Dr/ Mohamed El-Ghareeb Insulin resistance & pre-diabetes

• The pancreas is located in the abdomen, behind the stomach.
• The bulk of the pancreas is an exocrine gland secreting pancreatic fluid into the duodenum after a meal.
• Inside the pancreas are millions of clusters of cells called islets of Langerhans.
• The islets are endocrine tissue containing four types of cells, they are:

1.  beta cells, which secrete insulin and amylin

• Amylin is a peptide hormone that is co-secreted with insulin from the pancreatic β-cell and is thus deficient in diabetic people. It inhibits glucagon secretion, delays gastric emptying, and acts as a satiety agent

2 .alpha cells, which secrete glucagon;

3 .delta cells, which secrete somatostatin

4 . gamma cells, which secrete a pancreatic polypeptide [stimulates  pancreatic enzyme secretion and contracts the gallbladder) although  earlier suggestions were that it might control appetite as a satiety  hormone].

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Insulin

• Poly peptide hormone produced from beta cells of island of Langerhans in pancreas
• increase glucose uptake  by  effect  on  insulin  receptors  on

adipose tissues & muscles

• increase glycolysis
• increase lipogenesis
• increase synthesis of proteins
• anabolic hormone

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Insulin resistance

• Insulin resistance means  decreased  ability  of  target  tissues  like  liver,  muscles  &  adipose tissues  to  respond  properly  to normal  or increased level of insulin.
• Insulin may be low, normal or high
• Response to insulin is decreased so decreased glucose uptake (muscle, fat) & increase in glucose production (liver)
• The mechanism of insulin resistance is unclear but Both genetic & environmental factors are involved [more genetic predisposition]

Insulin resistance Symptoms

• When a person has insulin resistance, the pancreatic cells increase the production of insulin, and the person will not have any symptoms.
• But over time, the pancreatic cells can wear out due to the overproduction of insulin, and the person will experience certain symptoms. Some of the common symptoms are briefed below.

Acanthosis nigricans

• condition of dark and think skin.
• It is mainly seen in folds and creases of the skin like the neck, armpit and groin. People who are obese are commonly affected by this condition.
• The presence of acanthosis nigricans can be a symptom of insulin resistance which can lead to type 2 diabetes.

Extreme thirst or hunger

• Sometimes you would have just consumed food, but you will feel hungry very often è This is because the muscles did not get energy from the food you ate.
• As a result, the muscles and other tissues send a hunger message to the brain. This can lead to extreme hunger or thirst.

Feeling hungry even after a meal

• People feel hungry very often, even if they just have a snack or a meal.
• This is one of the common symptoms of insulin resistance.

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Increased or frequent urination

• Increased urination is one of the common symptoms of diabetes or pre- diabetes è People tend to urinate often when there is the presence of unused glucose in the blood è The body tries to eliminate the excess  glucose through urine. So people have the feeling to urinate often.

Tingling sensations in hands or feet

• excess glucose in the blood lead to poor circulation of blood and can also damage the nerves.

Feeling more tired than usual

• Insulin resistance can sometimes cause subtle symptoms.
• It will not be very obvious and can slowly make a person tired. Some people may relate it to not getting enough sleep and consuming unhealthy foods. But the underlying reason may  be due to insulin resistance.

Frequent infections

• This is because they have reduced blood circulation and nerve damage issues. As a result, this can increase the infection rate of the person.

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Insulin resistance Diagnosis

• Homeostatic model assessment of insulin resistance (HOMA-IR)
• HOMA-IR is a calculation that indicates your level of insulin sensitivity by taking into account the relationship between glucose and insulin. For this reason, HOMA-IR may be more informative for you and your doctor  than either fasting glucose or fasting insulin alone.
• the higher your HOMA-IR, the more insulin resistant you are

Results

• Optimal insulin sensitivity: < 1
• Early insulin resistance: > 1.9
• Significant insulin resistance: > 2.9

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Management of (IR)

• Weight reduction
• Exercise
• Dietary modification
• Weight loss is the 1st line therapeutic approach
• Maintaining a healthy weight is important to make the cells become insulin sensitive.
• It can be achieved with a healthy diet and a workout plan.
• If you have an unhealthy weight, make sure you shed those extra calories you gained.

• Exercise

  1. Exercise plays an  important  role  in  insulin  resistance.
  2. Make it a habit to work out daily.
  3. This will help you to be active and keeps a check on your blood glucose level.
• Dietary modification

• Pharmacotherapy.