Chapter category: Endocrine

Insulin Resistance

This chapter appears in the following book:

Mechanisms of Insulin Action

Edited by: Alan R. Saltiel and Jeffrey E. Pessin
ISBN: 978-0-387-72203-0
» Get more information about this book at landesbioscience.com «

Chapter authors:
C. Hamish Courtney and Jerrold M. Olefsky

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Insulin resistance can be said to exist “whenever normal concentrations of hormone produce a less than normal biological response”. In the 1930s, Himsworth first differentiated patients with diabetes mellitus into “insulin sensitive” and “insulin insensitive” based on the ability of subcutaneous insulin administration to dispose of an oral glucose load. He further suggested that this differentiation corresponded to the clinical presentation of diabetes: that of either young ketosis-prone insulin sensitive or middle aged, nonketotic, insulin insensitive patients. The former is now classified as type 1 diabetes mellitus with the latter “insulin insensitive” classified as type 2 diabetes mellitus. Upon the development of the radioimmunoassay technique in 1960, Yalow and Berson demonstrated that patients with the adult-onset form of diabetes had, on average, higher circulating insulin levels than nondiabetic subjects. It was thus concluded that “the tissues of the maturity onset diabetic do not respond to insulin as well as the tissues of the nondiabetic subjects respond to insulin.” The term “Syndrome X” or “Metabolic syndrome” has been coined to refer to subjects exhibiting features of insulin resistance and this has been further defined by the National Cholesterol Education Program (Table 1) and modified by the WHO to add the requirement of hyperinsulinemia (upper quartile of the nondiabetic population) or elevated fasting plasma glucose (110 mg/dl, but <126 mg/dl).5 Besides insulin resistance, associated manifestations of the syndrome include hypertension, dyslipidemia and obesity. Given its increasing prevalence and association with subsequent cardiovascular disease, insulin resistance represents a condition of considerable importance.

C. Hamish Courtney

Jerrold M. Olefsky
University of California San Diego

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Chapter category: Endocrine

Insulin Resistance

Additional chapters from this book:

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