usually prior to administering her scheduled insulin doses: fasting, pre-lunch, pre-dinner, and at bedtime. The patient's medication profile includes: Insulin aspart 42 units before each meal (breakfast, lunch, and dinner) Insulin aspart as a supple Continue reading >>

Insulin Resistance Syndromes

Insulin Resistance Syndromes

Diagnosis Biochemical diagnostic thresholds for severe insulin resistance (IR) are arbitrary, and should ideally be defined relative to BMI-adjusted population normal ranges, however one set of approximate diagnostic criteria is as follows: A: Non-diabetic and B.M.I. <30 kg/m2 Fasting insulin above 150 pmol/l OR Peak insulin on oral glucose tolerance testing above 1,500 pmol/l B: Absolute insulin deficiency and B.M.I. <30 kg/m2 Exogenous insulin requirement > 3U/kg/day. C: Partial beta cell decompensation and/or B.M.I. >30 kg/m2 Insulin levels are more difficult to interpret in the context of obesity or pre-existing diabetes, where glucotoxicity, and mixtures of endogenous and exogenous insulin in the circulation confuse the biochemical picture. In these settings the clinical history and features such as acanthosis nigricans are particularly useful in making a diagnosis of likely monogenic severe IR. Subjective clinical judgement is also required. Generic clinical features of severe insulin resistance Severe insulin resistance (IR) usually presents in one of three ways: Persistent hyperglycaemia despite large doses of insulin in patients with diabetes - Note, however, that many cases are unrecognised in the prediabetic phase. Indeed, a very common early feature of severe IR is spontaneous and symptomatic postprandial hypoglycaemia which may require medical intervention. This may dominate the clinical picture for years before hyperglycemia supervenes, which only occurs in the face of beta cell decompensation. Acanthosis Nigricans - The commonest presentation of monogenic severe IR is with the skin condition acanthosis nigricans (Figure 1). Ovarian hyperandrogenism, or “Polycystic Ovary Syndrome” - This may be severe, and oligo- or amenorrhoea are frequently the first Continue reading >>

How To Reverse Insulin Resistance At Midlife

How To Reverse Insulin Resistance At Midlife

Insulin resistance has become a huge problem in our culture and it can lead to many of the chronic health problems we see today, including obesity, type 2 diabetes and heart disease. It is also linked to high blood pressure, high cholesterol, thyroid problems, muscle loss, fat gain, fatty liver, breast cancer, endometrial cancer, and other cancers as well. And, insulin resistance has even been implicated in Alzheimer’s disease. In addition, did you know that insulin resistance can also cause many of the symptoms most women attribute to menopause? It’s true. Insulin has a cascading effect on all of your hormones, including estrogen, progesterone and testosterone. When insulin isn’t doing its job, it’s nearly impossible to reduce the symptoms of menopause, including hot flashes and night sweats. It also makes weight loss very difficult. Jason Fung, M.D. – who you can listen to on my radio show, Flourish – has done much research in the area of insulin control. His work shows that getting insulin in balance can be the key to getting your hormones and your health back in balance. What is Insulin and How Does It Work? Insulin is a hormone made by the pancreas. Its main job is to manage how your body uses glucose for energy. When blood sugar levels rise after a meal, your pancreas releases insulin to help your body’s cells — especially cells in the liver and muscles — absorb glucose. Your liver converts stored glucose to glycogen for future use. When blood sugar levels are too low, your pancreas releases a hormone called glucagon. Glucagon forces the liver to convert glycogen back to glucose, which causes your blood sugar to rise. You always have low levels of insulin circulating in your body. When insulin is out of balance, the result is abnormal blood sugar Continue reading >>

Treatment Approach To Patients With Severe Insulin Resistance

Treatment Approach To Patients With Severe Insulin Resistance

In Brief Patients with severe insulin resistance require >2 units/kg of body weight or 200 units/day of insulin. Yet, many patients do not achieve glycemic targets despite using very high doses of insulin. Insulin can cause weight gain, which further contributes to worsening insulin resistance. This article describes the pharmacological options for managing patients with severe insulin resistance, including the use of U-500 insulin and newer agents in combination with insulin. An increasing number of patients have severe insulin resistance and require large doses of insulin. Managing patients with severe insulin resistance is challenging because it is difficult to achieve good glycemic control using conventional treatment approaches (1). Moreover, weight gain, hypoglycemia, regimen complexity, and cost are frequent concerns as insulin doses escalate. Insulin resistance is characterized by an impaired response to either endogenous or exogenous insulin (2). Although insulin resistance is a common feature of type 2 diabetes, cases of severe insulin resistance remain relatively uncommon but are likely increasing as the prevalence of diabetes and obesity surges. The degree of insulin resistance can be measured using the euglyemic insulin clamp technique, but this is not a clinically useful method of determining whether a patient has severe insulin resistance in practice (3). The most widely reported and clinically useful definitions of severe insulin resistance are based on exogenous insulin requirements using either the number of units per kilogram of body weight per day or the total daily dose (1). Patients who require >1 unit/kg/day are considered to have insulin resistance, and those requiring >2 units/kg/day have severe resistance (3). Alternatively, a total daily insul Continue reading >>

How To Reverse Insulin Resistance: An Actionable Guide

How To Reverse Insulin Resistance: An Actionable Guide

If you’ve been in the space of alternative health and wellness for a while, then you’ve likely heard the term ‘insulin resistance’ floating around. But if not, I’m going to do that right now so your brain can stop screeching to a halt every time it reads that word. What Does Insulin Do? Insulin is a hormone. To put it quite simply, you can think of hormones as “body messengers” that communicate and respond to everything from hunger signals to reproduction, to emotions and a heck of a lot more. Because we are an intelligent and integrated feedback loop, some hormones have more than one, and/or, overlapping functions. Insulin is produced in the pancreas (which is part of the endocrine system). Its major responsibility (which is uber important) is to help regulate blood sugar. When you eat foods that contain any form of sugar, that sugar gets broken down into glucose. By the way, when I say that foods containing sugar I’m not just talking about sweet foods. I’m also talking about any carbohydrate (both simple and complex) containing foods. In this case, flavor is secondary to chemical make-up because that’s what ultimately determines how it’s going to be digested. Let me give some examples of foods that will get broken down into glucose: Desserts: ice cream, cookies, cakes, pies, candy, dried fruit… Sweet drinks: gatorade, creamers, soda, koolaid, juices… Simple carbs: bread, pasta, crackers, cereals… Complex carbs: quinoa, oats, brown & wild rice, corn, sprouted wheats, plantains, cassava, turnips, squashes… Fiber-rich: most fruits, most vegetables, peas, beans, legumes Those foods, the ones above and the others I didn’t have space to include, once simplified into glucose molecules (this is what we mean when we say blood sugar) are then esc Continue reading >>

Insulin Resistance Causes And Symptoms

Insulin Resistance Causes And Symptoms

One in three Americans—including half of those age 60 and older1— have a silent blood sugar problem known as insulin resistance. Insulin resistance increases the risk for prediabetes, type 2 diabetes and a host of other serious health problems, including heart attacks, strokes2 and cancer.3 What is Insulin Resistance? Insulin resistance is when cells in your muscles, body fat and liver start resisting or ignoring the signal that the hormone insulin is trying to send out—which is to grab glucose out of the bloodstream and put it into our cells. Glucose, also known as blood sugar, is the body’s main source of fuel. We get glucose from grains, fruit, vegetables, dairy products, and drinks that bring break down into carbohydrates. How Insulin Resistance Develops While genetics, aging and ethnicity play roles in developing insulin sensitivity, the driving forces behind insulin resistance include excess body weight, too much belly fat, a lack of exercise, smoking, and even skimping on sleep.4 As insulin resistance develops, your body fights back by producing more insulin. Over months and years, the beta cells in your pancreas that are working so hard to make insulin get worn out and can no longer keep pace with the demand for more and more insulin. Then – years after insulin resistance silently began – your blood sugar may begin to rise and you may develop prediabetes or type 2 diabetes. You may also develop non-alcoholic fatty liver disease (NAFLD), a growing problem associated with insulin resistance that boosts your risk for liver damage and heart disease. 5 Signs and Symptoms of Insulin Resistance Insulin resistance is usually triggered by a combination of factors linked to weight, age, genetics, being sedentary and smoking. - A large waist. Experts say the be 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 >>

What Is Severe Insulin Resistance?

What Is Severe Insulin Resistance?

Severe insulin resistance and lipodystrophy are rare metabolic disorders. They occur when the body does not use the insulin it produces properly. Insulin is a hormone (a chemical signal that travels in the bloodstream) made by the pancreas.It controls how the body uses sugars and fats and is essential for life. Its absence is the underlying problem in type 1 diabetes. However, from person to person there are significant differences in how sensitive the tissues of the body are to insulin. In other words, in some people a very small amount of insulin produces a large change in the blood levels of glucose and fats (these people are said to be very insulin sensitive), while in others much larger amounts are required to produce the same change (these people are said to be insulin resistant). Those with severe insulin resistance are those whose bodies respond least well to insulin. Although many with severe insulin resistance do go onto develop diabetes, severe insulin resistance is NOT the same as diabetes: as long as the pancreas can produce enough insulin to overcome the insulin resistance diabetes does not develop. However even before diabetes appears, insulin levels in the body may be extremely high, and this can produce a range of different problems in its own right. Rarely, people are born with severe insulin resistance and remain severely insulin resistant throughout their lives. Far more frequently insulin resistance develops only at puberty or in later life, while in some people it is only a temporary condition caused by other situations or illnesses. Most commonly a tendency towards insulin resistance is inherited, but only in the presence of environmental or lifestyle factors does it become a problem. Consequences of severe insulin resistance include development Continue reading >>

12 Signs Of Insulin Resistance

12 Signs Of Insulin Resistance

Most people think about diabetics when they see the word insulin, but problems with insulin can occur in a number of different conditions, in people with normal blood sugar. You have probably heard of insulin resistance; it is a significant health problem because it’s associated with an increased risk of obesity, heart attacks, polycystic ovarian syndrome, cancer and other serious conditions. People with insulin resistance usually have excessively high levels of this hormone, because it doesn’t work properly. We are seeing an increasing number of patients who have been diagnosed with insulin resistance by their own doctor, yet they don’t fully understand what this term means. How would you know if your insulin level is too high? There is a blood test that can measure your fasting insulin, but it isn’t always reliable and many doctors are not willing to order this test. This is a shame because elevated insulin is bad for your health and shortens your lifespan. Insulin has many important roles in your body. People with too much insulin in their bloodstream are said to have insulin resistance, syndrome X, metabolic syndrome or pre-diabetes. They are all interchangeable terms. Due to modern diets and lifestyles, nearly everybody produces more insulin in their pancreas than they should. This is a problem because if blood insulin levels have been high for years, the cells of your body start to ignore it. The insulin becomes less and less effective at its important job in your body (getting glucose inside your cells so you can burn it for energy). Knowing whether or not you have too high insulin is important because it can allow you to make some changes and avoid some serious health problems in the future. Luckily there are several tell tale signs or clues that your bo 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 >>

Strategies For Managing Severe Insulin Resistance

Strategies For Managing Severe Insulin Resistance

Strategies for Managing Severe Insulin Resistance San FranciscoSevere insulin resistance (eg, requiring >200 units of insulin per day) poses unique challenges that can undermine glycemic control. Current research and practical considerations in the use of concentrated insulin and other strategies to manage severe insulin resistance in type 1 and type 2 diabetes was addressed during the ADA meeting at a satellite symposium supported by an educational grant from Lilly USA, LLC. Diabetes affects 25.8 million people in the United States, translating to 8.3% of the US population, and another 79 million people have prediabetes, according to ADA statistics. Of the adults with type 1 and type 2 diabetes, the Centers for Disease Control and Preventions National Diabetes Fact Sheet, 2011, estimated that 26% use insulin, with 12% using insulin only and 14% using insulin plus oral antidiabetes drugs. Bruce Bode, MD, FACE, Atlanta Diabetes Associates, clinical associate professor, department of medicine, Emory University School of Medicine, opened the symposium by discussing insulin resistance and severe insulin resistance. A total daily insulin dose is a simple, practical, and clinically meaningful assessment of insulin sensitivity, according to a study by Ovalle in Diabetes Research and Clinical Practice in 2010, who defined severe insulin resistance as requiring >200 to 300 units of insulin a day and extreme insulin resistance as needing >300 units a day. It is unclear how many people have severe or extreme insulin resistance, but the number is growing, according to Dr. Bode. A study by Segal et al, published in American Journal of Health-System Pharmacy in 2010, found that from June 2007 to June 2009, use of U-500 regular insulin increased by 137%. The increase is attributed pr Continue reading >>

Insulin Resistance

Insulin Resistance

Tweet Insulin resistance is the name given to when cells of the body don’t respond properly to the hormone insulin. Insulin resistance is the driving factor that leads to type 2 diabetes, gestational diabetes and prediabetes. Insulin resistance is closely associated with obesity; however, it is possible to be insulin resistant without being overweight or obese. Modern research has shown that insulin resistance can be combatted by treatment methods that reduce how much insulin the body is producing or taking via insulin injections or insulin pumps. Reducing insulin resistance can be achieved by following low-carbohydrate and ketogenic diets. What is insulin resistance? The role of insulin is to allow cells of the body to take in glucose to be used as fuel or stored as body fat. [282] It also means that glucose is more likely to build up in the blood and this can lead to too high blood sugar levels. When the body becomes resistant to insulin, it tries to cope by producing more insulin. People with insulin resistance are often producing too more insulin than healthy people. Producing too much insulin is known as hyperinsulinemia. Symptoms of insulin resistance Initially, insulin resistance presents no symptoms. The symptoms only start to appear once it leads to secondary effects such as higher blood sugar levels. When this happens, the symptoms may include: Lethargy (tiredness) Hunger Difficulty concentrating (brain fog) Other signs that often appear in people with insulin resistance include: Weight gain around the middle (belly fat) High blood pressure High cholesterol levels If insulin resistance develops into prediabetes or type 2 diabetes, the symptoms will include increased blood glucose levels and more of the classic symptoms of type 2 diabetes. Causes of insulin r Continue reading >>

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