DOCTOR'S VIEW ARCHIVEMedical Author: Ruchi Mathur, M.D.
Medical Editor: William C. Shiel, Jr., MD, FACP, FACR
"My mother has diabetes. How do I know if I will develop diabetes?" This was the question posed to me by a 48 year old patient last week. This patient is an obese woman who is being treated for high cholesterol and high blood pressure. Her profile fits the high risk group for diabetes, which brings up the subject of insulin resistance.
During the middle of the last century, physicians noticed that patients treated with diabetes could be divided into two major groups: those with type 1 diabetes (requiring insulin to sustain life) and those with type 2 diabetes (non-insulin dependent). Over the next few years, this second group was noted to have high circulating levels of insulin. The term insulin resistance (IR) was coined to describe this subgroup of patients. What exactly does this mean and why is this distinction important?
Insulin is a growth factor that is responsible for many actions within the body. Most of these actions deal with the metabolism and usage of carbohydrates (sugars and starches), lipids (fats), and protein. Insulin is involved with cell growth and regulation. IR is the condition whereby the normal response of the body to a given amount of insulin in transporting glucose (sugar) into cells is diminished.
IR is also a risk factor for heart disease and death.
The ideal treatment of IR has not yet been agreed upon. Diabetes experts can help with options currently available for diabetes. While IR is associated with an increased risk of death, there has been no major study to show that treating IR early reduces the risks of complications. It is my personal opinion that over the next few years, we will see an important shift in the treatment of diabetes. While the actual treatment of diabetes will continue, and be more precise, I think we will start to see doctors focus their attention on the treatment of earlier forms of abnormal sugar metabolism (prediabetes).
In our clinic, we have taken to
measuring fasting insulin and glucose levels in patients at risk for the
development of diabetes, or with associated complaints such as polycystic
ovarian syndrome. If insulin levels are high, we discuss treatment options
including specific lifestyle changes as well as medications. While there are
pros and cons to any argument, one thing is certain. Maintaining a healthy
lifestyle, including exercise and good nutrition, is really the best way to
prevent and reverse the course of IR and its complications down the road.
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