Dr. Homayoun Daneschvar, an Internist at Beth Israel Deaconess, lectured today regarding insulin resistance. He explained that insulin resistance is a powerful independent predictor of a wide range of serious illnesses, including stroke, heart disease, and cancer. Studies have also shown that hyperinsulinemia in response to insulin resistance precedes the development of Type 2 diabetes.
As a group, we explored continuous versus pulsatile administration of insulin. If providers want to achieve glucose control (and avoid resistance), they should give pulsatile insulin to patients.
We also discussed the primary metabolic abnormalities associated with insulin resistance - high free fatty acids and high glucose level. Insulin is a potent inhibitor of lipolysis and when the body is resistant to insulin, the ability of insulin to inhibit lipolysis is impaired, resulting in chronically elevated plasma free fatty acids. If a provider were to rely on BMI, they would miss this problem. In explaining the roll of free fatty acids in insulin resistance, Dr. Daneschvar discussed "the overflow hypothesis," as depicted below:
“Overflow hypothesis.” Lean animals have little fat in visceral or subcutaneous compartment (I). Moderate fat feeding (II) increases fat in the visceral compartment primarily, resulting in visceral fat deposition and hepatic insulin resistance (III). Increased amounts of dietary fat (IV) result in visceral and subcutaneous fat deposition and hepatic and peripheral insulin resistance.
Source: http://onlinelibrary.wiley.com/doi/10.1038/oby.2006.277/full
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