Among other risk factors for the development of diabetes mellitus, the insulin resistance index homa ir is of considerable importance. But first you need to understand what constitutes insulin resistance, as such.
Thus, insulin resistance means the body's resistance to the hormone produced, which leads to a deterioration in glucose metabolism, prevents its entry into cells, and an increase in blood sugar and insulin levels.
As a result, insulin resistance is one of the main causes of type II diabetes, as well as many other serious diseases:
In addition to the hypoglycemic effect, insulin performs other important functions: it regulates fat and protein metabolism, affects DNA synthesis, and regulates the process of tissue growth. Therefore, the resistance of cells to insulin leads to serious changes in the metabolism of proteins and fats, the functioning of cells, etc.
In addition to insulin resistance, there is also the "insulin resistance syndrome", or metabolic syndrome. This concept includes a whole range of characteristic symptoms: a violation of various metabolic processes, visceral obesity, hypertension, an increased risk of cardiovascular diseases.
Like many other conditions, in some cases insulin resistance is not a pathology.
Physiological insensitivity to insulin is also observed in healthy people at night, in children it often develops during puberty.
Insulin resistance during pregnancy or in the second phase of the menstrual cycle is also considered normal.
Pathology insulin resistance is considered in the following cases:
However, it is interesting that insulin resistance can develop in the absence of harmful factors. For example, it does not always accompany diabetes. Also, insulin resistance can occur in people who are not overweight. But this happens only in 25% of cases, so it is believed that insulin insensitivity is a companion of obesity I and subsequent degrees.
In addition to those listed above, insulin resistance accompanies the following diseases:
The symptoms of insulin resistance are only apparent when the disease has already become severe. At this stage, metabolic disorders already begin to occur. Prior to this, it is very difficult to recognize the pathology.
One of the diagnostic methods is special tests for insulin resistance.
Sugar level
Currently, the calculation of the insulin resistance index is carried out using two formulas: HOMA IR and CARO. But before the patient needs to donate blood for analysis.
The homo test makes it possible to assess the risk of developing serious diseases (diabetes, atherosclerosis), as well as insulin resistance in certain body disorders.
The homo index is calculated using a special formula: insulin level (fasting) * blood glucose level (fasting) / 22.5.
Changes in the value of the homa index ir usually occur due to a change in the level of one of these indicators. If the glucose level exceeds the normal value, we can talk about insulin resistance and a high risk of developing diabetes, disorders of the heart and blood vessels.
Normal for people aged 20-60 is the homa insulin resistance index of 0 - 2.7. Thus, the norm is the complete absence of insulin sensitivity, or a slight increase. A value that is very different from the norm is the reason for the diagnosis of "insulin resistance" and indicates a greater risk of developing various diseases.
Normal blood glucose levels vary slightly with age. In children under 14 years of age, the normal rate is from 3 to 5.6 mmol / l. After 14 years, the normal rate increases to 4.4-5.9 mmol / l. There are no further differences in normal concentration by age. The normal level of insulin content is from 2.6 to 24.9 mcU / ml.
This type of analysis is prescribed not only for diabetes mellitus, but also for suspected other diseases, including polycystic ovary syndrome, hepatitis B and C in a chronic course, kidney failure, and some abnormal liver function caused by not drinking alcohol.
In order to get an accurate HOMA IR result, you must follow all the doctor's instructions, as various factors can affect the result:
The accuracy of compliance with the rules for the delivery of biomaterial significantly affects the final result.
The second type of insulin resistance testing is the CARO assay. The following formula is used to calculate the caro index: plasma glucose (mmol/l) / insulin (mmol/l).
Unlike the homo index, the norm of the caro index is much lower: the optimal result should not exceed 0.33.
Insulin resistance is a condition that requires urgent intervention. Therefore, it is not only possible to treat it, but it is necessary.
An exact treatment strategy for a high homa ir insulin resistance index has not yet been developed.
There are a number of measures that effectively help to improve the situation.
A serious risk factor is abdominal obesity, in which fat accumulates mainly in the abdomen. You can determine the type of obesity using a simple formula: FROM (waist circumference) / OB (hip circumference). The normal result for men is no more than 1, for women it is 0.8 or less.
Weight loss is extremely important in the treatment of insulin resistance. The fact is that the metabolic activity of adipose tissue is very high. It is she who is “guilty” of synthesizing fatty acids, which impair the absorption of insulin, that is, in fact, increase insulin resistance.
Effective weight loss is unlikely without exercise. The type of activity should be chosen based on your own capabilities, without trying to "jump over your head." The main thing here is to move more. Physical exercise can not only provide invaluable help in weight loss, but also enhance the effectiveness of treatment. Activity helps strengthen muscles, where 80% of all insulin receptors are located. Therefore, the better the muscles work, the better the receptors do their job.
Among other things, you will have to give up bad habits: smoking slows down metabolic processes in the body, and alcohol has a high glycemic index.
In some cases, when changes in nutrition and an increase in the patient's activity do not give the desired result, the doctor may prescribe additional medication. The variety of drugs is selected individually depending on the patient's condition. Most often, to reduce insulin resistance, Siofor, Glucofage, Aktos (less often), etc. are prescribed.
As practice has shown, it is unreasonable to replace drugs with folk remedies, since the latter practically do not give any result.
Therefore, you should not waste time on them and focus on changing the diet and following other recommendations from your doctor. In this case, the likelihood of a cure will be much higher.
A diet with a high insulin resistance index does not mean starvation. It should be based on the principles of healthy eating. All foods with a high glycemic index are excluded from the menu: first of all, potatoes, sweets, wheat flour bread, as they sharply increase blood glucose, which is unacceptable during treatment.
It is advisable to include more foods with a low glycemic index in the menu. Those that are rich in fiber will be especially good. Such food will be useful, as it is digested more slowly, and sugar rises gradually.
In addition, the menu should include foods rich in polyunsaturated fats. The amount of monounsaturated fats, on the other hand, should be reduced. Foods rich in polyunsaturated fats include avocados, as well as oils such as olive or flaxseed.
The amount of foods high in fat must be reduced (exclude butter, cream, lamb, pork, etc. from the diet). Also, the menu should include fish of different types, as it is rich in omega-3 fatty acids that increase the sensitivity of cells to insulin.
The menu for the duration of treatment should include fresh fruits (citrus fruits, apples, avocados, apricots), berries, vegetables (cabbage of any kind, beans, spinach, raw carrots, beets). Bread is allowed only from whole grain or rye flour. Of the cereals, buckwheat and oatmeal will be most useful.
Another product that will have to give up is coffee. Of course, this drink has many beneficial properties, but with insulin resistance it will only hurt: caffeine improves insulin production.
Changes will have to be made in the diet itself. First of all, you should not allow more than 3-3.5 hours to pass between meals. Therefore, even if it is customary to eat 2 times a day, this habit will have to be changed to fractional meals. A significant gap between meals, especially the appearance of severe hunger, causes hypoglycemia.
It is also important to observe the drinking regimen: during treatment it is worth drinking more clean water - at least 3 liters. If such a drinking regimen is unusual, you should not switch to it too abruptly - the kidneys may not be able to cope with the load. To begin with, it is better to drink a little more water than usual, but gradually bring the volume of water to 8 - 9 glasses per day. The video in this article will tell you in detail about the problem.
Insulin resistance is a violation of the interaction of incoming insulin on tissues. In this case, insulin can come both naturally from the pancreas, and through the introduction of an injection of the hormone.
The hormone, in turn, is involved in metabolism, growth and reproduction of tissue cells, DNA synthesis and gene transcription.
In modern times, insulin resistance is associated not only with metabolic disorders and an increased risk of type 2 diabetes. Including insulin resistance negatively affects the metabolism of fats and proteins, gene expression.
Including insulin resistance will disrupt the functionality of endothelial cells, which are the inner layer on the walls of blood vessels. As a result, the violation leads to vasoconstriction and the development of atherosclerosis.
The disorder is detected if the patient has symptoms of the metabolic syndrome. Signs such as fat deposits in the waist area, high blood pressure, poor blood tests for triglycerides and cholesterol may be present. Including such a phenomenon is diagnosed if the patient's analysis showed an increased protein in the urine.
Diagnosis of insulin resistance is carried out primarily through tests that must be taken regularly. However, due to the fact that the level of insulin in the blood plasma can change, diagnosing such a disease is very difficult.
If the tests were performed on an empty stomach, the norm of insulin levels in the blood plasma is 3-28 mcU / ml. If insulin in the blood is elevated and exceeds the specified rate, the patient has hyperinsulinism.
The reasons for the fact that insulin in the blood is too high may be due to the fact that the pancreas produces an excess amount of it in order to compensate for the insulin resistance of tissues.
Such an analysis may indicate that the patient may develop type 2 diabetes or cardiovascular disease.
To accurately identify the disorder, a hyperinsulinemic insulin clamp is performed. This laboratory method consists of continuous intravenous administration of insulin and glucose for four to six hours.
Such diagnostics is very time-consuming, so it is used quite rarely. Instead, a blood test is done on an empty stomach to check for plasma insulin levels.
As it turned out in the course of research, this violation can most often occur:
The HOMA Insulin Resistance Index is used to determine whether there is insulin resistance. After the analysis of the level of insulin and fasting glucose is passed, the calculation of the HOMA index is carried out.
With an increase in the level of fasting insulin or glucose, the HOMA index also increases. For example, if the analysis showed the level of glycemia on an empty stomach 7.2 mmol / liter, and insulin 18 mcU / ml, the HOMA index is 5.76. Insulin levels are considered normal if the HOMA index is less than 2.7.
Insulin allows you to activate metabolic processes such as glucose transport and glycogen synthesis. This hormone is also responsible for DNA synthesis.
Insulin provides:
Insulin also helps prevent unwanted symptoms such as:
It is important to understand that the hormone does not allow fat tissues to break down. Because of this reason, if insulin resistance is observed and insulin levels are elevated, it is almost impossible to reduce excess weight.
In the treatment of certain diseases, insulin sensitivity of muscle and adipose tissues is primarily considered. Meanwhile, these tissues have different insulin resistance.
So, to suppress the breakdown of fats in tissues, no more than 10 mcU / ml of insulin in the blood is required. At the same time, to suppress the entry of glucose from the liver into the blood, approximately 30 μU / ml of insulin is needed. To increase the uptake of glucose by muscle tissues, you need 100 mcU / ml or more of the hormone in the blood.
Tissues lose sensitivity to insulin due to genetic predisposition and unhealthy lifestyle.
At a time when the pancreas begins to fail to cope with the increased load, the patient develops type 2 diabetes mellitus. If insulin resistance syndrome is treated early, many complications can be avoided.
It is important to understand that insulin resistance can occur in people who do not have metabolic syndrome. In particular, resistance is diagnosed in people with:
Including insulin resistance in some cases is diagnosed in women during pregnancy, but after the birth of a child, this condition usually disappears.
Also, resistance can increase with age, therefore, on what kind of lifestyle a person leads. It depends whether he will suffer from type 2 diabetes mellitus in old age or have problems in the cardiovascular system.
The causes of diabetes mellitus lie directly in the insulin resistance of muscle, adipose tissue and liver cells. Due to the fact that the body becomes less sensitive to insulin, less glucose enters the muscle cells. The active breakdown of glycogen to glucose and the production of glucose from amino acids and other raw materials begins in the liver.
With insulin resistance of adipose tissues, the anti-lipolytic effect of insulin weakens. Initially, this process is compensated by increased production of insulin from the pancreas.
Late in the disease, body fat begins to break down into glycerol and free fatty acids.
These substances after entering the liver are converted into very dense lipoproteins. This unhealthy substance is deposited on the walls of blood vessels, as a result of which it develops.
In particular, an increased level of glucose enters the blood from the liver, which is formed due to glycogenolysis and gluconeogenesis.
With insulin resistance in a patient, an increased level of the hormone insulin has been observed in the blood for many years. If a person at this moment can lead to the fact that the patient may develop type 2 diabetes mellitus.
After some time, the cells of the pancreas cease to cope with such a load, the level of which is increased many times over. As a result, the body begins to produce less insulin, which leads to diabetes. To prevent this from happening, it is necessary to start the prevention and treatment of the disease as early as possible.
As you know, in people with diabetes, the risk of early death increases several times. According to doctors, insulin resistance and hyperinsulinemia are the main serious risk factors for stroke and heart attack. It does not matter if the patient has diabetes.
Elevated insulin negatively affects the condition of blood vessels, leading to their narrowing and the appearance of atherosclerotic plaques. Including the hormone promotes the growth of smooth muscle cells and fibroblasts.
Thus, hyperinsulinemia becomes one of the main causes of atherosclerosis. Symptoms of this disease are detected long before the development of diabetes.
A major link between excess insulin and the development of cardiovascular disease can be identified. The fact is that insulin resistance contributes to:
These factors can occur both in type 2 diabetes mellitus and in its absence. For this reason, the sooner the patient begins treatment, the more likely it is. that there will be no complications.
If there are signs of insulin resistance, treatment is with a therapeutic diet that restricts carbohydrate intake. This helps to control and restore balance in case of metabolic disorders in the body. Such a diet is introduced both in diabetes mellitus and in its absence. At the same time, such a menu in daily nutrition should become the main one throughout life.
After treatment with a therapeutic diet begins, the patient will begin to feel better after three to four days. Including a week later
Different people are characterized by a different ability of insulin to stimulate the absorption of glucose. It is important to know that a person may have normal sensitivity to one or more of the effects of this compound and at the same time be completely resistant to others. Next, we will analyze the concept of "insulin resistance": what it is, how it manifests itself.
Before analyzing the concept of "insulin resistance", what it is and what signs it has, it should be said that this disorder is quite common. More than 50% of people with hypertension suffer from this pathology. Most often, insulin resistance (what it is, will be described below) is found in the elderly. But in some cases it comes to light and in the childhood. The syndrome of insulin resistance often remains unrecognized until metabolic disorders begin to appear. The risk group includes persons with dyslipidemia or impaired glucose tolerance, obesity, hypertension.
What it is? What are the features of the violation? insulin resistance is an incorrect response of the body to the action of one of the compounds. The concept is applicable to different biological effects. This, in particular, refers to the effect of insulin on protein and lipid metabolism, gene expression, and the function of the vascular endothelium. The disturbed response leads to an increase in the concentration of the compound in the blood relative to that required for the available amount of glucose. Insulin resistance syndrome is a combined disorder. It involves changes in glucose tolerance, type 2 diabetes, dyslipidemia, and obesity. "Syndrome X" also implies resistance to glucose uptake (insulin-dependent).
To date, experts have not been able to fully study it. Disorders that lead to the development of insulin resistance can occur at the following levels:
Anomalies of insulin molecules are quite rare and have no clinical significance. Receptor density may be reduced in patients due to negative feedback. It is caused by hyperinsulinemia. Often, patients have a moderate decrease in the number of receptors. In this case, the level of feedback is not considered a criterion by which the degree of insulin resistance is determined. The causes of the disorder are reduced by experts to post-receptor signal transduction disorders. Provoking factors, in particular, include:
These are the main factors that more often than others can provoke insulin resistance. Treatment includes the use of:
Influence on glucose metabolism occurs in adipose tissue, muscles and liver. Skeletal muscle metabolizes approximately 80% of this compound. Muscles in this case act as an important source of insulin resistance. Glucose is taken up into cells by a special transport protein, GLUT4. Activation of the insulin receptor triggers a series of phosphorylation reactions. They ultimately lead to the translocation of GLUT4 into the cell membrane from the cytosol. This allows glucose to enter the cell. Insulin resistance (the norm will be indicated below) is caused by a decrease in the degree of GLUT4 translocation. At the same time, there is a decrease in the use and uptake of glucose by cells. Along with this, in addition to facilitating glucose uptake in peripheral tissues, hyperinsulinemia suppresses the production of glucose by the liver. With type 2 diabetes, it resumes.
It is combined with insulin resistance quite often. When the patient exceeds the weight by 35-40%, the sensitivity decreases by 40%. The one located in the anterior abdominal wall has a higher metabolic activity than the one located below. In the course of medical observations, it has been established that increased release of fatty acids from abdominal fibers into the portal bloodstream provokes the production of triglycerides by the liver.
Insulin resistance, the symptoms of which are predominantly metabolically related, may be suspected in patients with abdominal obesity, gestational diabetes, a family history of type 2 diabetes, dyslipidemia, and hypertension. At risk and women with PCOS (polycystic ovaries). Due to the fact that obesity is a marker of insulin resistance, it is necessary to assess the nature of the distribution of fatty tissue. Its location can be gynecoid - in the lower part of the body, or android type - in the anterior wall of the peritoneum. Upper body accumulation is a more significant predictor of insulin resistance, altered glucose tolerance, and DM than lower body obesity. To determine the amount of tissue, you can use the following method: determine the ratio of waist, hips and BMI. With indicators of 0.8 for women and 0.1 for men and a BMI greater than 27, abdominal obesity and insulin resistance are diagnosed. Symptoms of pathology are also manifested externally. In particular, wrinkled, rough hyperpigmented areas are noted on the skin. Most often they appear in the armpits, on the elbows, under the mammary glands. is a formula calculation. HOMA-IR is calculated as follows: fasting insulin (µU/mL) x fasting glucose (mmol/L). The result obtained is divided by 22.5. The result is an index of insulin resistance. Norma -<2,77. При отклонении в сторону увеличения может диагностироваться расстройство чувствительности тканей.
Today, there is no single explanation of the mechanism of the influence of insulin resistance on the damage to the cardiovascular system. There may be a direct effect on atherogenesis. It is caused by the ability of insulin to stimulate lipid synthesis and the proliferation of smooth muscle components in the vascular wall. At the same time, atherosclerosis can be caused by concomitant metabolic disorders. For example, it can be hypertension, dyslipidemia, changes in glucose tolerance. In the pathogenesis of the disease, the impaired function of the vascular endothelium is of particular importance. Its task is to maintain the tone of the blood channels due to the secretion of mediators of vasodilation and vasoconstriction. In the state, it provokes relaxation of the smooth muscle fibers of the vascular wall with the release of nitric oxide (2). At the same time, its ability to enhance endothelium-dependent vasodilation changes significantly in obese patients. The same applies to patients with insulin resistance. With the development of the inability of the coronary arteries to respond to normal stimuli and expand, we can speak of the first stage of microcirculation disorders - microangiopathy. This pathological condition is observed in most patients with DM (diabetes mellitus).
Insulin resistance can provoke atherosclerosis through disturbances in the process of fibrinolysis. PAI-1 (plasminogen activator inhibitor) is found in high concentrations in diabetic and obese patients without diabetes. The synthesis of PAI-1 is stimulated by proinsulin and insulin. The level of fibrinogen and other procoagulant factors is also increased.
Insulin resistance is a precursor to the clinical manifestation of DM. Beta cells in the pancreas are responsible for lowering glucose levels. The decrease in concentration is carried out by increasing the production of insulin, which, in turn, leads to relative hyperinsulinemia. Euglycemia can persist in patients for as long as the beta cells are able to maintain a sufficiently high plasma insulin level to overcome resistance. Ultimately, this ability is lost, and the concentration of glucose increases significantly. The key factor responsible for fasting hyperglycemia in T2DM is hepatic insulin resistance. The healthy response is to lower glucose production. With insulin resistance, this reaction is lost. As a result, the liver continues to overproduce glucose, leading to fasting hyperglycemia. With the loss of the ability of beta cells to provide hypersecretion of insulin, there is a transition from insulin resistance with hyperinsulinemia to altered glucose tolerance. Subsequently, the condition is transformed into clinical diabetes and hyperglycemia.
There are several mechanisms that cause its development against the background of insulin resistance. As observations show, the weakening of vasodilation and the activation of vasoconstriction can contribute to an increase in vascular resistance. Insulin stimulates the nervous (sympathetic) system. This leads to an increase in the plasma concentration of norepinephrine. Patients with insulin resistance have an increased response to angiotensin. In addition, the mechanisms of vasodilation may be disturbed. In a normal state, the introduction of insulin provokes relaxation of the muscular vascular wall. Vasodilation in this case is mediated by the release/production of nitric oxide from the endothelium. In patients with insulin resistance, endothelial function is impaired. This leads to a decrease in vasodilation by 40-50%.
With insulin resistance, the normal suppression of the release of free fatty acids after eating from adipose tissue is disrupted. The increased concentration forms a substrate for enhanced triglyceride synthesis. This is an important step in the production of VLDL. With hyperinsulinemia, the activity of an important enzyme, lipoprotein lipase, decreases. Among the qualitative changes in the spectrum of LDL against the background of type 2 diabetes and insulin resistance, an increased degree of oxidation of LDL particles should be noted. Glycated apolipoproteins are considered to be more susceptible to this process.
Insulin sensitivity can be improved in several ways. Of particular importance is weight loss and physical activity. Diet is also important for people diagnosed with insulin resistance. The diet helps to stabilize the condition within a few days. Increased sensitivity will further contribute to weight loss. For people who have established insulin resistance, treatment consists of several stages. Stabilization of diet and physical activity is considered the first stage of therapy. For people who have insulin resistance, the diet should be low in calories. A moderate decrease in body weight (by 5-10 kilograms) often improves glucose control. Calories are 80-90% distributed between carbohydrates and fats, 10-20% are proteins.
Means "Metamorphine" refers to medicines of the group of biguanides. The drug helps to increase peripheral and hepatic sensitivity to insulin. In this case, the agent does not affect its secretion. In the absence of insulin, Metamorphin is ineffective. Troglitazone is the first thiazolidinedione drug to be approved for use in the United States. The drug enhances the transport of glucose. This is probably due to the activation of the PPAR-gamma receptor. And due to this, the expression of GLUT4 is enhanced, which, in turn, leads to an increase in insulin-induced glucose uptake. For patients who have insulin resistance, treatment can be prescribed and combined. The above agents may be used in combination with a sulfonylurea, and sometimes with each other to obtain plasma glucose and other disorders. The drug "Metamorphine" in combination with a sulfonylurea enhances the secretion and sensitivity to insulin. At the same time, glucose levels decrease after meals and on an empty stomach. In patients who were prescribed combined treatment, manifestations of hypoglycemia were more often observed.
Content
If insulin resistance predominates in the patient's body - what is it, what are the symptoms, how to properly take an analysis and dietary features, a knowledgeable specialist will tell you. This pathological process is accompanied by the body's resistance to its own insulin, which results in the need for its additional administration by means of injections or insulin pumps. If insulin sensitivity is reduced, the patient is at risk of diabetes mellitus, medical supervision and participation is required.
If there is no metabolic response to the hormone insulin, this means that insulin resistance predominates in the patient's body. Glucose production is reduced, preceded by overweight, a form of obesity. The pathology progresses. It is important to understand that as a result of a decrease in insulin sensitivity, not only metabolism is disturbed, serious changes occur during cell growth, reproduction, DNA synthesis, and gene transcription. This kind of pathology is difficult to cure. Therefore, patients at risk should regularly take appropriate tests.
Determining the homa index is an auxiliary diagnostic method necessary to identify the disease and clarify the final diagnosis. For analysis, mainly venous blood is taken, for the level of insulin and sugar on an empty stomach. According to the results of a laboratory study, the emphasis is placed on two indicators of the test at once:
If we talk in more detail about the female body, the fairer sex with obesity are at risk. This also applies to pregnant women who, when carrying a fetus, gain excess weight. The danger is that after natural delivery, insulin resistance may persist. It is possible to normalize the production of glucose in such a clinical picture only with medication.
With problems with fat metabolism in the body, insulin resistance develops, which significantly reduces the quality of life of the patient. In most cases, it is possible to determine the metabolic syndrome by analyzing venous blood, however, it is quite realistic to assume a characteristic ailment by external and internal signs. The symptoms of insulin resistance are:
From laboratory studies:
Before starting effective treatment of insulin resistance, it is important to find out the etiology of the pathological process and get rid of pathogenic factors forever. More often, insulin resistance has a genetic predisposition associated with hormonal imbalance. Therefore, it is mandatory to examine the pancreas, to perform a blood test not only for homa, but also for gomons. Other triggering factors are listed below:
It is important to know at what concentrations insulin prevails in the blood in order to timely prevent extensive pathologies of the whole organism. The nome index should normally range from 3 to 28 µU/ml, while other indicators markedly increase the risk of atherosclerosis. The most reliable method of laboratory research is the clamp test or euglycemic hyperinsulinemic clamp, which not only provides a quantitative assessment of insulin resistance, but also determines the etiology of the pathological process.
To reliably determine insulin resistance, the patient must donate a portion of venous blood on an empty stomach. Eating should be stopped 12 hours before the laboratory test, while it is desirable to control the water balance. Of the additional recommendations for passing the analysis, doctors place special emphasis on the following points:
These two pathological processes are closely related. It is important to know that the special beta cells of the pancreas keep blood glucose levels tolerable by increasing insulin secretion. As a result, relative euglycemia and hyperinsulinemia develop, which make it difficult to produce a sufficient dose of insulin. So in the blood, the level of glucose pathologically increases, there is no tolerance, hyperglycemia progresses. To neutralize the pathological process, it is necessary to reduce the scale of adipose tissue by an operative method.
Progressive pregnancy can provoke normal insulin sensitivity. Doctors take this fact into account when conducting a number of laboratory tests, however, if markers remain in the blood after childbirth, there is a serious pathology. When carrying a fetus, it is necessary to fight excess weight, lead an active lifestyle, get carried away with aerobic training. Otherwise, the pathologies of the cardiovascular system progress, the risks of atherosclerosis of the vessels increase.
Separately, it is worth clarifying that with insulin resistance, hyperandrogenism progresses, which can become the main cause of diagnosed infertility. The ovaries produce the hormone testosterone in excess, thereby contributing to the exacerbation of polycystic disease. If the abnormal production of ovarian hormones is not eliminated in a timely manner, it will be problematic for a woman to feel the joy of motherhood.
It is important to understand that the diet reduces the rate of insulin in the cells, controls its increased accumulation in certain parts of the body. However, it is not enough to choose therapeutic nutrition for insulin resistance, a comprehensive approach to the problem is required with the obligatory rejection of all bad habits and the appointment of drug therapy. The following medical recommendations contribute to a speedy recovery:
Of the medicines, doctors without fail prescribe synthetic hormones in a full course. This is a way to normalize the work of the pancreas, regulate the disturbed hormonal background and control the concentration of insulin in the cells. Doctors in the treatment distinguish two categories of medications. This:
In order to understand how it works and why drug therapy is needed for insulin resistance, below is a brief description of the most effective drugs in a given therapeutic direction:
We will talk about aerobic training, which have a systemic effect throughout the body - reduce weight, increase tone, and prevent cardiovascular and nervous pathologies. Here are the most effective exercises for insulin resistance:
With insulin resistance and the absence of timely therapy, the patient is in for serious health troubles. Therefore, it is important to go on a diet in time and take hormones. The following diagnoses, which are difficult to treat conservatively, constitute a potential threat:
Attention! The information provided in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and give recommendations for treatment, based on the individual characteristics of a particular patient.
Did you find an error in the text? Select it, press Ctrl + Enter and we'll fix it!Determining the indicators of this index helps to determine the presence of insensitivity to the action of insulin in the early stages, to assess the estimated risks of developing diabetes, atherosclerosis, pathologies of the cardiovascular system.
Insulin resistance refers to the resistance (loss of sensitivity) of body cells to the action of insulin. In the presence of this condition, the patient has both elevated insulin and elevated glucose in the blood. If this condition is combined with dyslipidemia, impaired glucose tolerance, obesity, then this pathology is called the metabolic syndrome.
Insulin resistance develops in the following situations:
These are not all the reasons for the development of insulin resistance. Alcohol abusers also have this condition. In addition, this pathology accompanies thyroid diseases, polycystic ovaries, Itsenko-Cushing's syndrome, pheochromocytoma. Sometimes insulin resistance is observed in women during pregnancy.
Clinical symptoms begin to appear in the later stages of the disease. Individuals with insulin resistance have an abdominal type of obesity (deposition of fat in the abdomen). In addition, they have skin changes - hyperpigmentation in the armpits, neck, mammary glands. In addition, in such patients, pressure rises, changes in the psycho-emotional background, and digestive problems are observed.
Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), the HOMA index are all synonyms for the insulin resistance index. To determine this indicator, a blood test is required. The index values can be calculated using two formulas: the HOMA-IR index and the CARO index:
Patients initially need to take a venous blood test, and then do an insulin resistance test. Diagnosis and determination of insulin resistance occurs subject to the following rules:
30 minutes before the test, you can not experience any physical activity.
Back to index
The optimal value of HOMA-IR should not exceed 2.7. Fasting glucose, which is used to calculate the index, varies depending on the age of the person:
Back to index
The HOMA index is increased at values from 2.7. An increase in indicators may indicate the presence of pathology. Physiologically, the insulin resistance index may increase if the conditions for donating blood for analysis are not met. In such a situation, the analysis is redone and the assessment of indicators is carried out again.
Diet therapy is one of the key points in the treatment of insulin resistance.
With an increased index value, more vegetables should be introduced into the diet.
Insulin insensitivity therapy aims to reduce body fat weight. If the HOMA index is elevated, it is first recommended to make adjustments to the daily diet. Be sure to reduce the amount of fat and carbohydrates consumed. Baking, sweets, fried foods, pickles, smoked meats, dishes with a high content of spices are completely excluded. Recommended consumption of vegetables, lean meat (chicken, turkey, rabbit) and fish. The best way to prepare meals:
It is required to eat fractionally - 5-6 times a day. In addition, it is recommended to drink 1.5-2 liters of pure water per day. Coffee, strong tea, alcohol must be completely excluded from consumption. In addition, patients with insulin resistance are recommended to go in for sports: running, yoga, swimming. Be sure to do morning exercises. The necessary lifestyle is established by the attending physician on an individual basis.
The information is given for general information only and should not be used for self-treatment. Do not self-medicate, it can be dangerous. Always consult your doctor. In case of partial or complete copying of materials from the site, an active link to it is required.
Insulin resistance is a pathological condition in which the sensitivity of cells to insulin is reduced or absent. This hormone is responsible for the regulation of blood glucose levels, and is also involved in metabolic processes throughout the body.
With insulin insensitivity, the transport of nutrients into cells is difficult, which leads to a decrease in glucose uptake by tissues and an increase in its amount in the blood.
Insulin resistance is not considered an independent disease, but is a factor that creates the conditions for the appearance of a number of ailments:
According to the theory of the "thrifty genotype" by V. Neal (1962), the development of insulin resistance may be associated with the mechanism of adaptation of the body during periods of lack or excess of food:
Cell resistance to insulin appears without obvious signs, which is difficult to diagnose.
The main symptoms of insulin resistance are:
With IR, obtaining an accurate diagnosis through laboratory tests is a rather difficult process, since the level of insulin in the blood is constantly changing.
The first signs that indicate the presence of insulin resistance:
Heredity as a factor of predisposition to insulin resistance is quite common. But since this indicator is often not diagnosed, pathology can be detected due to the presence of concomitant diseases. For example, if the family has relatives with diabetes, obesity or hypertension.
Insulin resistance and metabolic syndrome, also called insulin resistance syndrome, are fundamentally different from each other:
This series of pathological disorders of hormonal and metabolic metabolism includes:
First of all, the symptoms of insulin resistance are observed externally:
But this is not always the case. Sometimes the index of insulin resistance is increased in people who are not overweight. Then the main indicator is the analysis to determine the level of sugar and insulin in the blood.
Methods for diagnosing resistance:
The main risk factors for the development of insulin resistance:
One of the indicators indicating an increase or normal insulin resistance index is the ratio of body weight and height.
The body mass index is calculated according to the Quetelet formula: I \u003d m / h2, where the data m is weight, and h is height. If a woman's weight is 60 kg and her height is 1.64 m, then the equation looks like this: I=60/(1.64×1.64)=22.3 kg/m².
This means that the body mass index is within the normal range and indicates no risk of insulin resistance.
The concept of the norm of the insulin resistance index does not have specific meanings. Therefore, for an accurate diagnosis, it is better to conduct several studies. Methods for assessing the level of glucose and insulin in the body on an empty stomach are the most popular. The CARO and HOMA IR tests are simple and effective, and their time is minimal.
It is very important to properly prepare before taking a blood test:
One of the simplest tests to determine the insulin resistance index is the HOMA IR. For the study, venous blood is used, which determines the increased insulin resistance index or the norm.
If the HOMA value is more than 2.5-2.7, this means that the insulin resistance index is increased.
Carrying out the CARO test to determine the insulin resistance index is similar to HOMA IR, the calculation formula and norm values are different.
The norm of the resistance index according to the test is within the value of 0.33.
After eating, the level of glucose rises, more insulin is needed to transport it to the cells.
Insulin resistance increases the load on the pancreas, which needs to produce more hormone to maintain sugar levels within normal limits. As a result, hyperinsulinemia occurs, which has a particularly negative effect on the human body.
Elevated levels of insulin in the blood trigger various disorders:
Insulin resistance leads to:
This process proceeds slowly, with timely treatment and prevention, the disease can be avoided.
An increase in sympathetic tone, along with other manifestations of IR, causes pathological diseases of the cardiovascular system:
Insulin resistance is a precursor to type II diabetes.
With prolonged hyperinsulinemia:
Factors provoking the development of the disease:
A positive result in the treatment of insulin resistance is possible only with the systematic implementation of simple principles.
The fact is that over time, the state of insulin resistance only progresses, so for a full recovery you need:
First of all, you need to increase physical activity in order to reduce the percentage of adipose tissue in the body. Constant physical activity can effectively cope with the task, but only with an active lifestyle and proper nutrition.
Reducing weight by at least 5-10% will help lower blood pressure, improve glucose uptake and insulin sensitivity of cells.
The development of insulin resistance directly depends on food preferences. Foods containing simple carbohydrates, sweets, starchy foods, alcohol provoke insulin resistance. Such food is calorie-rich, which means that a significant increase in glucose levels immediately after eating.
This leads to the need to release additional insulin, which triggers various metabolic disorders in the body and other pathologies.
Nutrition tips to reduce insulin resistance:
Taking medicines that regulate blood sugar levels are prescribed in case of severe insulin resistance only by a doctor. Self-treatment with medications can lead to serious consequences in the form of poor health and the clinical picture of the disease.
Complex drugs aimed at increasing insulin sensitivity and lowering glucose levels are Glucophage, Diaformin, Insufor, Metamin, Metformin.
Therefore, it is possible in advance to reduce the risk of their development through prevention. Following a healthy diet, regular exercise at least 3 times a week, an active lifestyle will help get rid of insulin resistance and other related conditions.
For cooperation, please contact by e-mail:
The information on the site is provided for informational purposes only. Consult your doctor before making any decision. The management of Diabet911.com is not responsible for the use of information posted on the site.
© All rights reserved. Internet magazine about diabetes Diabet911.com
Copying of material is possible only with an active link to the site.
Among other risk factors for the development of diabetes mellitus, the insulin resistance index homa ir is of considerable importance. But first you need to understand what constitutes insulin resistance, as such.
Thus, insulin resistance means the body's resistance to the hormone produced, which leads to a deterioration in glucose metabolism, prevents its entry into cells, and an increase in blood sugar and insulin levels.
As a result, insulin resistance is one of the main causes of type II diabetes, as well as many other serious diseases:
In addition to the hypoglycemic effect, insulin performs other important functions: it regulates fat and protein metabolism, affects DNA synthesis, and regulates the process of tissue growth. Therefore, the resistance of cells to insulin leads to serious changes in the metabolism of proteins and fats, the functioning of cells, etc.
In addition to insulin resistance, there is also the "insulin resistance syndrome", or metabolic syndrome. This concept includes a whole range of characteristic symptoms: a violation of various metabolic processes, visceral obesity, hypertension, an increased risk of cardiovascular diseases.
Like many other conditions, in some cases insulin resistance is not a pathology.
Physiological insensitivity to insulin is also observed in healthy people at night, in children it often develops during puberty.
Insulin resistance during pregnancy or in the second phase of the menstrual cycle is also considered normal.
Pathology insulin resistance is considered in the following cases:
However, it is interesting that insulin resistance can develop in the absence of harmful factors. For example, it does not always accompany diabetes. Also, insulin resistance can occur in people who are not overweight. But this happens only in 25% of cases, so it is believed that insulin insensitivity is a companion of obesity I and subsequent degrees.
In addition to those listed above, insulin resistance accompanies the following diseases:
The symptoms of insulin resistance are only apparent when the disease has already become severe. At this stage, metabolic disorders already begin to occur. Prior to this, it is very difficult to recognize the pathology.
One of the diagnostic methods is special tests for insulin resistance.
Currently, the calculation of the insulin resistance index is carried out using two formulas: HOMA IR and CARO. But before the patient needs to donate blood for analysis.
The homo test makes it possible to assess the risk of developing serious diseases (diabetes, atherosclerosis), as well as insulin resistance in certain body disorders.
The homo index is calculated using a special formula: insulin level (fasting) * blood glucose level (fasting) / 22.5.
Changes in the value of the homa index ir usually occur due to a change in the level of one of these indicators. If the glucose level exceeds the normal value, we can talk about insulin resistance and a high risk of developing diabetes, disorders of the heart and blood vessels.
The homa insulin resistance index of 0 - 2.7 is considered normal for older people. Thus, the norm is the complete absence of insulin sensitivity, or a slight increase. A value that is very different from the norm is the reason for the diagnosis of "insulin resistance" and indicates a greater risk of developing various diseases.
Normal blood glucose levels vary slightly with age. In children under 14 years of age, the normal rate is from 3 to 5.6 mmol / l. After 14 years, the normal rate increases to 4.4-5.9 mmol / l. There are no further differences in normal concentration by age. The normal level of insulin content is from 2.6 to 24.9 mcU / ml.
This type of analysis is prescribed not only for diabetes mellitus, but also for suspected other diseases, including polycystic ovary syndrome, hepatitis B and C in a chronic course, kidney failure, and some abnormal liver function caused by not drinking alcohol.
In order to get an accurate HOMA IR result, you must follow all the doctor's instructions, as various factors can affect the result:
The accuracy of compliance with the rules for the delivery of biomaterial significantly affects the final result.
The second type of insulin resistance testing is the CARO assay. The following formula is used to calculate the caro index: plasma glucose (mmol/l) / insulin (mmol/l).
Unlike the homo index, the norm of the caro index is much lower: the optimal result should not exceed 0.33.
Insulin resistance is a condition that requires urgent intervention. Therefore, it is not only possible to treat it, but it is necessary.
An exact treatment strategy for a high homa ir insulin resistance index has not yet been developed.
There are a number of measures that effectively help to improve the situation.
A serious risk factor is abdominal obesity, in which fat accumulates mainly in the abdomen. You can determine the type of obesity using a simple formula: FROM (waist circumference) / OB (hip circumference). The normal result for men is no more than 1, for women it is 0.8 or less.
Weight loss is extremely important in the treatment of insulin resistance. The fact is that the metabolic activity of adipose tissue is very high. It is she who is “guilty” of synthesizing fatty acids, which impair the absorption of insulin, that is, in fact, increase insulin resistance.
Effective weight loss is unlikely without exercise. The type of activity should be chosen based on your own capabilities, without trying to "jump over your head." The main thing here is to move more. Physical exercise can not only provide invaluable help in weight loss, but also enhance the effectiveness of treatment. Activity helps strengthen muscles, where 80% of all insulin receptors are located. Therefore, the better the muscles work, the better the receptors do their job.
Among other things, you will have to give up bad habits: smoking slows down metabolic processes in the body, and alcohol has a high glycemic index.
In some cases, when changes in nutrition and an increase in the patient's activity do not give the desired result, the doctor may prescribe additional medication. The variety of drugs is selected individually depending on the patient's condition. Most often, to reduce insulin resistance, Metformin 850, Siofor, Glucofage, Aktos (less often), etc. are prescribed.
As practice has shown, it is unreasonable to replace drugs with folk remedies, since the latter practically do not give any result.
Therefore, you should not waste time on them and focus on changing the diet and following other recommendations from your doctor. In this case, the likelihood of a cure will be much higher.
A diet with a high insulin resistance index does not mean starvation. It should be based on the principles of healthy eating. All foods with a high glycemic index are excluded from the menu: first of all, potatoes, sweets, wheat flour bread, as they sharply increase blood glucose, which is unacceptable during treatment.
It is advisable to include more foods with a low glycemic index in the menu. Those that are rich in fiber will be especially good. Such food will be useful, as it is digested more slowly, and sugar rises gradually.
In addition, the menu should include foods rich in polyunsaturated fats. The amount of monounsaturated fats, on the other hand, should be reduced. Foods rich in polyunsaturated fats include avocados, as well as oils such as olive or flaxseed.
The amount of foods high in fat must be reduced (exclude butter, cream, lamb, pork, etc. from the diet). Also, the menu should include fish of different types, as it is rich in omega-3 fatty acids that increase the sensitivity of cells to insulin.
The menu for the duration of treatment should include fresh fruits (citrus fruits, apples, avocados, apricots), berries, vegetables (cabbage of any kind, beans, spinach, raw carrots, beets). Bread is allowed only from whole grain or rye flour. Of the cereals, buckwheat and oatmeal will be most useful.
Another product that will have to give up is coffee. Of course, this drink has many beneficial properties, but with insulin resistance it will only hurt: caffeine improves insulin production.
Changes will have to be made in the diet itself. First of all, you should not allow more than 3-3.5 hours to pass between meals. Therefore, even if it is customary to eat 2 times a day, this habit will have to be changed to fractional meals. A significant gap between meals, especially the appearance of severe hunger, causes hypoglycemia.
It is also important to observe the drinking regimen: during treatment it is worth drinking more clean water - at least 3 liters. If such a drinking regimen is unusual, you should not switch to it too abruptly - the kidneys may not be able to cope with the load. To begin with, it is better to drink a little more water than usual, but gradually bring the volume of water to 8 - 9 glasses per day. The video in this article will tell you in detail about the problem.
Insulin resistance is a dysfunction of metabolic processes in the human body, in which the susceptibility of peripheral tissues to endogenous and exogenous insulin decreases. This failure leads to an increase in the level of glucose in the blood. This condition leads to the gradual development of non-insulin dependent type 2 diabetes in women and men over 35 years of age.
What does this concept mean and how is the diagnosis carried out? To diagnose diabetes at an early stage, to identify the metabolic syndrome, they take a test to determine the degree of insulin resistance of the body (Homa-ir).
How should I take a blood test for an insulin resistance test to determine metabolic disorders? For the test in women and men, blood is taken from a vein on an empty stomach in a laboratory. Before the study, you must refrain from eating for 8-12 hours.
The calculation of the index (caro or homa-ir) is performed according to the formula:
Homa-ir \u003d IRI (μU / ml) × GPN (mmol / l) / 22.5;
Caro = GPN (mmol / l) / IRI (μU / ml).
IRI is the level of immunoreactive insulin in a blood test on an empty stomach, and GPN is the glucose contained in the blood plasma on an empty stomach. Normally, the index homa ir (Homa) for women and men does not exceed 2.7. If the test results exceed the specified value, insulin resistance (IR) is diagnosed. With an increase in fasting glycemia, the Homa index is also increased.
The Caro test score is normally less than 0.33. To confirm the pathology, the analysis must be done 3 times.
What is the calculation of the Homa index, which means the deviation of the result of the analysis from the norm in men and women? Indications of Homa-ir do not belong to the main criteria for the diagnosis of metabolic syndrome, it is carried out as an additional study. Increased rates can be with chronic hepatitis C, cirrhosis of the liver, non-alcoholic steatosis, type 2 diabetes mellitus, prediabetes.
What is the name of the laboratory analysis to determine insulin resistance, how much does the study cost and how many times should it be done? Clamp test to determine the calculated Homa-ir index. The cost of the analysis depends on how many times it needs to be done and the pricing policy of the laboratory. On average, one test costs about 300 rubles, in total up to 3 studies may be required.
What is the Nome index, what does it mean if it is elevated above the norm, and what should be done? This condition can lead to the development of diabetes, diseases of the heart and circulatory system.
An excess of insulin in the body of women and men negatively affects the state of blood vessels, causing the progression of atherosclerosis. The hormone can contribute to the accumulation of cholesterol plaques in the walls of arteries, thickening of the blood, and the formation of blood clots. This significantly increases the risk of stroke, heart attack, ischemia of the heart and other organs, gangrene of the extremities.
Is it possible to get sick with diabetes mellitus if IR is violated? In the stage of insulin resistance, the body produces more and more insulin in an attempt to compensate for the excess glucose in the blood, thus overcoming tissue resistance. But over time, the insular apparatus is depleted, the pancreas can no longer synthesize the hormone in sufficient volume. Glucose levels rise, and type 2 diabetes mellitus develops.
IR can cause the development of chronic hypertension in women and men.
Insulin affects the functioning of the nervous system, this increases the content of norepinephrine, which causes vasospasm. As a result, blood pressure rises. The protein hormone delays the excretion of fluid and sodium from the body, which also contributes to the development of hypertension.
Violation of IR in women can cause disruption of the functioning of the reproductive organs. Develops polycystic ovary syndrome, infertility.
Elevated insulin levels lead to an imbalance of beneficial and harmful lipoproteins in the blood. This increases the likelihood of developing or exacerbates existing atherosclerosis of the vessels.
What should be done with elevated homa-ir, is it possible to completely cure insulin resistance? You can restore the metabolic processes in the body with the help of regular physical activity, following a low-carbohydrate diet, giving up bad habits, following a diet, sleep and rest.
Sweets, potatoes, pasta, semolina, white bread are excluded from the diet. You can eat fresh vegetables, fruits, lean meats, dairy products, bran and rye bread.
Is it possible to get rid of insulin resistance? With timely lifestyle correction, you can reduce the risk of pancreatic depletion, normalize metabolism, and increase cell susceptibility to the hormone.
An important criterion for therapy is the reduction of excess body weight, physical activity. About 80% of insulin receptors are found in muscle tissue, so the hormone is absorbed during sports. Weight loss helps stabilize blood pressure.
If physical activity and diet therapy do not give results, it is possible to normalize the level of glycemia by taking hypoglycemic drugs.
The information on the site is provided for informational purposes only, does not claim to be reference and medical accuracy, and is not a guide to action. Do not self-medicate. Consult with your physician.
Index of insulin resistance; insulin resistance.
Homeostasis Model Assessment of Insulin Resistance; HOMA-IR; insulin resistance.
What biomaterial can be used for research?
How to properly prepare for research?
Insulin resistance is a decrease in the sensitivity of insulin-dependent cells to the action of insulin, followed by a violation of glucose metabolism and its entry into cells. The development of insulin resistance is due to a combination of metabolic, hemodynamic disorders against the background of inflammatory processes and genetic predisposition to diseases. This increases the risk of diabetes, cardiovascular disease, metabolic disorders, metabolic syndrome.
Insulin is a peptide hormone synthesized from proinsulin by the beta cells of the islets of Langerhans of the pancreas. Insulin is involved in the transport of glucose from the blood to tissue cells, in particular muscle and adipose tissue. The hormone also activates glycolysis and the synthesis of glycogen, fatty acids in liver cells, reduces lipolysis and ketogenesis, takes part in the accumulation of energy compounds in cells and their use in metabolic processes. With the development of resistance of cells and tissues to insulin, its concentration in the blood increases, which leads to an increase in the concentration of glucose. As a result, it is possible to develop type 2 diabetes mellitus, atherosclerosis, including coronary vessels, arterial hypertension, coronary heart disease, ischemic stroke.
To assess insulin resistance, the HOMA-IR index (Homeostasis Model Assessment of Insulin Resistance) can be used. It is calculated using the formula: HOMA-IR = fasting insulin (μU/mL) x fasting glucose (mmol/L)/22.5. An increase in HOMA-IR values is noted with an increase in fasting glucose or insulin levels. This corresponds to increased resistance of cells and tissues to insulin and an increased risk of developing type 2 diabetes and cardiovascular disease. The threshold value of insulin resistance, calculated using the HOMA-IR index, is defined as a percent or its cumulative population distribution.
The insulin resistance index can be used as an additional diagnostic indicator of the metabolic syndrome. Metabolic syndrome is a complex risk factor for cardiovascular disease, type 2 diabetes, atherosclerosis, hepatic steatosis, and some types of cancer. As a result, a complex of metabolic, hormonal and clinical disorders develops against the background of obesity as a result of the development of insulin resistance.
The HOMA-IR index is an informative indicator of the development of impaired glucose tolerance and diabetes mellitus in patients with glucose levels below 7 mmol / l. Also, the calculation of this indicator can be used in cases of suspected development of insulin resistance in women with polycystic ovary syndrome, gestational diabetes mellitus, chronic renal failure, chronic hepatitis B and C, non-alcoholic steatosis of the liver, a number of infectious, oncological, autoimmune diseases and the treatment of certain drugs (glucocorticoids, oral contraceptives and others).
Glucose assessment
3.9 to 5.5 mmol/L (70-99 mg/dL)
5.6 to 6.9 mmol/L (mg/dL)
Elevated level (prediabetes)
7 mmol/l (126 mg/dl) and higher with multiple repetitions of the analysis
Insulin Resistance Index (HOMA IR):
For persons from 20 to 60 years old: 0 - 2.7.
Increased insulin resistance;
Who orders the study?
General practitioner, general practitioner, cardiologist, endocrinologist, surgeon, obstetrician-gynecologist, neuropathologist.
Compared to these tests, the HOMA Insulin Resistance Index is a simpler method. To assess this parameter, you only need to determine the level of insulin and fasting glucose.
The formula for calculating the HOMA index is as follows:
The most common method for assessing insulin resistance involves determining the basal (fasting) ratio of glucose to insulin.
The study is carried out strictly on an empty stomach, after an 8-12-hour period of overnight fasting. The profile includes:
Insulin resistance is associated with an increased risk of developing diabetes and cardiovascular disease and appears to be a component of the pathophysiological mechanisms underlying the association of obesity with these types of diseases (including the metabolic syndrome).
The ratio of basal (fasting) insulin and glucose, as a reflection of their interaction in a feedback loop, has been shown to be highly correlated with the assessment of insulin resistance in the classic direct method for assessing the effects of insulin on glucose metabolism, the hyperinsulinemic euglycemic clamp method.
With an increase in fasting glucose or insulin, the HOMA-IR index, respectively, increases. For example, if fasting glucose is 4.5 mmol/L and insulin is 5.0 µU/mL, HOMA-IR = 1.0; if fasting glucose is 6.0 mmol and insulin is 15 µU/ml, HOMA-IR = 4.0.
The threshold value of insulin resistance, expressed in HOMA-IR, is usually defined as the 75th percentile of its cumulative population distribution. The HOMA-IR threshold is insulin method dependent and difficult to standardize. The choice of cut-off value, in addition, may depend on the objectives of the study and the selected reference group.
The HOMA-IR index is not included in the main diagnostic criteria for the metabolic syndrome, but it is used as an additional laboratory study of this profile. In assessing the risk of developing diabetes in a group of people with glucose levels below 7 mmol / l, HOMA-IR is more informative than fasting glucose or insulin alone.
The use in clinical practice for diagnostic purposes of mathematical models for assessing insulin resistance, based on determining the level of insulin and plasma glucose on an empty stomach, has a number of limitations and is not always acceptable for deciding whether to prescribe hypoglycemic therapy, but can be used for dynamic monitoring.
Impaired insulin resistance is noted with increased frequency in chronic hepatitis C (genotype 1). An increase in HOMA-IR among these patients is associated with a worse response to therapy than in patients with normal insulin resistance, and therefore the correction of insulin resistance is considered one of the new goals in the treatment of hepatitis C. An increase in insulin resistance (HOMA-IR) is observed in non-alcoholic hepatic steatosis .
Strictly on an empty stomach after a night fasting period of at least 8 and no more than 14 hours. Consult with your doctor regarding the appropriateness of the study against the background of the drugs used.
The interpretation of the results of the study contains information for the attending physician and is not a diagnosis. The information in this section should not be used for self-diagnosis or self-treatment. An accurate diagnosis is made by the doctor, using both the results of this examination and the necessary information from other sources: history, results of other examinations, etc.
(2.7 is the threshold corresponding to the 75th percentile of the population of adult years, without diabetes; the choice of threshold may depend on the objectives of the study)
An increase in HOMA-IR values corresponds to an increase in insulin resistance and an increased risk of developing diabetes and cardiovascular disease.
A study aimed at determining insulin resistance by assessing fasting glucose and insulin levels and calculating the insulin resistance index.
Insulin resistance is a decrease in the sensitivity of insulin-dependent cells to the action of insulin, followed by a violation of glucose metabolism and its entry into cells. The development of insulin resistance is due to a combination of metabolic, hemodynamic disorders against the background of inflammatory processes and genetic predisposition to diseases.
This increases the risk of diabetes, cardiovascular disease, metabolic disorders, metabolic syndrome. Insulin is a peptide hormone synthesized from proinsulin by the beta cells of the islets of Langerhans of the pancreas.
With the development of resistance of cells and tissues to insulin, its concentration in the blood increases, which leads to an increase in the concentration of glucose. As a result, it is possible to develop type 2 diabetes mellitus, atherosclerosis, including coronary vessels, arterial hypertension, coronary heart disease, ischemic stroke.
To assess insulin resistance, the HOMA-IR index (Homeostasis Model Assessment of Insulin Resistance) can be used. It is calculated using the formula: HOMA-IR = fasting insulin (μU/mL) x fasting glucose (mmol/L)/22.5. An increase in HOMA-IR values is noted with an increase in fasting glucose or insulin levels.
The insulin resistance index can be used as an additional diagnostic indicator of the metabolic syndrome. Metabolic syndrome is a complex risk factor for cardiovascular disease, type 2 diabetes, atherosclerosis, hepatic steatosis, and some types of cancer.
As a result, a complex of metabolic, hormonal and clinical disorders develops against the background of obesity as a result of the development of insulin resistance. The HOMA-IR index is an informative indicator of the development of impaired glucose tolerance and diabetes mellitus in patients with glucose levels below 7 mmol / l.
The development of insulin resistance in the following diseases and conditions:
The normal values of the IR-HOMA index are the absence of the development of insulin resistance.
What can influence the result?
With an increase in fasting glucose or insulin, the HOMA-IR index, respectively, increases. The threshold value of insulin resistance, calculated using the HOMA-IR index, is defined as a percent or its cumulative population distribution.
The most common method for assessing insulin resistance involves determining the basal (fasting) ratio of glucose to insulin. In assessing the risk of developing diabetes in a group of people with glucose levels below 7 mmol / l, HOMA-IR is more informative than fasting glucose or insulin alone.
The HOMA-IR threshold is insulin method dependent and difficult to standardize. Insulin resistance is a decrease in the sensitivity of insulin-dependent cells to the action of insulin, followed by a violation of glucose metabolism and its entry into cells.
Insulin is involved in the transport of glucose from the blood to tissue cells, in particular muscle and adipose tissue. With the development of resistance of cells and tissues to insulin, its concentration in the blood increases, which leads to an increase in the concentration of glucose.
To assess insulin resistance, the HOMA-IR index (Homeostasis Model Assessment of Insulin Resistance) can be used. It is calculated using the formula: HOMA-IR = fasting insulin (μU/mL) x fasting glucose (mmol/L)/22.5. The insulin resistance index can be used as an additional diagnostic indicator of the metabolic syndrome.
The choice of cut-off value, in addition, may depend on the objectives of the study and the selected reference group. Insulin resistance is an impaired biological response of body tissues to the action of insulin.
Elevated insulin levels in the blood occur when the pancreas produces too much insulin to compensate for tissue insulin resistance. 66% of individuals with impaired glucose tolerance. This mechanism ensures the activation of metabolic (glucose transport, glycogen synthesis) and mitogenic (DNA synthesis) effects of insulin. For the treatment of diseases, insulin sensitivity of muscle and adipose tissue, as well as liver cells, is of the greatest importance.
Normally, to suppress by 50% lipolysis (fat breakdown) in adipose tissue, an insulin concentration in the blood of no more than 10 mcU / ml is sufficient. We remind you that lipolysis is the breakdown of adipose tissue. The action of insulin suppresses it, as well as the production of glucose by the liver.
Insulin resistance of adipose tissue is manifested in the fact that the anti-lipolytic effect of insulin weakens. At first, this is compensated by increased production of insulin by the pancreas. Because insulin resistance for many years is compensated by excess production of insulin by beta cells of the pancreas.
When blood sugar levels rise, this further increases insulin resistance in tissues and inhibits the function of beta cells to secrete insulin. Insulin causes proliferation and migration of smooth muscle cells, lipid synthesis in them, fibroblast proliferation, activation of the blood coagulation system, and a decrease in fibrinolysis activity. An effective way to treat insulin resistance in the early stages of type 2 diabetes, and even better before it develops, is a carbohydrate-restricted diet.
Every day we follow the news in the treatment of insulin resistance. It is best if you take up jogging as a physical activity, as described here. If you do this, then personally your chances of doing without insulin increase to 90-95%.
The prices for research do not include the cost of consumables and services for taking biomaterial. These costs are paid additionally, their amount may vary depending on the characteristics of the selected study. The development of insulin resistance is due to a combination of metabolic, hemodynamic disorders against the background of inflammatory processes and genetic predisposition to diseases.
The HOMA-IR index is an informative indicator of the development of impaired glucose tolerance and diabetes mellitus in patients with glucose levels below 7 mmol/l. When assessing the risk of developing diabetes and cardiovascular disease. The information in this section should not be used for self-diagnosis or self-treatment.
And it doesn’t matter where insulin comes from, from your own pancreas (endogenous) or from injections (exogenous). Insulin resistance increases the likelihood of not only type 2 diabetes, but also atherosclerosis, heart attack, and sudden death due to blockage of the vessel by a blood clot.
Diagnosing insulin resistance with tests is problematic. This analysis result indicates that the patient has a significant risk of type 2 diabetes mellitus and/or cardiovascular disease. It is the carrier of glucose into the cell through the membrane. Insulin resistance is the problem of a huge percentage of all people. It is assumed that it is caused by genes that have become predominant in the course of evolution.
This corresponds to increased resistance of cells and tissues to insulin and an increased risk of developing type 2 diabetes and cardiovascular disease. The HOMA-IR index is not included in the main diagnostic criteria for the metabolic syndrome, but it is used as an additional laboratory study of this profile.
The Insulin Resistance Index (HOMA-IR) is a measure of the resistance of body cells to the effects of insulin. The calculation of the coefficient is necessary to determine the likelihood of hyperglycemia, atherosclerotic vascular damage, and the development of prediabetes.
Insulin resistance is the resistance of body cells to the effects of insulin, leading to impaired glucose metabolism: its entry into cells decreases, and blood levels increase. This condition is called hyperglycemia and is associated with a high risk of developing diabetes, heart and vascular disease, metabolic syndrome, and obesity.
The ratio of insulin and fasting blood glucose levels reflects their interaction. HOMA-IR is a mathematical model of this process. The study is highly informative as a technique for assessing risks and monitoring the condition of patients, the limitation is the lack of a standardized norm, the dependence of the final value on the methods for determining the initial data.
The insulin resistance index is a method for monitoring and determining the risk of developing metabolic syndrome, type 2 diabetes, and cardiovascular diseases. In diagnostics, it is not widely used; it is prescribed additionally when the main laboratory criteria are ambiguous. Indications for research:
Signs of insulin resistance. The calculation of the coefficient is carried out as part of a comprehensive examination of people with hyperglycemia, hyperinsulinemia, hyperglyceridemia, a tendency to thrombosis, arterial hypertension, and generalized obesity. The probability of developing type 2 diabetes mellitus, coronary artery disease, ischemic stroke, atherosclerosis is determined.
Taking medications. An increased risk of developing glucose tolerance exists during treatment with glucocorticoids, estrogen preparations, and oral contraceptives. In these cases, the test is prescribed periodically for the timely detection of disorders of carbohydrate metabolism, correction of therapy.
Hepatitis C. A relationship has been found between an increase in the test result and a decrease in the body's response to treatment in hepatitis C. Recently, the calculation of HOMA-IR is recommended to be performed in order to control insulin tolerance. Its decrease is considered as a condition for the effectiveness of therapy.
HOMA-IR is calculated based on your insulin and blood glucose levels. It is necessary to donate blood in the morning, strictly on an empty stomach. Rules for preparing for the procedure:
The threshold is the 75th percentile of the total population distribution. For people from 20 to 60 years old, it is 0-2.7. The boundaries of the norm are conditional, depending on the methods of analysis, on the objectives of the survey. The following factors influence the result:
The insulin resistance index increases with an increase in the concentration of insulin and glucose in the blood. Threshold exceeding is defined in the following cases:
In patients with an initially elevated result, a decrease in the indicator reflects the effectiveness of the treatment. In the initial diagnosis, a low value of the coefficient is the norm.
The insulin resistance index has a predictive value when examining patients with obesity, arterial hypertension, metabolic syndrome, diabetes mellitus, and cardiovascular diseases.
Diabetes mellitus (DM) is an urgent medical and social problem for most countries of the world. The incidence of this disease has significantly exceeded the expected parameters, and at the moment the incidence of diabetes is characterized by the International Diabetes Federation as an epidemic.
According to an expert assessment, the number of patients with diabetes in 2007 is 246 million (about 6% of the population aged 20-79 years), and by 2025 it will increase to 380 million. About 90-95% are patients with type 2 diabetes. Even more patients (308 million) have early disorders of carbohydrate metabolism: impaired fasting glycemia and impaired glucose tolerance. At the same time, experts say that the number of undiagnosed diabetes can exceed the registered level by 2-3 times.
The World Health Organization defines type 2 diabetes as a disorder of carbohydrate metabolism caused by predominant insulin resistance (IR) and relative insulin deficiency or a predominant defect in insulin secretion with or without IR. Thus, type 2 diabetes is a group of heterogeneous disorders of carbohydrate metabolism.
This largely explains the lack of generally accepted theories of the etiology and pathogenesis of this disease. It is undoubted that in type 2 diabetes there are two main defects simultaneously: IR and dysfunction of β-cells.
This sequence of events is typical for both patients with metabolic syndrome and patients with normal body weight. But in some patients with type 2 diabetes, the primary defect can occur at the level of beta cells and manifest as impaired insulin secretion. IR in such patients develops in combination with or following impaired insulin secretion.
Patients of this type are much less common and are mainly represented by individuals with normal body weight. But whatever defect (i.e., reduced secretion of insulin or IR) initiates the development of type 2 diabetes, it then leads to the appearance of a second defect.
It is important that for the occurrence of a significant violation of carbohydrate metabolism, both mechanisms must be present. Therefore, it is extremely important to use reliable and reliable methods for quantifying impaired insulin action at the tissue level.
In a broad sense, IR is understood as a decrease in the biological response to one or more effects of insulin action. However, IR is more often defined as a condition that is accompanied by a decrease in the utilization of glucose by body tissues under the influence of insulin, i.e. resistance of cells of various organs and tissues to the hypoglycemic action of insulin.
But since the biological effect of insulin is to regulate metabolic reactions (metabolism of carbohydrates, fats and proteins) and mitogenic processes (growth processes, tissue differentiation, DNA synthesis, gene transcription), the modern concept of IR is not limited to parameters characterizing only carbohydrate metabolism, and also includes changes in the metabolism of fats, proteins, endothelial cell function, gene expression, etc.
The sensitivity of peripheral tissues to insulin is determined by the presence of specific receptors, the function of which mediates the stimulatory effect of insulin on the utilization of glucose with the participation of glucose transporters (GLUTs) by peripheral tissues.
Initiation of insulin hormonal signaling begins with phosphorylation of the p-subunit of the insulin receptor, which is mediated by tyrosine kinase. This phosphorylation and then sustained autophosphorylation of the insulin receptor is required for subsequent steps in the post-receptor action of insulin and in particular for GLUT activation and translocation.
The greatest clinical significance is the loss of sensitivity to insulin in muscle, adipose and liver tissues. IR of muscle tissue is manifested in a decrease in the supply of glucose from the blood to myocytes and its utilization in muscle cells. IR of adipose tissue manifests itself in resistance to the anti-lipolytic action of insulin, leading to the accumulation of free fatty acids and glycerol.
Along with the term insulin resistance, there is the concept of insulin resistance syndrome (metabolic syndrome). It is a combination of clinical and laboratory manifestations: impaired carbohydrate metabolism: impaired fasting glycemia, impaired glucose tolerance or diabetes, central obesity, dyslipidemia (increased levels of triglycerides and LDL cholesterol, decreased HDL cholesterol), arterial hypertension, increased levels of thrombotic and antifibrinolytic factors and, ultimately, a high predisposition to the development of atherosclerosis and cardiovascular disease.
The criteria for metabolic syndrome as defined by the International Diabetes Federation (IDF, 2005) are:
plus any two of the four listed factors:
Metabolic syndrome is the most common manifestation of IR. However, the concept of IR state is much broader. Classical examples of severe inherited IR are leprechaunism, Rabson-Mendenhall syndrome, type A IR.
Various factors influence the sensitivity of tissues to insulin: age, overweight and especially the distribution of adipose tissue, blood pressure, the presence of dyslipidemia, physical condition and body fitness, smoking, coronary heart disease and a family history of diabetes, as well as a number of somatic diseases.
IR is a genetically determined factor in the application of external influences, such as nutrition quality, low activity, alcohol abuse, age, gender (the risk of metabolic syndrome is higher in postmenopausal women), psycho-emotional factors, drugs (glucocorticoids, nicotinic acid, sexual hormones).
IR occurs not only in type 2 diabetes, but also in other diseases accompanied by metabolic disorders. IR occurs in more than 25% of apparently healthy individuals without obesity, while its severity is comparable to the severity of IR observed in patients with type 2 diabetes. The main diseases and conditions associated with IR are listed below:
The concept of insulin sensitivity still does not have a clear norm, a decrease below which would be considered as IR. However, it is known that at the lowest rates, obesity, impaired glucose tolerance, increased lipid levels, increased blood pressure and disorders in the blood coagulation system are much more common than in the rest of the population.
At the present stage, the most attention is paid to the following methods of quantitative assessment of the action of insulin: hyperinsulinemic euglycemic clamp and structural mathematical models based on intravenous (minimal model, FSIGTT) and oral (0810) glucose tolerance test or determination of glucose and insulin on an empty stomach (with the calculation of a number of indices, in including HOMA, QUICKI).
The most accurate method, recognized as the "gold standard" for assessing IR, is the euglycemic hyper-insulinemic clamp proposed by Andres R. et al. in 1966 and developed by DeFronzo K. et al. in 1979. To assess IR, the test is considered the most reliable and reproducible both in DM and in healthy people.
Typically, the rate of insulin infusion is 40 mU per m2 of body surface per minute, or approximately 1 mU/kg/min. Glycemia is measured every 5-10 minutes. on glucose analyzers or use constant monitoring of the level of glycemia using an artificial pancreas apparatus (“Biostator”).
To eliminate the effect of hyperglycemia itself on glucose utilization and exclude glucosuria, the normoglycemic variant of the clamp method is used, deviations from the selected target level of glycemia should not exceed 10%. With a decrease in glycemia, the rate of glucose administration is increased, with an increase, it is reduced.
After 120-240 minutes, dynamic equilibrium is reached: the rate of glucose administration is equal to the rate of its uptake by tissues. Thus, the total amount of glucose administered over the last 60-120 min. studies in an equilibrium state, characterizes the insulin sensitivity index.
Glucose is administered in the form of a 10-20% solution, the accuracy of the injection rate is ensured using a volumetric dispenser. It is possible to introduce two solutions with the help of an artificial pancreas apparatus (“Biostator”).
During the period of gradual decrease in glycemia from the initial level to the target values, the rate of glucose infusion is changed by the researcher depending on the level of glycemia every 10 minutes. This stage of the study takes from 2 to 4 hours, depending on the initial hyperglycemia.
Then the frequency of determining glycemia increases (every 5 minutes) with a constant change in the rate of glucose administration until the desired level of normoglycemia is reached and maintained. A constant level of glycemia and the rate of glucose infusion into the state of dynamic equilibrium of the introduction and consumption of glucose are maintained for 60 minutes. The total duration of the study is 4-6 hours.
The rate of glucose infusion in the equilibrium state determines the rate of glucose utilization by peripheral tissues, which is used to calculate the utilization factor (M-index), as the arithmetic mean of 10-12 discrete values of the glucose infusion rate, divided by the body weight of the subject or the lean body mass ( if it is defined), for 1 min.
The more glucose must be injected per unit of time to maintain a stable level of glycemia, the more the patient is sensitive to the action of insulin. If the amount of glucose injected is small, then the patient is insulin resistant.
After the end of the study, the insulin infusion is stopped. The introduction of glucose is continued for 30-40 minutes. at a high rate to prevent hypoglycemia in conditions of suppressed hepatic glucose production.
The advantages of the hyperinsulinemic euglycemic clamp are: the ability to assess insulin sensitivity without the risk of hypoglycemia and the subsequent release of contra-insular hormones, without the intervention of endogenous insulin and the influence of various levels of hyperglycemia.
In addition, the clamp is easily combined with the latest metabolic research methods, such as isotope technology, venous catheterization of various regions, indirect calorimetry and tissue biopsy, microdialysis of adipose tissue, nuclear magnetic resonance spectroscopy and positron emission tomography.
As an attempt to develop a more practical method for measuring IR for use in large populations, Bergman et al. in 1979 a minimal model was proposed. At the same time, frequent determinations of glucose and insulin are carried out during an intravenous glucose tolerance test for 180 minutes.
The results are entered into a computer model (MINMOD) based on certain assumed principles of glucose and insulin kinetics. The method allows you to simultaneously determine the insulin sensitivity index (SI) and acute insulin response (AIR). In healthy people, the results correlate significantly with clamp data.
On the other hand, the study is simpler, provides valuable epidemiological data, and also characterizes both the action and secretion of insulin, which are the main predictors of the development of type 2 diabetes.
And yet, despite its widespread use in scientific research, the test is used in clinical practice to a limited extent due to the high cost, complexity, and duration of the procedure. In large epidemiological studies, shortened versions of the intravenous and oral glucose tolerance test are also used using the principles of the minimal model: FSIGTT, OSIG.
The simplest and most convenient method for assessing IR in clinical practice is the change in fasting plasma insulin concentration. Hyperinsulinemia with normoglycemia, as a rule, indicates the presence of IR and is a harbinger of the development of type 2 diabetes. However, with the development of type 2 diabetes, the level of glycemia increases, and insulin decreases.
In addition, various indices have been proposed for assessing IR, calculated from the ratio of plasma insulin and glucose concentrations on an empty stomach and/or after a food load. Given the approximate nature of the method, its use is possible only in large epidemiological studies and is of little use for individual measurements.
With regard to the diagnosis of insulin resistance, there are a number of difficulties in choosing the optimal technique. Many methods have been developed to assess insulin resistance. Among these, three methods have received the most attention: the euglycemic insulin clamp, the “minimal model,” and fasting insulin levels.
The gold standard is the hyperinsulinemic euglycemic Glukoseklamp, which determines the rate of disappearance of glucose during parenteral glucose intake. The infused amount of glucose infusion to maintain euglycemia with continuous insulin administration is a measure of insulin sensitivity. Due to high technical costs and invasiveness, this method is reserved for solving scientific problems and is not suitable for routine measurement.
The euglycemic test cannot objectively assess the presence of insulin resistance. This is confirmed by the fact that when using this method, insulin resistance occurs in more than 25% of apparently healthy individuals without obesity, the severity of which is comparable to the insulin resistance observed in patients with type 2 diabetes mellitus.
Today there are no single generally accepted criteria for hyperinsulinemia. Various authors propose to consider hyperinsulinemia as a state when the concentration of IRI in the blood plasma in the morning on an empty stomach exceeds from 5.3 to 25 μU/ml. As a criterion for hyperinsulinemia, it is also recommended to consider the level of IRI more than 25-28 mcU/ml 2 hours after glucose loading.
More complex calculated indicators characterizing the insulin response have been proposed:
The following quantitative criteria for metabolic syndrome X are given for parameters of insulin metabolism. Hyperinsulinemia on an empty stomach is considered when the IRI level is 212.5 mcd/ml and above. This criterion proposed by Paolisso G. et al. is close to the value (12.7 mcd/ml) obtained in a large study in Mexico, the upper limit of the normal level of IRI (up to 12.9 mcd/ml) proposed by SMHaffner and co-authors, and fully corresponds to the results [Didenko V. A., 1999].
An additional difficulty in unifying the criteria for hyperinsulinemia is created by the fact that the absolute level of IRI also depends on the method of determination and the sets by which this determination is made. The exact frequency of this symptom is unknown due to differences in methods and diagnostic criteria. Moreover, the results of studies in the population cannot be compared due to the heterogeneity of the sample and the use of various diagnostic criteria (clinical, endocrine, morphological).
Conway et al, measuring basal plasma insulin levels in non-obese PCOS patients, found hyperinsulinemia in 30%. Falcone at al. (1992) using an intravenous glucose tolerance test with calculation of insulin resistance, revealed hyperinsulinemia in 65%.
HOMA=Insulin , which allows you to evaluate insulin resistance. For the HOMA index for children, the norm values depending on gender and age have values. These indices, however, cannot distinguish between hepatic and peripheral insulin resistance.
The oral glucose tolerance test, which measures blood glucose and insulin, as well as the insulin/glucose ratio or the insulin sensitivity index as ISIcederholm, provides insight into insulin resistance. It is calculated by the formula:
According to Nobels F., Dewailly D. (1992) oral glucose tolerance test, an increase in the area under the curve of plasma insulin levels (more than 2 standard deviations) is observed in 27% of patients with PCOS without obesity and in 12% with obesity .
F.Caro (1991) believes that a sufficiently reliable criterion for the presence of insulin resistance is a decrease in the ratio of blood glucose concentration (in mg / dl) to the level of IRI (in μU / ml) below 6 (when measuring glucose concentration in mmol / l, the quantitative criterion is the value 0.33).
The intravenous glucose tolerance test is not suitable for determining insulin resistance in diabetics due to a defect in insulin secretion.
To diagnose insulin resistance, it is proposed to determine the degree of protein ordering. An increase in the parameter (more than 0.570 rel. units), indicating the development of membrane pathology due to increased lipid peroxidation and protein glycation, is the basis for predicting a severe course of the disease. A decrease in protein exposure (0.20 rel. units and below), accompanied by hyperlactacidemia and a decrease in glucose utilization by erythrocytes, indicates the development of insulin resistance and insulin overdose. [L.L. Vakhrusheva et al., 1999].
With any of these technologies, there is great variation in insulin sensitivity in healthy subjects, which may match those of diabetics. Therefore, based on the measurement of insulin resistance, it is very difficult to distinguish between subjects with and without diabetes mellitus.
On the other hand, this fact reveals the physiological nature of insulin resistance as a reaction of the body. Its reversibility is demonstrated in cases of “normal or preserved” insulin sensitivity, which is detected in a certain proportion of patients, usually with normal or even reduced body weight.
Thank you for your understanding and cooperation.
© 2018 How to deal with diabetes · Copying materials from this site without permission is prohibited
