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Medical Author:

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Medical Editor:

Robert Ferry Jr., MD

Robert Ferry Jr., MD

Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.

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In this Article

• Insulin resistance facts
• What is insulin resistance?
• What causes insulin resistance?
• What is the relationship between insulin resistance and diabetes?
• What medical conditions are associated with insulin resistance?
• Who is at risk for insulin resistance?
• How is insulin resistance diagnosed?
• How is insulin resistance managed?
• Lifestyle changes (diet, weight loss, exercise)
• Medications
• What's new in insulin resistance?
• Patient Comments: Insulin Resistance - Symptoms
• Patient Comments: Insulin Resistance - Describe Your Experience
• Find a local Endocrinologist in your town
• Insulin Resistance Index

There are several causes for insulin resistance, and genetic factors (inherited component) are usually significant. Some medications can contribute to insulin resistance. In addition, insulin resistance is often seen with the following conditions:

• the metabolic syndrome, which is a group of conditions involving excess weight (particularly around the waist), high blood pressure, and elevated levels of cholesterol and triglycerides in the blood
• obesity
• pregnancy
• infection or severe illness
• stress
• inactivity and excess weight
• during steroid use

Type 2 diabetes mellitus (T2D) is the type of diabetes that occurs later in life or with obesity at any age. Insulin resistance precedes the development of type 2 diabetes, sometimes by years. In individuals who will ultimately develop type 2 diabetes, it has been shown that blood glucose and insulin levels are normal for many years, until at some point in time, insulin resistance develops.

At this point, high insulin levels are often associated with central obesity, cholesterol abnormalities, and/or high blood pressure (hypertension). When these disease processes occur together, it is called the metabolic syndrome.

One action of insulin is to cause the body's cells (particularly the muscle and fat) to remove and use glucose from the blood. This is one way by which insulin controls the level of glucose in blood. Insulin has this effect on the cells by binding to insulin receptors on the surface of the cells. You can think of it as insulin "knocking on the doors" of muscle and fat cells. The cells hear the knock, open up, and let glucose in to be used. With insulin resistance, the muscles don't hear the knock (they are resistant). So, the pancreas is notified that it needs to make more insulin, which increases the level of insulin in the blood and causes a louder knock.

The resistance of the cells continues to increase over time. As long as the pancreas is able to produce enough insulin to overcome this resistance, blood glucose levels remain normal. When the pancreas can no longer produce enough insulin, the blood glucose levels begin to rise. Initially, this happens after meals - when glucose levels are at their highest and more insulin is needed - but eventually while fasting too (for example, upon waking in the morning). When blood sugar rises abnormally, type 2 diabetes is present.