Fortnightly Review: Insulin resistance

BMJ 1996;313:1385-1389 (30 November)

Education and debate

Andrew J Krentz, consultant physician ^a

^a Diabetes Resource Centre, Royal South Hants Hospital, Southampton SO14 0YG

Summary points

Insulin resistance is a state in which normal concentrations of insulin produce a subnormal biological response
Patients with insulin resistance have hyperinsulinaemia together with normoglycaemia or hyperglycaemia
Insulin resistance is commonly associated with obesity, non-insulin dependent diabetes mellitus, and essential hypertension
The insulin resistance syndrome includes impaired insulin stimulated glucose uptake, hyperinsulinaemia, glucose intolerance, hypertension, and dyslipidaemia
Drugs such as corticosteroids, ß blockers, and high dose thiazides can exacerbate insulin resistance; angiotensin converting enzyme inhibitors and (alpha) blockers may reduce resistance
Reducing insulin resistance is important in managing non-insulin dependent diabetes--for example, by losing weight, aerobic exercise, and stopping smoking; moderate alcohol consumption improves insulin resistance
Metformin improves multiple aspects of the insulin resistance syndrome. Novel insulin action enhancing drugs including the thiazolidinediones are under evaluation

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