Diabetes
Sally Robinson in Priorities for Health Promotion and Public Health, 2021
Insulin resistance means that the body’s cells are less responsive to insulin than ‘normal’, which leads to high levels of blood glucose, hyperglycaemia. It is also called having reduced insulin sensitivity. It can lead to high blood pressure and high blood cholesterol (Patel and Abate, 2013). The most common cause of insulin resistance is too much body fat.
Diabetes basics
Erica Whettem in Nursing & Health Survival Guide, 2014
Type 2 diabetes is a progressive condition characterized by insulin resistance and relative insulin deficiency. Onset is usually more gradual than type 1 diabetes (p.3) and may go undetected for several years, leading to the development of long-term complications (p.44) prior to diagnosis (p.6). Lifestyle (p.8) interventions form the foundation of care, with the addition of medication (p.19), including insulin, as required for glycaemic control (p.30). The commonest cause of insulin resistance is obesity – 80–90% of people with type 2 diabetes are overweight (p.17) at diagnosis. Insulin production continues but typically declines over time. The majority of people with diabetes have type 2 (85–90%). It is more common in people of South Asian, African and Afro-Caribbean origin, and in people with a family history of the disease. Previously regarded as mature-onset, with escalating obesity levels type 2 diabetes is now presenting in younger people, including growing numbers of children. It is often preceded by a state of impaired glucose regulation (p.6).
Cardiovascular disease
Partha Ghosh, Shahid Anis Khan in Transcultural Geriatrics, 2018
There are some independent markers for the pro-coagulant state which constitutes a risk factor for cardiovascular disease. These factors include plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (t-PA) and to some extent fibrinogen, von Willebrand factor (vWF) and factor VII:C. PAI-1 in Indo-Asians has been shown to be higher than in the general population and fibrinogen has also been reported to be higher in Indo-Asians. Fibrinogen is higher in Indo-Asian patients with CHD and diabetes as compared with patients with just CHD. The level of factor VII.C is recorded to be lower in Indo-Asians as compared with the white population. These factors on their own or in combination may provide a possible link with increased cardiovascular disease in Indo-Asians. However, their precise role in the pro-coagulant state in Indo-Asians is less clear. There is evidence that insulin resistance syndrome and diabetes are associated with these risk factors.
Visceral adipose tissue is more strongly associated with insulin resistance than subcutaneous adipose tissue in Chinese subjects with pre-diabetes
Published in Current Medical Research and Opinion, 2018
Lin Liu, Jitao Feng, Gong Zhang, Xiaodan Yuan, Fan Li, Tingting Yang, Shujie Hao, Dejian Huang, Cunyi Hsue, Qinging Lou
Aims: To investigate the value of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) in a cohort of a community’s residents who were diagnosed as pre-diabetes, and to evaluate the association of VAT and SAT with insulin resistance. Methods: This study was based on cross-sectional analysis of data from 107 adults. VAT and SAT were assessed by computed tomography. Insulin resistance was defined by homeostasis model assessment of insulin resistance >2.69. The relationship of VAT and SAT with insulin resistance were examined by linear regression. Logistic regression was used to analyze the association of VAT and SAT with insulin resistance. Results: A total of 87 subjects had VAT ≥100 cm2. Thirty-six out of 107 (33.6%) subjects were detected to have insulin resistance, 71 were normal (66.4%), and all had insulin resistance with VAT ≥100 cm2. VAT (r = 0.378, p < .001) and SAT (r = 0.357, p < .001) were significantly and positively correlated with insulin resistance. In multiple regression analysis when VAT and SAT were simultaneously included after adjustment for age, gender, BMI, and WC, the association between VAT and insulin resistance was still maintained (p = .003), but that of SAT was lost. Conclusion: Pre-diabetic subjects with insulin resistance had elevated levels of VAT. VAT was more strongly associated with insulin resistance than SAT in Chinese subjects with pre-diabetes.
Insulin resistance in polycystic ovary syndrome: maker or marker?
Published in Expert Review of Obstetrics & Gynecology, 2010
Gurkan Bozdag, Bulent O Yildiz
Insulin resistance plays a central role in the pathophysiology of polycystic ovary syndrome (PCOS). However, this finding is not universal in PCOS, and many women with insulin resistance do not develop this syndrome, leading to much controversy. Insulin resistance is more prevalent in certain phenotypes of PCOS, but tests of insulin resistance are not included in any of the currently used diagnostic criteria to define PCOS. Several genetic and environmental factors and their interactions appear to modulate the presence, degree and expression of insulin resistance. Tissue-specific defects in insulin signaling have been described, and different tissues contribute to insulin resistance differently in PCOS. Our understanding of the syndrome may benefit from greater insight into the mechanisms of the complex inter-relationship between insulin resistance and PCOS.
Insulin resistance and heart injury in rats with insulin resistance or type 2 diabetes mellitus
Published in Acta Cardiologica, 2010
Zhong-Hua Yang, Xiao-Dong Peng
Objectives — This study sought to observe heart injury in rats with insulin resistance and type 2 diabetes mellitus, and to explore the relation between insulin resistance and diabetic cardiomyopathy in the presence of type 2 diabetes mellitus. Methods — Type 2 diabetes mellitus and insulin resistance were studied in animal models using Wistar rats. Glucose infusion rates (index of insulin resistance, insulin resistance), heart weight, the heart weight to body weight ratio, myocardial apoptotic index, cardiac hydroxyproline content, and cardiac tissue collagen type 1 and collagen type 3 content were measured. Ultramicrostructure of cardiac muscle cells was also observed. Results — Glucose infusion rates in type 2 diabetes mellitus and insulin resistance rats decreased (P < 0.01). Injury change of the ultramicrostructure of myocardial cells occurred in rats with type 2 diabetes mellitus and insulin resistance. Heart weight, myocardial apoptotic index, cardiac hydroxyproline content, type 1 and collagen type 3 content increased in rats with type 2 diabetes mellitus, and insulin resistance (P < 0.05) and in rats with insulin resistance were all lower than they were in type 2 diabetes mellitus rats (P < 0.05). In rats with type 2 diabetes mellitus and insulin resistance, associations of glucose infusion rates with heart weight, heart weight to body weight ratio, myocardial apoptotic index, cardiac hydroxyproline content, and cardiac tissue collagen type 1 and collagen type 3 were all negative; this result was statistically significant (P < 0.05). However, in normal rats, none of these associations was statistically significant. Conclusions — In the presence of type 2 diabetes mellitus, there exists insulin resistance and heart injury. Insulin resistance can injure the heart and plays a significant role in pathogenesis of diabetic cardiomyopathy in type 2 diabetes mellitus.