Insulin Resistance, Type 1 And Type 2 Diabetes, And Related Complications 2017
Copyright © 2017 Joseph Fomusi Ndisang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The global escalation of obesity and diabetes in developed and developing nations poses a great health challenge. Obesity is one of the major causes of type 2 diabetes. Type 1 diabetes is primarily due to the autoimmune-mediated destruction of pancreatic beta cell leading to insulin deficiency [1–3]. This is usually accompanied by alterations in lipid metabolism, enhanced hyperglycemia-mediated oxidative stress, endothelial cell dysfunction, and apoptosis [1–3]. Similarly, in type 2 diabetes, increased glucotoxicity, lipotoxicity, endoplasmic reticulum-induced stress, and apoptosis lead to the progressive loss of beta cells [1–5]. While type 1 diabetes is characterized by the presence of beta cell autoantibodies, a combination of peripheral insulin resistance and dysfunctional insulin secretion by pancreatic beta cells is implicated in the pathogenesis of type 2 diabetes [1–3]. However, both forms of diabetes are associated by a wide variety of complications such as cardiomyopathy, nephropathy, and neuropathy. Although insulin resistance has traditionally been associated with type 2 diabetes, mounting evidence indicates that the incidence of insulin resistance in type 1 diabetes is increasing ; therefore, novel mechanistic approaches deciphering insulin resistance are needed. Many pathophysiological factors are implicated in insulin resistance [5, 7]. Although the exact natures of these factors are not completely understood, it is widely accepted that oxidative stress, inflammation, and genetic, habitu Continue reading >>
Insulin Sensitivity Factor
The drop in blood glucose level, measured in milligrams per deciliter (mg/dl), caused by each unit of insulin taken. Knowing their insulin sensitivity factor can help people with Type 1 diabetes to determine the dose of short-acting or rapid-acting insulin to take. Health-care professionals use the “1500 rule” to calculate insulin sensitivity factor for people who use Regular (short-acting) insulin. The 1500 rule works as follows: Divide 1500 by the total daily dose of Regular insulin, in units. For example, if a person’s total daily dose is 30 units of Regular insulin, his insulin sensitivity factor would be 50 (1500 ÷ 30). So one unit of Regular insulin would be estimated to lower his blood glucose by 50 mg/dl. Health-care professionals use the “1800 rule” to calculate insulin sensitivity factor for people who use the rapid-acting insulin analogs lispro (brand name Humalog), aspart (NovoLog), and glulisine (Apidra). This is done by dividing 1800 by the total daily dose of rapid-acting insulin. If the total daily insulin dose is 40 units, the insulin sensitivity factor would be 1800 divided by 40, or 45. Insulin sensitivity factor can be calculated only for people with Type 1 diabetes. It cannot be calculated reliably for people with Type 2 diabetes, whose pancreases often still make some insulin and who have varying degrees of insulin resistance. Continue reading >>
All You Need To Know About Insulin Sensitivity Factor
Insulin is a hormone that plays an important role in the body's metabolism by controlling blood sugar levels and other processes. It is produced by beta cells in the pancreas and released it into the bloodstream after we eat to enable some body cells, such as muscle, fat, and heart cells, to absorb the sugar from the food we eat. Insulin also helps store glucose in the liver as glycogen when it is not needed, so it can be released when blood sugar levels are low or when more energy is needed. Therefore, insulin is essential for regulating blood sugar, ensuring that levels remain within certain limits and do not climb too high or fall too low. What is insulin sensitivity factor? Insulin sensitivity factor, or correction factor, refers to the number of milligrams per deciliter (mg/dl) fall in blood sugar levels caused by taking 1 unit of insulin. Knowing this number can help people with type 1 diabetes lower their blood sugar levels when they are out of their target range. This is usually added to the premeal insulin dose and is based on how much higher the person's blood sugar level is compared to their target. Target blood sugar levels need to be determined in discussions with a doctor. According to the American Diabetes Association, they should be as close as possible to healthy non-diabetic levels of: Between 70 and 130 mg/dl before a meal No higher than 180 mg/dl up to 2 hours after a meal Insulin treatment plans vary, but most people with type 1 diabetes are now on a basal-bolus insulin routine. A basal-bolus insulin routine involves injecting a longer-acting form of insulin to keep blood sugar levels stable between meals and when sleeping and injections of faster-acting insulin to cover meals. For people on a pump, an amount of fast-acting insulin is delivered thro Continue reading >>
Insulin Resistance And Associated Factors In Patients With Type 1 Diabetes
Abstract To assess the presence of insulin resistance (IR) in patients with type 1 diabetes (T1DM) according to the estimated glucose disposal rate formula (eGDR) and the insulin sensitivity score (ISS) and to estimate the correlation between these two measures and identify the clinical and laboratory markers related to IR. Cross-sectional study of adults with T1DM (n = 135). The results of the formulas that estimate IR were separated into quartiles and correlated with demographic data, clinical characteristics and laboratory parameters. We analyzed the total and regional adiposity by dual-energy X-ray absorptiometry and skin fold thickness measurements. Two thirds of the patients were overweight or obese. A moderate correlation was found between eGDR and ISS (r = 0.612). The results of both formulas were positively correlated with BMI (r = −0.373 eGDR and r = −0.721 ISS), thoracic-abdominal fat (r = −0.484 eGDR and r = −0.758 ISS), waist/height ratio (r = −0.537 eGDR and r = −0.779 ISS), subscapular skinfold (mm) (r = −0.356 eGDR and r = −0.569 ISS), total dose insulin IU/lean mass (kg) (r = −0.279 eGDR and r = −0.398 ISS), age (years) (r = −0.495 eGDR and r = −0.190 ISS) and diabetes duration (years) (r = −0.428 eGDR and r = −0.187 ISS). A moderate agreement (Kappa 0.226) was observed between the 1st quartile of results determined by the formulas in 10.4% of the patients, but the 4th quartile presented a strong correlation (Kappa 0.679). The individuals with IR that were classified in the 1st quartile by the ISS formula had a higher chance of presenting with acanthosis nigricans (OR = 5.58, 95% CI =1.46-21.3). The correlations found in this study indicate the possibility of using clinical and laboratory data to estimate IR in patients with Continue reading >>
How To Determine Your Insulin Sensitivity Factor
For many people with diabetes, insulin injections are the key to keeping their blood sugar at normal levels. Getting the right amount of insulin can seem a bit tricky at first. This is where you’ll need to do some math to get the dose just right. The pancreas makes the hormone insulin. Insulin helps the body use sugar as an energy source. It also helps balance your blood glucose levels. People with type 1 diabetes don’t make enough insulin. People with type 2 diabetes don’t properly use the insulin their bodies make. Taking insulin is necessary for people with type 1 diabetes, but it can also be important for people who have type 2 diabetes. An insulin dose that’s too high could lower your blood sugar too much. This can cause hypoglycemia. Hypoglycemia occurs when your blood sugar falls below 70 milligrams per deciliter (mg/dL). Hypoglycemia can lead to a loss of consciousness and seizures. Learn more: Humalog vs. NovoLog: Important differences and more » An insulin dose that’s too low may not bring your blood sugar to the target level. The resulting high blood sugar is called hyperglycemia. Hyperglycemia can lead to serious complications over time that can affect your: heart kidneys eyes nerves other organs You’ll need to know how sensitive you are to insulin to know the right dose of insulin to take. In other words, you’ll need to know how much insulin you need to lower your blood sugar by a certain amount. Insulin sensitivity isn’t the same for everyone. Some people with diabetes are more sensitive to insulin that others. In general, people with type 1 diabetes are more sensitive to insulin than people with type 2 diabetes. Your sensitivity to insulin can vary during the day based on your level of activity and your body’s rhythm of daily hormone se Continue reading >>
Insulin Sensitivity In Subjects With Type 2 Diabetes. Relationship To Cardiovascular Risk Factors: The Insulin Resistance Atherosclerosis Study.
Abstract OBJECTIVE: Among nondiabetic subjects, insulin resistance has been associated with increased cardiovascular risk factors, including dyslipidemia, hypertension, impaired fibrinolysis, and coagulation. Less is known about the relationship between insulin resistance and cardiovascular risk factors in subjects with type 2 diabetes. RESEARCH DESIGN AND METHODS: To examine this issue, we determined insulin sensitivity (SI) in 479 type 2 diabetic subjects by minimal model analyses of frequently sampled intravenous glucose tolerance tests in the Insulin Resistance Atherosclerosis Study (IRAS), a large multicenter study of insulin sensitivity and cardiovascular disease in African-Americans, Hispanics, and non-Hispanic whites. We defined insulin-sensitive subjects as having SI > or = 1.61 x 10(-4) min-1.microU-1.ml-1 (above median in nondiabetic subjects of all ethnic groups in the IRAS). Using this definition, only 37 type 2 diabetic subjects were insulin sensitive, and the remaining 442 were insulin resistant. RESULTS: After adjustment for age, sex, ethnicity, and clinic, insulin resistance was significantly correlated with total triglycerides, VLDL cholesterol, VLDL triglyceride, fibrinogen, PAI-1, and fasting glucose, and was inversely correlated with HDL cholesterol level and LDL size. Carotid intimal-medial thickness was greater in insulin-resistant than in insulin-sensitive subjects, but this difference was not statistically significant. After further adjustment for waist circumference (marker of visceral adiposity), insulin-resistant subjects continued to have higher plasminogen activator inhibitor 1 and VLDL triglyceride levels, lower HDL cholesterol levels, and smaller LDL particle size than did insulin-sensitive subjects. After further adjustment for fasting g Continue reading >>
- Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA)*
- Relationship Between Risk Factors, Age, and Mortality in Type 1 Diabetes Patients
- Effects of resveratrol on glucose control and insulin sensitivity in subjects with type 2 diabetes: systematic review and meta-analysis
Tweet Insulin sensitivity describes how sensitive the body is to the effects of insulin. Someone said to be insulin sensitive will require smaller amounts of insulin to lower blood glucose levels than someone who has low sensitivity. Insulin sensitivity varies from person to person and doctors can perform tests to determine how sensitive an individual is to insulin. How does insulin sensitivity affect people with diabetes? People with low insulin sensitivity, also referred to as insulin resistance, will require larger amounts of insulin either from their own pancreas or from injections in order to keep blood glucose stable. Having insulin resistance is a sign that your body is having difficulty metabolising glucose, and this can indicate wider health problems such as high blood pressure and cholesterol levels may also be present. By contrast, having a particularly high sensitivity to insulin can also cause problems for people with type 1 diabetes, particularly young children. Why is insulin sensitivity important? Low insulin sensitivity can lead to a variety of health problems. The body will try to compensate for having a low sensitivity to insulin by producing more insulin. However, a high level of circulating insulin (hyperinsulinemia) is associated with damage to blood vessels, high blood pressure, heart disease and heart failure, obesity, osteoporosis and even cancer. Periods of stress and illness can both introduce short term periods of reduced insulin sensitivity. In most cases, insulin sensitivity should recover once the stress or illness has passed. Can high insulin sensitivity be problematic? Generally speaking, having a good sensitivity to insulin is a sign of good health, however, there are times when a higher sensitivity can be problematic. For people with t Continue reading >>
What’s A Correction Factor? An Insulin Sensitivity? A Ratio?
Share: A Correction Factor (sometimes called insulin sensitivity), is how much 1 unit of rapid acting insulin will generally lower your blood glucose over 2 to 4 hours when you are in a fasting or pre-meal state. However, you should keep in mind: this is an estimate it may need to change as your baseline dose changes expect variations - sometimes 1 unit will lower it by more, and other times 1unit will lower it by less! calculating how much 1 unit of insulin will drop your blood sugar is a trial and error process, and sensitivity to insulin varies with the individual To get your total daily dose, add up all your usual meal time insulin and basal insulin. For example, Tom wants to calculate his correction factor: daily insulin dose: 8 units at breakfast, 6 units at lunch,10 at dinner and N/NPH 8 units at breakfast and 18 units at 10 pm Total Daily Dose (TDD) = 8 + 8 + 6+ 10 + 18 = 50 Correction Factor (CF) = 100/50 = 2 Therefore, one unit of rapid acting insulin would lower Tom’s blood sugar by 2 mmol/L over the next 2 to 4 hours. The average adult needs approximately 1 unit of insulin for every 2 mmol increase in blood sugar, but this can vary a lot between individuals: some people need 1 unit of insulin for every 1 mmol/L increase in blood sugar others need 1 unit of insulin for every 3 -5 mmol/L increase in blood sugar Using your CF before meal doses Before meal means there has been about 4 hours or more since you last ate or took an insulin dose for carbohydrate containing food or beverage. The correction factor or insulin sensitivity can be used to make a scale for pre meal insulin doses. BG Breakfast Lunch Dinner Bed Basal < 3.9 -2 -2 -2 Snack 4.0 - 5.9 Baseline Baseline Baseline Baseline Baseline 6.0 - 7.9 Baseline Baseline Baseline Baseline Baseline 8.0 – 9.9 Continue reading >>
What Is An Insulin Sensitivity Factor?
If you are taking rapid-acting insulin (sometimes called meal or bolus insulin, such as Novorapid, Humalog or Apidra), you educator may talk to you about the option of using an insulin sensitivity factor (ISF, for short) to better control your blood sugars. An ISF tells you how many mmol/l (or ‘blood sugar points’) 1 unit of rapid insulin will lower your blood sugar by. You can use an ISF to calculate how much extra insulin you will need to take when your blood sugar is high, to bring it back into your target range. If you are eating a meal, this would be extra insulin you would need to take, on top of what you would normally take for that meal. As an example, if your ISF is 1:3, this means that 1 unit of rapid insulin will lower your blood sugar by 3 mmol/l. If your ISF is 1:5, this means that 1 unit of rapid insulin will lower your blood sugar by 5 mmol/l. Everyone is different and will use different ISFs and blood sugar targets. You educator can help you figure out what your ISF and target range should be. Once you know what your ISF is, you can use the following steps to calculate how much extra insulin you will need to bring your blood sugar back into target range: Test blood sugar to get your current value Use current blood sugar – blood sugar target to find out how many mmol/l you need to come down to reach your target range Divide value from step 2 by your ISF. To practice, lets say that my ISF is 1:2 (1 unit of rapid insulin lowers my blood sugar by 2 mmol/l), and when I test my blood sugar, it is 12.0 mmol/l. I have set my target to be 6 mmol/l. I can use the steps from above: My blood sugar is 12.0 mmol/l 12.0 -6.0 = 6.0 My blood sugar needs to come down 6.0 mmol/l to reach my target 6.0 / 2 (my ISF) = 3 I will need to take 3 units of additional insulin Continue reading >>
Calculating Insulin Dose
You'll need to calculate some of your insulin doses. You'll also need to know some basic things about insulin. For example, 40-50% of the total daily insulin dose is to replace insulin overnight. Your provider will prescribe an insulin dose regimen for you; however, you still need to calculate some of your insulin doses. Your insulin dose regimen provides formulas that allow you to calculate how much bolus insulin to take at meals and snacks, or to correct high blood sugars. In this section, you will find: First, some basic things to know about insulin: Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement. The basal or background insulin dose usually is constant from day to day. The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. This is called the bolus insulin replacement. Bolus – Carbohydrate coverage The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio.The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. Generally, one unit of rapid-acting insulin will dispose of 12-15 grams of carbohydrate. This range can vary from 4-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress. Bolus – High blood sugar correction (also known as insulin sensitivity factor) The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Generally, to correct a high blood Continue reading >>
Type 2 Diabetes: When Insulin Secretion Fails To Compensate For Insulin Resistance
This article does not have an abstract to display. Diabetes mellitus is the most common metabolic disease worldwide. Every day, 1700 new cases of diabetes are diagnosed in the United States, and at least one-third of the 16 million Americans with diabetes are unaware of it. Diabetes is the leading cause of blindness, renal failure, and lower limb amputations in adults and is a major risk factor for cardiovascular disease and stroke. Normal glucose homeostasis requires the finely tuned orchestration of insulin secretion by pancreatic β cells in response to subtle changes in blood glucose levels, delicately balanced with secretion of counter-regulatory hormones such as glucagon. Type 1 diabetes results from autoimmune destruction of pancreatic β cells causing insulin deficiency. Type 2 or noninsulin-dependent diabetes mellitus (NIDDM) accounts for >90% of cases and is characterized by a triad of (1) resistance to insulin action on glucose uptake in peripheral tissues, especially skeletal muscle and adipocytes, (2) impaired insulin action to inhibit hepatic glucose production, and (3) dysregulated insulin secretion (DeFronzo 1997). In most cases, Type 2 diabetes is a polygenic disease with complex inheritance patterns (reviewed in9, 6). Environmental factors, especially diet, physical activity, and age, interact with genetic predisposition to affect disease prevalence. Susceptibility to both insulin resistance and insulin secretory defects appears to be genetically determined (9, 6). Defects in insulin action precede the overt disease and are seen in nondiabetic relatives of diabetic subjects. Initially, increased insulin secretion compensates for insulin resistance but overt disease occurs over time as β cell compensation fails. The possibility that Type 2 diabetes cou Continue reading >>
What’s Your Insulin Sensitivity Factor?
Whether you have type 1 or type 2 diabetes, if you’re taking insulin via pump, pen, or syringe, you need to know your “insulin sensitivity factor” or “correction factor.” Without knowing this number, you don’t know how much insulin you need to correct a high blood sugar and risk either going far too low after an injection or simply not going low enough to meet the goal of a healthy blood sugar level. What is an “Insulin Sensitivity Factor”? A ISF (insulin sensitivity factor) is the number of points in your blood sugar by which 1 unit of insulin will reduce your blood sugar. For instance, my ISF is 1:100, which means that if my blood sugar is 200 mg/dL and I want to take a correction dose to bring it down to 125 mg/dL, I would need to take .75 units of insulin. Depending on your level of activity, insulin sensitivity or insulin resistance, your age, your diet, the amount of carbohydrates you consume on a daily basis, and your bodyweight, your ISF could range anywhere from 2 to 200! Children are obviously far more sensitive to insulin than grown adults. Teenagers tend to have higher insulin needs than adults because of growth hormones, and those with type 2 diabetes are more likely to have greater insulin resistance (hence the type 2 diabetes diagnosis). I have worked both with adult type 2 diabetes who had ISF ratios of 1:3 (1 unit drops them 3 points in their blood sugar) and young children who had ISF ratios of 1:150 (1 unit drops them 150 points). How to Determine Your ISF: Gary Scheiner, MS. CDE. explains on page 163 of his book, “Think Like a Pancreas,” that you can actually get a close estimate of your ISF based on your total daily insulin usage in this chart on the right. But don’t stop there simply with the number you get from the chart on t Continue reading >>
Influence Of Family History Of Type 2 Diabetes On Insulin Sensitivity In Prepubertal Children
Influence of Family History of Type 2 Diabetes on Insulin Sensitivity in Prepubertal Children Departments of Preventive Medicine (M.I.G., K.C., M.L.C.), Los Angeles, California 90033 Physiology and Biophysics (M.I.G., R.N.B.), Keck School of Medicine, University of Southern California, Los Angeles, California 90033 Address all correspondence and requests for reprints to: Michael I. Goran, Ph.D., Department of Preventive Medicine, University of Southern California, 1540 Alcazar Street, Room 208-D, Los Angeles, California 90033. Search for other works by this author on: Departments of Preventive Medicine (M.I.G., K.C., M.L.C.), Los Angeles, California 90033 Search for other works by this author on: Physiology and Biophysics (M.I.G., R.N.B.), Keck School of Medicine, University of Southern California, Los Angeles, California 90033 Search for other works by this author on: Departments of Preventive Medicine (M.I.G., K.C., M.L.C.), Los Angeles, California 90033 Search for other works by this author on: Department of Nutrition Sciences (B.A.G.), University of Alabama at Birmingham, Birmingham, Alabama 35294 Search for other works by this author on: The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 1, 1 January 2003, Pages 192195, Michael I. Goran, Kate Coronges, Richard N. Bergman, Martha L. Cruz, Barbara A. Gower; Influence of Family History of Type 2 Diabetes on Insulin Sensitivity in Prepubertal Children, The Journal of Clinical Endocrinology & Metabolism, Volume 88, Issue 1, 1 January 2003, Pages 192195, The objective of this study was to examine the influence of positive family history (FH) of type 2 diabetes (T2D) on aspects of insulin resistance in prepubertal children. Twenty-one children (Tanner stage I or II) with a positive FH were compared with Continue reading >>
Insulin Resistance: Causes, Symptoms, Diagnosis, And Consequences | Everyday Health
RELATED: Everything You Need to Know About Insulin if You Have Type 2 Diabetes Understanding Insulin Resistance and Its Effect on Blood Sugar Control Although the production and release of insulin is a natural metabolic response after eating, some people don’t use insulin properly. To receive energy, your cells, fat, and muscles must be able to absorb the glucose in your bloodstream. If your body doesn’t respond well to insulin, glucose can build up in your blood and raise your blood sugar level. To help you maintain a normal blood sugar level, your pancreas compensates for this resistance by releasing more insulin. (3) The effects of insulin resistance on the body vary from person to person. Sometimes, the increased production of insulin by the pancreas is enough to overcome insulin resistance and normalize blood sugar levels. But other times, the pancreas is unable to produce sufficient amounts of insulin to overcome the resistance. This triggers high blood sugar and other health problems. (3) Although insulin resistance can exist on its own without another diagnosis, it relates to certain health conditions, too. Here are a few: If your pancreas struggles to produce enough insulin to handle the glucose in your body, your blood sugar level can become mildly elevated and you may develop prediabetes . This means your blood sugar is higher than normal but not high enough to be diagnosed with diabetes. This condition — which affects about 84.1 million people — is a precursor to type 2 diabetes . Having prediabetes also is associated with an increased risk for heart disease, stroke, eye problems, and kidney disease. In the case of prediabetes, your pancreas works overtime to secrete enough insulin to regulate your blood sugar. But if your pancreas can’t keep up w Continue reading >>
Insulin Resistance And Type 2 Diabetes
For well over half a century, the link between insulin resistance and type 2 diabetes has been recognized. Insulin resistance is important. Not only is it the most powerful predictor of future development of type 2 diabetes, it is also a therapeutic target once hyperglycemia is present. In this issue of Diabetes, Morino et al. (1) report a series of studies that provide evidence of a genetic mechanism linking expression of lipoprotein lipase (LPL) to peroxisome proliferator–activated receptor (PPAR)-δ expression and mitochondrial function. This is likely to contribute to the muscle insulin resistance that predisposes to type 2 diabetes. Observation of abnormal mitochondrial function in vitro in type 2 diabetes (2) was soon followed by in vivo demonstration of this abnormality in insulin-resistant, first-degree relatives of people with type 2 diabetes (3). Further reports of a modest defect in muscle mitochondrial function in type 2 diabetes were published shortly thereafter (4,5). These studies raised the question of whether type 2 diabetes could be a primary disorder of the mitochondria. However, the study of first-degree relatives tended to be misinterpreted as having shown a major defect in mitochondrial function in type 2 diabetes, although it had studied nondiabetic groups from the opposite ends of the insulin resistance–sensitivity spectrum. Indeed, other studies showed no defect in mitochondrial function in type 2 diabetes (6,7), which led to further confusion. Mitochondrial function was then shown to be acutely modifiable by changing fatty acid availability (8) and that it was affected by ambient blood glucose concentration (9). When ambient blood glucose levels were near normal in diabetes, no defect in mitochondrial function was apparent. But if mitochond Continue reading >>