Insulin resistance
The content of the article:
- Causes and risk factors
- Forms of the disease
- Insulin resistance symptoms
- Diagnostics
- Insulin Resistance Treatment
- Diet for insulin resistance
- Possible complications and consequences
- Forecast
- Prevention
Insulin resistance is a violation of the metabolic response to endogenous or exogenous insulin. In this case, immunity can manifest itself both to one of the effects of insulin, and to several.
Insulin is a peptide hormone produced in the beta cells of the islets of Langerhans in the pancreas. It has a multifaceted effect on metabolic processes in almost all tissues of the body. The main function of insulin is the utilization of glucose by cells - the hormone activates key glycolysis enzymes, increases the permeability of cell membranes to glucose, stimulates the formation of glycogen from glucose in muscles and liver, and also enhances the synthesis of proteins and fats. The mechanism that stimulates the release of insulin is an increase in the concentration of glucose in the blood. In addition, the formation and secretion of insulin is stimulated by food intake (not only carbohydrate). Elimination of the hormone from the bloodstream is performed primarily by the liver and kidneys. Disruption of the action of insulin on tissues (relative insulin deficiency) is of key importance in the development of type 2 diabetes mellitus.
In industrialized countries, insulin resistance is recorded in 10-20% of the population. In recent years, there has been an increase in the number of insulin-resistant patients among adolescents and young people.
Insulin resistance can develop on its own or be the result of a disease. According to the data of the conducted studies, insulin resistance is recorded in 10-25% of people without metabolic disorders and obesity, in 60% of patients with arterial hypertension (with an arterial pressure of 160/95 mm Hg and above), in 60% of cases of hyperuricemia, in 85% of people with hyperlipidemia, in 84% of patients with type 2 diabetes mellitus, as well as in 65% of people with impaired glucose tolerance.
Causes and risk factors
The mechanism of insulin resistance development is not fully understood. Its main cause is considered to be violations at the post-receptor level. It has not been established exactly which genetic disorders underlie the development of the pathological process, despite the fact that there is a clear genetic predisposition to the development of insulin resistance.
Source: magicworld.su
The onset of insulin resistance may be due to a violation of its ability to suppress glucose production in the liver and / or stimulate glucose uptake by peripheral tissues. Since a significant part of glucose is utilized by muscles, it is assumed that the cause of the development of insulin resistance may be a violation of glucose utilization by muscle tissue, which is stimulated by insulin.
In the development of insulin resistance in type 2 diabetes mellitus, congenital and acquired factors are combined. Monozygous twins with type 2 diabetes mellitus show more pronounced insulin resistance compared to twins without diabetes mellitus. The acquired component of insulin resistance manifests itself during the manifestation of the disease.
The causes of secondary insulin resistance in type II diabetes mellitus include a state of prolonged hyperglycemia, which leads to a decrease in the biological effect of insulin (glucose-induced insulin resistance).
In type 1 diabetes mellitus, secondary insulin resistance occurs due to poor diabetes control; with improved compensation of carbohydrate metabolism, insulin sensitivity increases markedly. In patients with type 1 diabetes mellitus, insulin resistance is reversible and correlates with the blood glycosylated hemoglobin content.
Risk factors for the development of insulin resistance include:
- genetic predisposition;
- overweight (when the ideal body weight is exceeded by 35–40%, the sensitivity of tissues to insulin decreases by about 40%);
- arterial hypertension;
- infectious diseases;
- metabolic disorders;
- period of pregnancy;
- trauma and surgery;
- lack of physical activity;
- the presence of bad habits;
- taking a number of medicines;
- poor nutrition (primarily the use of refined carbohydrates);
- insufficient night sleep;
- frequent stressful situations;
- elderly age;
- belonging to certain ethnic groups (Hispanics, African Americans, Native Americans).
Forms of the disease
Insulin resistance can be primary and secondary.
By origin, it is divided into the following forms:
- physiological - can occur during puberty, during pregnancy, during a night's sleep, with an excessive amount of fat from food;
- metabolic - observed in type 2 diabetes mellitus, decompensation of type 1 diabetes mellitus, diabetic ketoacidosis, obesity, hyperuricemia, malnutrition, alcohol abuse;
- endocrine - observed in hypothyroidism, thyrotoxicosis, pheochromocytoma, Itsenko-Cushing's syndrome, acromegaly;
- non - endocrine - occurs with cirrhosis of the liver, chronic renal failure, rheumatoid arthritis, heart failure, cancer cachexia, myotonic dystrophy, trauma, surgery, burns, sepsis.
Insulin resistance symptoms
There are no specific signs of insulin resistance.
High blood pressure is often noted - it has been found that the higher the blood pressure, the greater the degree of insulin resistance. Also, in patients with insulin resistance, appetite is often increased, there is an abdominal type of obesity, and gas production may be increased.
Other signs of insulin resistance include difficulty concentrating, blurred consciousness, decreased vitality, fatigue, daytime sleepiness (especially after eating), depressed mood.
Diagnostics
To diagnose insulin resistance, they collect complaints and anamnesis (including family history), physical examination, and laboratory analysis for insulin resistance.
When collecting anamnesis, attention is paid to the presence of diabetes mellitus, hypertension, cardiovascular diseases in close relatives, gestational diabetes during pregnancy in women giving birth.
Laboratory diagnostics for suspected insulin resistance includes a complete blood count and urine analysis, a biochemical blood test, as well as laboratory determination of the level of insulin and C-peptide in the blood.
Source: diabetik.guru
In accordance with the diagnostic criteria for insulin resistance adopted by the World Health Organization, it is possible to assume its presence in a patient on the following grounds:
- abdominal obesity;
- an increased level of triglycerides in the blood (above 1.7 mmol / l);
- a reduced level of high density lipoproteins (below 1.0 mmol / l in men and 1.28 mmol / l in women);
- impaired glucose tolerance or increased fasting blood glucose (fasting glucose above 6.7 mmol / L, glucose level two hours after oral glucose tolerance test 7.8-11.1 mmol / L);
- excretion of albumin in the urine (microalbuminuria above 20 mg / min).
To determine the risks of insulin resistance and associated cardiovascular complications, the body mass index is determined:
- less than 18.5 kg / m 2 - underweight, low risk;
- 18.5-24.9 kg / m 2 - normal body weight, normal risk;
- 25.0–29.9 kg / m 2 - overweight, increased risk;
- 30.0–34.9 kg / m 2 - 1st degree obesity, high risk;
- 35.0–39.9 kg / m 2 - obesity degree 2, very high risk;
- 40 kg / m 2 - obesity grade 3, extremely high risk.
Insulin Resistance Treatment
Medical treatment of insulin resistance consists in taking oral hypoglycemic drugs. Patients with type 2 diabetes mellitus are prescribed hypoglycemic drugs that enhance the utilization of glucose by peripheral tissues and increase the sensitivity of tissues to insulin, which leads to compensation of carbohydrate metabolism in such patients. To avoid liver dysfunctions during drug therapy, it is recommended to monitor the concentration of hepatic transaminases in the blood serum of patients at least once every three months.
In case of arterial hypertension, antihypertensive therapy is prescribed. With an increased content of cholesterol in the blood, lipid-lowering drugs are indicated.
It should be borne in mind that drug therapy for insulin resistance without correcting excess body weight is ineffective. Lifestyle correction plays an important role in treatment, primarily nutrition and physical activity. In addition, it is necessary to adjust the daily routine in order to ensure a full night's rest.
A course of physiotherapy exercises allows you to tone the muscles, as well as increase muscle mass and thus reduce the concentration of glucose in the blood without additional production of insulin. Patients with insulin resistance are advised to engage in physical therapy for at least 30 minutes a day.
Reducing the amount of adipose tissue with significant fat deposits can be performed surgically. Surgical liposuction can be laser, water-jet, radiofrequency, ultrasonic, it is performed under general anesthesia and allows you to get rid of 5-6 liters of fat in one procedure. Non-surgical liposuction is less traumatic, can be performed under local anesthesia and has a shorter recovery time. The main types of non-surgical liposuction are cryolipolysis, ultrasonic cavitation, and injection liposuction.
For morbid obesity, treatment with bariatric surgery may be considered.
Diet for insulin resistance
A prerequisite for the effectiveness of therapy for insulin resistance is diet. The diet should be predominantly protein-vegetable, carbohydrates should be represented by foods with a low glycemic index.
Recommended for consumption are vegetables with a low starch content and foods rich in fiber, low-fat meats, seafood and fish, dairy and sour milk products, buckwheat dishes, as well as foods rich in omega-3 fatty acids, potassium, calcium, magnesium.
Limit vegetables with a high starch content (potatoes, corn, pumpkin), exclude white bread and baked goods, rice, pasta, whole cow's milk, butter, sugar and pastries, sweetened fruit juices, alcohol, and fried and fatty foods …
For patients with insulin resistance, a Mediterranean diet is recommended, in which olive oil is the main source of dietary lipids. The diet can include non-starchy vegetables and fruits, dry red wine (in the absence of pathologies of the cardiovascular system and other contraindications), dairy products (natural yogurt, feta cheese, feta). Dried fruits, nuts, seeds, olives are allowed to be consumed no more than once a day. You should limit the consumption of red meat, poultry, animal fat, eggs, table salt.
Possible complications and consequences
Insulin resistance can cause atherosclerosis by impairing fibrinolysis. In addition, type 2 diabetes mellitus, cardiovascular diseases, skin pathologies (acanthosis black, acrochordon), polycystic ovary syndrome, hyperandrogenism, growth abnormalities (enlargement of facial features, accelerated growth) can develop against its background. Disturbances in the regulation of lipid metabolism in insulin resistance lead to the development of fatty degeneration of the liver (both mild and severe) with the subsequent risk of cirrhosis or liver cancer.
Forecast
With timely diagnosis and properly selected treatment, the prognosis is favorable.
Prevention
In order to prevent the development of insulin resistance, it is recommended:
- correction of excess body weight;
- balanced diet;
- rational work and rest regime;
- sufficient physical activity;
- avoidance of stressful situations;
- rejection of bad habits;
- timely treatment of diseases that can cause the development of insulin resistance;
- timely seeking medical help and conducting an analysis for insulin resistance in case of suspicion of a violation of carbohydrate metabolism;
- avoidance of uncontrolled use of drugs.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
