Diabetes: Insulin Resistance Syndrome

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• Introduction to insulin resistance syndrome
• What is insulin resistance?
• What are the components of the insulin resistance syndrome?
• How is insulin resistance syndrome diagnosed?
• What is the treatment for insulin resistance syndrome?
• Is insulin resistance syndrome preventable?

Introduction

Insulin resistance syndrome is a term used to describe a combination of medical conditions that have a common link -- an increased risk of premature heart disease.

The cluster of medical conditions that make up the insulin resistance syndrome places a person at risk of developing type 2 diabetes and atherosclerosis (hardening of the arteries). It is estimated that 70 to 80 million Americans have the combination of diseases caused by insulin resistance syndrome.

Those diseases are:

• Obesity
• Type 2 diabetes
• High blood pressure
• Abnormal cholesterol levels
• Heart disease
• Polycystic ovarian syndrome

What Is Insulin Resistance?

Normally, food is absorbed into the bloodstream in the form of sugars such as glucose and fats and other basic substances. The increase in glucose in the bloodstream signals the pancreas (an organ located behind the stomach) to increase the secretion of a hormone called insulin. This hormone attaches to cells, removing glucose from the bloodstream so that it can be used for energy.

In insulin resistance, the body's cells have a diminished ability to respond to the action of the insulin hormone. To compensate for the resistance, the pancreas secretes more insulin.

People with this syndrome have insulin resistance and high levels of insulin in the blood as a marker of the disease rather than a cause.

Over time people with insulin resistance can develop high sugars or diabetes as the high insulin levels can no longer compensate for elevated sugars.

What Are The Components of the Insulin Resistance Syndrome?

• Impaired fasting glucose, impaired glucose tolerance or type 2 diabetes. This occurs because the pancreas is unable to turn out enough insulin to overcome the insulin resistance. Blood glucose levels rise and diabetes is diagnosed.
• High blood pressure. The mechanism is unclear, but studies suggest that the worse the blood pressure, the worse the insulin resistance.
• Abnormal cholesterol levels. The typical cholesterol levels of a person with insulin resistance are low HDL, or good cholesterol, and high levels of another blood fat called triglyceride.
• Heart disease. The insulin resistance syndrome can result in atherosclerosis (hardening of the arteries) and an increased risk of blood clots.
• Obesity. A major factor in the development of insulin resistance syndrome is obesity especially abdominal obesity. Obesity promotes insulin resistance and negatively impacts insulin responsiveness in a person. Weight loss can improve the body's ability to recognize and use insulin appropriately.
• Kidney damage. Protein in the urine is a sign that kidney damage has occurred, although not everyone uses this component to define the insulin resistant syndrome.

How Is Insulin Resistance Syndrome Diagnosed?

There is no simple test to diagnose the insulin resistance syndrome. Rather, your doctor may suspect the syndrome if you have the following:

• More than one parent or sibling who has type 2 diabetes, hypertension, or cardiovascular disease
• Obesity or overweight (BMI - body mass index- above 25)
• More fat around the waist than around the hips (an apple shape)
• Age greater than 40 years
• Gestational diabetes when pregnant
• A history of a condition called polycystic ovary syndrome (PCOS)
• Pre-diabetes
• Are a member of certain ethnic groups (Latino, Blacks, Native American)

The current epidemic of obesity in children also puts them at risk for the development of the insulin resistance syndrome.

What's The Treatment?

Metformin (Glucophage), Actos and Avandia are all approved to treat the insulin resistance that occurs with type 2 diabetes. These drugs make your body more sensitive to the actions of insulin. Multiple drugs, such as cholesterol-lowering drugs or anti-hypertensive drugs are usually necessary to treat the different conditions that are part of the insulin resistance syndrome.

Is It Preventable?

Yes. If you live a healthy lifestyle, you may be able to avoid getting these diseases. Here are some tips:

• Exercise. Try walking 30 minutes a day for at least 5 days a week (exercise can be divided into 3 separate periods of 10 minutes each)
• Stay at a healthy weight
• Eat right. A healthy balanced and caloric restricted diet is recommended.

Reviewed by Certified Diabetes Educators in the Department of Patient Education and Health Information and by physicians in the Department of Endocrinology at The Cleveland Clinic.

Edited by Brunilda Nazario, MD, WebMD, October 2004.

Portions of this page copyright © The Cleveland Clinic 2000-2005