Insulin resistance management

Because of the polyfactorial nature of disease states, such as obesity, type 2 diabetes, and Metabolic Syndrome, it is expected that drugs targeting the lipid synthesis and metabolism pathways will be used in the context of combination therapy [7]. Pre-clinical and clinical results to date indicate that pronounced efficacy could be achieved toward the management of associated lipid levels and insulin resistance, and thus, investigation in these areas provides significant promise. 

The sulfonylureas are ineffective for the management of type I and severe type II diabetes mellitus, since the number of viable -cells in these forms of diabetes is small. Severely obese diabetics often respond poorly to the sulfonylureas, possibly because of the insulin resistance that often accompanies obesity. 

Leptin therapy has corrected obesity in a child with congenital leptin deficiency. In obese individuals, the presence of circulating high levels of leptin has been attributed to resistance or some other defect in the leptin receptors. This apparent paradox of high leptin levels associated with obesity is analogous to insulin resistance seen in type 2 diabetes mellitus. In general, in the vast majority of obese patients, the molecular defects remain unknown. Diet and exercise are the mainstays in the management of obesity. 

Dyslipidaemia is strongly correlated to insulin resistance and hyperinsulinaemia. It is present at the time of diagnosis of diabetes as part of the insulin-resistance syndrome and persists despite treatment of glycaemia. It should be treated in its own right indeed, given the evidence of benefit from RCTs, effective management of dyslipidaemia needs to move centrestage in the prevention of CVD. 

Simopoulos, A.P, Evolutionary aspects of diet Fatty acids, insulin resistance and obesity, in Obesity New Directions in Assessment and Management, Vanitallie, T.B. and Simopoulos, A.P, Eds., Charles Press, Philadelphia, 1995, 241. 

A very detailed review of potential mechanisms leading to adverse reactions to statins summarized a large body of evidence and guidelines for managing patients who have had adverse reactions [13 ]. Rare consequences relating to proinflammatory effects on the immune system, the developing evidence on insulin resistance, rmd the controversy over possible associations with cancers were fully discussed. 

Furthermore, Aloe vera has shown its potential in the management of diabetes mellitus (DM). In this age of increased number of diabetics, Aloe vera gel can prove to be an inexpensive and reliable source of treatment. Clinical trials have shown that in obese individuals with prediabetes or early untreated T)M, Aloe vera gel complex reduced body weight, body fat mass, and insulin resistance (Choi et al., 2013). Abo-Youssef and Messiha (2013) also proved the antidiabetie effect oiAloe vera leaf pulp extract in vivo and in vitro as compared to glimiperide. Another important detail is that Aloe vera contains anthraquinones, namely aloesin, aloe-emodin and barbaloin, that exert chemo-preventive effect through modulating antioxidant and detoxification enzyme activity levels, which are one of the indicators of tumorigenesis (El-Shemy et al., 2010) and can thus be used as a cancer treatment. 

In a patient who does have a close family history of diabetes-2, a glucocorticoid should be avoided if possible, because it can increase insulin resistance and make manifest diabetes-2 glucose dysmetabo-lism. Accordingly, asking about a close family history of diabetes-2 is very important in managing a chronic immune dysschwannian polyneuropathy (CIDP) (sometimes less precisely called chronic inflammatory demyelinating polyneuropathy), or other dysimmune patient. 

M. E. Peterson, Diagnosis and management of insulin resistance in dogs and cats with diabetes mellitus, Vet. Clin. North Am. Small Anim. Pract., 1995, 25, 691-713. 

It can be hypothesized that a reduction in the general and postprandial glycemic and insulinemic response may delay the development of insulin resistance and thus the development of diabetes (NIDDM) although there is very little direct evidence to support this hypothesis. However, diets high in both carbohydrate and dietary fiber have been reported to improve insulin sensitivity. Much of the research in this area has studied the effect of dietary fiber on the management rather than the prevention or etiology of diabetes. 

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