Insulin Resistance – This book covers the entire syllabus of “Pharmacology” prescribed by BNMC- for diploma in nursing science & midwifery students. We tried to accommodate the latest information and topics. This book is an examination setup according to the teachers’ lectures and examination questions.
At the end of the book, previous questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourish. The unique way of presentation may make your reading of the book a pleasurable experience.
Insulin Resistance
Insulin resistance developed when daily requirement of insulin becomes more than 200 units/day. An insulin resistant patient can receive high concentration of insulin even up-to 5000 units/day.
Insulin resistant may be due to
- Obesity (most common cause of mild resistant).
- Decline in number of insulin receptor.
- Reduction of affinity of receptors to insulin.
- Defects in post-receptor mechanism.
- Insulin- resistance associated with antibiotics directed against the insulin receptor.
Types of insulin resistance
A. Acute insulin resistance. Due to –
- Infection
- Trauma
- Surgery
- Emotional stress
- Corticosteroid
- Ketoacidosis
- Other hypoglycaemic hormones
B. Chronic insulin resistance. Due to –
- IgG anti-insulin antibody formation.
- Endocrine disorders
- Lipodystrophyic type of diabetes.
Mechanism of insulin resistance:
1. Antibody mediated: High dose and long term insulin therapy → Development of IgG anti-insulin antibody → Inactivation of insulin by the antibodies → Development of resistance.
2. Insulin therapy: Development of antibody against insulin receptor
3. Acidosis: Reduce the effect of insulin on peripheral glucose utilization insulin → resistance.
4. Endocrine disorder (such as acromegaly, adrenal hypercorticism): increase release of glucocorticoids → increase blood glucose level → increase insulin requirement → insulin- resistance.
5. Insulin resistance in
- Obese diabetics: Due to excess free fatty acid and reduction of the number of insulin receptor.
- Patients with diabetic ketoacidosis → presence of super-utilizable amount of ketoacid in plasma → higher amount of insulin required → Insulin resistance.
Treatment of insulin resistance
1. Change the preparation of insulin: Beef insulin being more antigenic than pork. So, highly purified pork insulin is given.
2. Administration of oral hypoglycaemic agent (sulfonylurea) to release non-antigenic endogenous insulin and to increase insulin sensitivity by raising insulin receptor number per cell. It is useful where pancreatic function is not totally lost.
3. Administration of glucocorticoids (prednisolone 20-40 mg/day) over weeks or months to suppress the antibody formation.
4. Reduction of obesity.
5. Correction of ketoacidosis and endocrine disorder.
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