A insulin resistance

Fig. 32. The 30-year-old male patient with acquired generalized lipodystrophy (AGE) shows lacking lipids in the subcutaneous layer and in the musculature in a Ti-weighted spin-echo image (a) and in a fat selective image (b). Only marrow fat in the tibia and fibula of the patient seems to be not affected by the disease. Comparison between a spectrum from a insulin resistant subject without AGE (c) and the spectrum from the AGE patient (d) reveals that the AGE patient has nearly lacking EMCE and markedly reduced IMCE content.

Dunaif A. Insulin resistance in polycystic ovarian syndrome. Ann N Y Acad Sci 1993 687 60-4. 

Examples of disorders caused by mutations in the insulin receptor gene are leprechaunism and type A insulin resistance. A severe form of leprechaunism is due to mutations in both alleles of the insulin receptor gene. These patients exhibit insulin resistance, intrauterine growth retardation, and many other metabolic abnormalities. Patients with type A insulin resistance exhibit insulin... 

Fonseca, V.A., Insulin resistance, diabetes, hypertension, and renin-angiotensin system inhibition reducing risk for cardiovascular disease. J Clin Hypertens (Greenwich), 2006. 8(10) p. 713-20 quiz 721-2. 

Insulin and Amylin. Insulin is a member of a family of related peptides, the insulin-like growth factors (IGFs), including IGF-I and IGF-II (60) and amylin (75), a 37-amino acid peptide that mimics the secretory pattern of insulin. Amylin is deficient ia type 1 diabetes meUitus but is elevated ia hyperinsulinemic states such as insulin resistance, mild glucose iatolerance, and hypertension (33). Insulin is synthesized ia pancreatic P cells from proinsulin, giving rise to the two peptide chains, 4. and B, of the insulin molecule. IGF-I and IGF-II have stmctures that are homologous to that of proinsulin (see INSULIN AND OTHER ANTIDIABETIC DRUGS). 

Type 2 diabetes is a heterogeneous and progressive endocrine disorder associated with insulin resistance (impaired insulin action) and defective function of the insulin-secreting (3-cells in the pancreatic islets of Langerhans. These endocrine disorders give rise to widespread metabolic disturbances epitomised by hyperglycaemia. The present classes of antidiabetic agents other than insulin act to either increase insulin secretion, improve insulin action, slow the rate of intestinal... 

PPARy is a transcription factor which controls the expression of enzymes and proteins involved in fat and glucose metabolism. More importantly, stimulation of this receptor induces differentiation of preadipocytes to adipose cells. It is believed that the formation of additional, small fat cells lowers free fatty acids and hepatic triglycerides, thereby collecting insulin resistance. 

Thiazolidinediones (synonyms glitazones, insulin sensitizers rosiglitazone, pioglitazone) are a novel class of oral antidiabetic drugs that activate the transcription factor peroxisome proliferator-activated receptor (PPARy). Thiazolidinediones ameliorate insulin resistance in obese animal models and in individuals... 

Insulin resistance occurs when the normal response to a given amount of insulin is reduced. Resistance of liver to the effects of insulin results in inadequate suppression of hepatic glucose production insulin resistance of skeletal muscle reduces the amount of glucose taken out of the circulation into skeletal muscle for storage and insulin resistance of adipose tissue results in impaired suppression of lipolysis and increased levels of free fatty acids. Therefore, insulin resistance is associated with a cluster of metabolic abnormalities including elevated blood glucose levels, abnormal blood lipid profile (dyslipidemia), hypertension, and increased expression of inflammatory markers (inflammation). Insulin resistance and this cluster of metabolic abnormalities is strongly associated with obesity, predominantly abdominal (visceral) obesity, and physical inactivity and increased risk for type 2 diabetes, cardiovascular and renal disease, as well as some forms of cancer. In addition to obesity, other situations in which insulin resistance occurs includes... 

Disorders of lipoprotein metabolism involve perturbations which cause elevation of triglycerides and/or cholesterol, reduction of HDL-C, or alteration of properties of lipoproteins, such as their size or composition. These perturbations can be genetic (primary) or occur as a result of other diseases, conditions, or drugs (secondary). Some of the most important secondary disorders include hypothyroidism, diabetes mellitus, renal disease, and alcohol use. Hypothyroidism causes elevated LDL-C levels due primarily to downregulation of the LDL receptor. Insulin-resistance and type 2 diabetes mellitus result in impaired capacity to catabolize chylomicrons and VLDL, as well as excess hepatic triglyceride and VLDL production. Chronic kidney disease, including but not limited to end-stage... 

TNF is a pleiotropic cytokine exerting a wide range of cellular responses, that affect biological processes such as lipid metabolism, coagulation, and insulin resistance and the function of endothelial cells. As a major proinflammatory cytokine TNF is also involved in progression of diseases like cancer, Alzheimer, Diabetes type II, cardiovascular, pulmonary or neurological disorders, and many autoimmune diseases. Blocking the action of TNF clearly reduces its inflammatory potential on various autoimmune disorders like Crohn s disease, rheumatoid arthritis (RA), and psoriasis. 

Insulin Desensitization Insulin Receptor Insulin Resistance Insulin Secretagogues Insulin-like Growth Factor Integrase Integrin, a 4(31 Integrin, a 4(3 7 Integrin, a IIb(3 3... 

An individual can also become insulin resistant because of the development of antibodies gainst insulin. These patients have impaired receptor function and become so unresponsive to insulin that the daily dose requirement may be in excess of500 units per day (U/ d), rather than the usual 40 to 60 U/d. High-potency insulin in a concentrated form (U500 see the Summary Drug Table Insulin Preparations) is used for patients requiring more than 200 U/d. 

These hormones cause few adverse reactions when administered as directed. Antibodies to somatropin may develop in a small number of patients, resulting in a failure to experience response to therapy, namely, failure of the drug to produce growth in the child. Some patients may experience hypothyroidism or insulin resistance Swelling, joint pain, and muscle pain may also occur. 

Insulin is a powerful anabolic hormone but it is unlikely that insulin deficiency causes skeletal muscle atrophy by direct action on muscle fibers (as opposed to neurogenic atrophy) except in chronic untreated cases. There is however a close parallel between the catabolic states induced by glucocorticoid excess and by insulin deficiency. Moreover, impaired insulin action is implicated in other endocrine myopathies as a contributory cause of muscle wasting. Both acromegaly and thyrotoxicosis are associated with insulin resistance due to a postreceptor defect, and secondary hyperparathyroidism due to hypophosphatemia also gives rise to insulin insensitivity. 

Diabetes is a metabolic disorder where glucose metabolism in the body is impaired. Type 1 diabetes is an early onset disease in which the pancreatic cells lose the function of insulin secretion either by genetic disposition or by a viral attack. Type 2 diabetes is a late onset disease developed due to insufficient insulin secretion or insulin resistance resulting in impaired glucose metabolism. 

---