Insulin Resistance and Disturbance of Glucose Metabolism
Pp. 101-174 (74)
Resistance and Disturbance of Glucose Metabolism
Insulin resistance is an early and major feature in the development of type 2 diabetes mellitus (noninsulin- dependent diabetes mellitus), but it is also associated with hyperlipidemia, hypertension, obesity, cardiovascular disease, nonalcoholic fatty liver disease, and various monogenic disorders such as Rabson- Mendenhall syndrome, leprechaunism, type A insulin resistance, and CFTDM syndrome (congenital muscle fiber type disproportion myopathy). Moreover, disturbances in sleep (sleep apnoea) and ovarian dysfunction are also characterized by insulin resistance. It is a major problem that is increasing rapidly worldwide. A number of factors increase the risk for insulin resistance, including genetic predisposition, obesity and inactivity, aging, medications, polycystic ovary syndrome, and rare disorders such as partial lipodystrophy. Diets high in saturated fats and carbohydrates are associated with glucose intolerance, obesity, coronary heart disease, and type 2 diabetes mellitus. Glucotoxicity, lipotoxicity, and glucolipotoxicity are secondary phenomena that are proposed to play a role in all forms of type 2 diabetes. Insulin resistance typically reflects multiple defects of insulin receptor and post-receptor signaling that impair a diverse range of metabolic and vascular actions.