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Insulin Resistance Syndrome

Aka: Insulin Resistance Syndrome, Impaired Glucose Tolerance, Impaired Fasting Glucose, Insulin Resistance, Glucose Intolerance, Metabolic Syndrome, Syndrome X
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  1. See Also
    1. Diabetes Mellitus
    2. Type I Diabetes Mellitus
    3. Type II Diabetes Mellitus
    4. Glucose Metabolism
    5. Diabetes Mellitus Education
    6. Diabetes Mellitus Complications
    7. Diabetic Ketoacidosis
    8. Hyperosmolar Hyperglycemic State
    9. Diabetes Mellitus Control in Hospital
    10. Diabetes Mellitus Glucose Management
    11. Hypertension in Diabetes Mellitus
    12. Hyperlipidemia in Diabetes Mellitus
    13. Diabetic Retinopathy
    14. Diabetic Nephropathy
    15. Diabetic Neuropathy
  2. Epidemiology
    1. Prevalence in U.S.
      1. Total estimated at 70-80 million
      2. Affects 25% of adults and 4% of teens
  3. Pathophysiology
    1. Diminished Insulin response results in hyperinsulinemia
      1. Fewer Insulin receptors on cells
      2. Less Glucose transporter (Glut 4) in cells
    2. Hyperinsulinemia predisposes to cardiovascular disease
    3. Precursor to Type II Diabetes Mellitus
  4. Risk Factors
    1. Strong Family History of Diabetes Mellitus
    2. Prior Gestational Diabetes Mellitus or Fetal Macrosomia
    3. Obesity
      1. Body Mass Index 30 kg/m2 or higher
      2. Waist to hip ratio increased
        1. Men: 1.0 or higher
        2. Women: 0.8 or higher
  5. Diagnosis: Three or more conditions below
    1. Insulin Resistance (see labs below)
    2. Hypertension (Blood Pressure 130/85 or higher)
      1. Seen in up to 40% of Metabolic Syndrome patients
    3. Hyperlipidemia (see labs below)
    4. Coronary Artery Disease
    5. Polycystic Ovary Syndrome
    6. Acanthosis Nigricans
    7. HAIR-AN Syndrome
    8. Abdominal Obesity
      1. Men with Waist Circumference >40 inches or 102 cm
      2. Women with Waist Circumference >35 inches or 88 cm
  6. Labs
    1. Screening Indications
      1. See Risk Factors above
      2. Body Mass Index >25 kg/m2
      3. Family History of Diabetes Mellitus
      4. Prior history of Gestational Diabetes
      5. Age over 45 years
      6. HDL Cholesterol <35 mg/dl
      7. Serum Triglycerides >250 mg/dl
      8. Polycystic Ovary Syndrome
      9. Hypertension
    2. Impaired Glucose Metabolism
      1. Fasting Glucose: 100 to 125 mg/dl
        1. Known as Impaired Fasting Glucose
        2. New guidelines suggest bottom cut-off of 100 mg/dl
        3. Metabolic Syndrome defined as 110 mg/dl or higher
      2. Two hour Glucose Tolerance Test (75 g): 140-199 mg/dl
        1. Known as Impaired Glucose Tolerance
    3. Lipid Profile
      1. Serum Triglycerides >150 mg/dl
      2. Serum very Low Density Lipoprotein (VLDL) increased
      3. Serum HDL Cholesterol decreased
        1. Men <40 mg/dl
        2. Women <50 mg/dl
    4. Best lab markers for Insulin Resistance
      1. Plasma Insulin level (or Glucose to Insulin Ratio)
      2. Plasma Triglyceride levels
      3. Triglyceride to HDL ratio
      4. McLaughlin (2003) Ann Intern Med 139:802-9
  7. Management: Prevention of progression to Diabetes
    1. Moderate aerobic Exercise for 30 minutes every day
      1. Example: Brisk walking for total of 150 min/week
    2. Decreased caloric intake
      1. Keep fat intake <30% with saturated fat <10%
      2. Salad, vegetables, fruits
      3. Whole grains and legumes
      4. Fish high in Omega-3 Fatty Acids and lean meats
      5. Reduce intake of simple sugars
    3. Foods associated with improved Insulin sensitivity
      1. Coffee
        1. Salazar-Martinez (2004) Ann Intern Med 140:1-8
        2. Tuomilehto (2004) JAMA 291:1213-9
      2. Cinammon (1/2 teaspoon per day)
        1. Appears to have Insulin-like activity
        2. May increase Insulin sensitivity
        3. Improves lipid profile
        4. Khan (2003) Diabetes Care 26(12):3215-8
      3. Moderate Alcohol consumption
        1. Howard (2004) Ann Intern Med 140:211-9
    4. Weight Reduction (lose 7-15% of prior weight)
    5. Increase Dietary Fiber to 15 gram per 1000 calories
    6. Cardiac Risk Management
      1. Same as Diabetes Mellitus and Coronary Artery Disease
      2. Aspirin 81 mg PO qd
      3. Hyperlipidemia
        1. LDL Cholesterol <100 mg/dl
        2. HDL Cholesterol >40 mg/dl (50 mg/dl in women)
        3. Triglycerides <150 mg/dl
        4. Statins are preferred agents
          1. Sowers (2003) Am J Cardiol 91:14B-22B
      4. Hypertension
        1. Goal Blood Pressure < 125/75 mmhg
        2. Consider ACE Inhibitor or Angiotensin Blocker
    7. Consider pharmacologic agents for Glucose control
      1. Glucophage (Metformin)
      2. Acarbose (Precose)
      3. Avandia or Actos
    8. References
      1. (2002) N Engl J Med 346:393-403
      2. Scott (2003) Am J Cardiol 92(2 suppl):35i-42i
      3. (2006) Lancet 368:1096-105
  8. Course
    1. High risk for Type II Diabetes Mellitus
    2. Diabetes Prevention Program (DPP)
      1. Basic diet and Exercise: 11% develop diabetes/year
      2. Metformin 850 bid/diet/Exercise: 7.8% develop DM/year
      3. Intensive diet, Exercise: 4.8% develop diabetes/year
        1. Classes and coaches
        2. Weight Reduction of 7%
      4. Reference
        1. (1999) Diabetes Care 22:623-34
  9. References
    1. (1997) Diabetes Care 21:310-4
    2. (2001) JAMA 285:2486-97
    3. Goutham (2001) Am Fam Physician 63(6): 1159-66

Insulin Resistance (C0021655)

Definition (MSH) Diminished effectiveness of INSULIN in lowering blood sugar levels: requiring the use of 200 units or more of insulin per day to prevent HYPERGLYCEMIA or KETOSIS.
Concepts Pathologic Function (T046)
MSH D007333
SnomedCT 48606007
English Resistance, Insulin, Insulin resistance syndrome, Insulin Resistance [Disease/Finding], insulin resistance syndrome, Drug resistance to insulin, Insulin resistance, Drug resistance to insulin (disorder), Insulin Resistance, insulin resistance
Italian Insulino-resistenza, Sindrome da resistenza insulinica, Resistenza all'insulina
Japanese インスリン抵抗性, インスリン抵抗性症候群, ｲﾝｽﾘﾝﾃｲｺｳｾｲｼｮｳｺｳｸﾞﾝ, ｲﾝｽﾘﾝﾃｲｺｳｾｲ
Swedish Insulinresistens
Czech insulin - rezistence, Syndrom inzulinové rezistence, Inzulinová rezistence
Finnish Insuliiniresistenssi
Russian INSULINOREZISTENTNOST', ИНСУЛИНОРЕЗИСТЕНТНОСТЬ
Spanish resistencia a la insulina, resistencia a la insulina (trastorno), resistencia a la insulina de causa farmacológica, resistencia a la insulina de causa farmacológica (trastorno), Resistencia a la insulina, Síndrome de resistencia a la insulina, Resistencia a la Insulina
Croatian INZULINSKA REZISTENCIJA
Polish Oporność na insulinę, Insulinooporność
Hungarian Insulin resistentia, Insulin resistentia syndroma
Portuguese Insulinorresistência, Síndrome de insulinorresistência, Resistência à Insulina
Dutch insulineresistentiesyndroom, insulineresistentie, Insulineresistentie, Resistentie, insuline-
French Syndrome d'insulino-résistance, Insulinorésistance, Insulino-résistance, Résistance à l'insuline
German Insulinresistenzsyndrom, Insulinresistenz
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Microvascular Angina (C0206064)

Definition (MSH) ANGINA PECTORIS or angina-like chest pain with a normal coronary arteriogram and positive EXERCISE TEST. The cause of the syndrome is unknown. While its recognition is of clinical importance, its prognosis is excellent. (Braunwald, Heart Disease, 4th ed, p1346; Jablonski Dictionary of Syndromes & Eponymic Diseases, 2d ed). It is different from METABOLIC SYNDROME X, a syndrome characterized by INSULIN RESISTANCE and HYPERINSULINEMIA, that has increased risk for cardiovascular disease.
Concepts Disease or Syndrome (T047)
MSH D017566
SnomedCT 194869009, 233845001
English Angina Pectoris with Normal Coronary Arteriogram, Angina, Microvascular, Chest pain norm cor angio, Cardiac syndrome X (disorder), Syndrome X (Cardiac), Microvascular Angina [Disease/Finding], cardiac syndrome x, syndrome x, microvascular angina, Cardiac Syndrome X, Cardiac syndrome X, Chest pain with normal coronary angiography, Cardiac syndrome X (finding), Microvascular Angina, Syndrome X, Cardiac, Angina Syndrome Xs, Angina Syndrome X, Angina X Syndromes, Angina X Syndrome, Syndrome X, Angina, Syndrome Xs, Angina, Syndrome, Angina X, X Syndrome, Angina, Syndrome X, syndrome X, Microvascular angina
Dutch microvasculaire angina, cardiaal syndroom X, Angina pectoris met normaal coronair arteriogram, Angina, microvasculaire, Syndroom X, Cardiaal syndroom X, Microvasculaire angina, Syndroom X, angineus, Syndroom X, cardiaal
German mikrovaskulaere Angina pectoris, Herzsyndrom X, Angina pectoris mit normalem Koronararteriogramm, Syndrom X, X-Syndrom, Angina, mikrovaskuläre
Portuguese Angina microvascular, Síndrome X cardíaca, Síndrome X Anginosa, Angina Microvascular, Angina Pectoris com Coronariografia Normal, Síndrome Cardíaca X, Síndrome X Cardíaca
Spanish Angina microvascular, Síndrome cardiaco X, Cardiac syndrome X, Sindrome X Anginoso, Síndrome X Anginoso, síndrome cardíaco X (hallazgo), síndrome cardíaco X, Angina Microvascular, Angina Pectoris con Arteriograma Coronario Normal, Síndrome Cardíaco X, Síndrome X Cardíaco, Sindrome Cardiaco X, Sindrome X Cardiaco
French Syndrome cardiaque X, Angor microvasculaire, Angine de poitrine à coronarographie normale, Angor à coronaires saines, Angine microvasculaire, Angor avec coronaires normales, Angine de poitrine à coronaires saines, Angor à coronarographie normale, Syndrome X cardiaque
Italian Sindrome X cardiaca, Angina pectoris con arteriogramma coronarico normale, Sindrome da angina, Angina microvascolare, Sindrome cardiaca X, Sindrome X
Japanese 心Ｘ症候群, ｼﾝXｼｮｳｺｳｸﾞﾝ, ﾋﾞｼｮｳｹｯｶﾝｾｲｷｮｳｼﾝｼｮｳ, X症候群-心臓性, シンドロームX-心臓性, 微小血管性狭心症, 心臓性X症候群, 心臓性シンドロームX, 正常冠動脈造影図型狭心症, 狭心症-微小血管性, 狭心症-正常冠動脈造影図型
Swedish Mikrovaskulär angina
Czech srdce - syndrom X, mikrovaskulární angina pectoris, angina pectoris s normálním koronarografickým nálezem, Mikrovaskulární angína, Kardiální syndrom X
Finnish Mikrovaskulaarinen angina
Russian MIKROVASKULIARNAIA STENOKARDIIA, STENOKARDIIA S NORMAL'NOI KORONAROGRAFIEI, STENOKARDIIA MIKROVASKULIARNAIA, SINDROM X, X SINDROM, X СИНДРОМ, СИНДРОМ X, СТЕНОКАРДИЯ МИКРОВАСКУЛЯРНАЯ, СТЕНОКАРДИЯ С НОРМАЛЬНОЙ КОРОНАРОГРАФИЕЙ, МИКРОВАСКУЛЯРНАЯ СТЕНОКАРДИЯ
Polish Zespół X kardiologiczny, Sercowy zespół X, Dusznica mikronaczyniowa, Dławica mikronaczyniowa
Hungarian Microvascularis angina, Cardialis x syndroma
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Impaired glucose tolerance (C0271650)

Definition (NCI) A condition referring to fasting plasma glucose levels being less than 140 mg per deciliter while the plasma glucose levels after a glucose tolerance test being more than 200 mg per deciliter at 30, 60, or 90 minutes. It is observed in patients with diabetes mellitus. Other causes include immune disorders, genetic syndromes, and cirrhosis.
Definition (NCI) A disorder characterized by an inability to properly metabolize glucose.
Definition (MSH) A pathological state in which BLOOD GLUCOSE level is less than approximately 140 mg/100 ml of PLASMA at fasting, and above approximately 200 mg/100 ml plasma at 30-, 60-, or 90-minute during a GLUCOSE TOLERANCE TEST. This condition is seen frequently in DIABETES MELLITUS, but also occurs with other diseases and MALNUTRITION.
Concepts Disease or Syndrome (T047)
MSH D018149
ICD10 R73.09
SnomedCT 154720005, 190752008, 9414007, 267426009
English Glucose Intolerance, Glucose Intolerances, Intolerances, Glucose, GLUCOSE INTOLERANCE, Intolerance, Glucose, Impaired glucose tolerance, NOS, IGT - Impair glucose tolerance, glucose intolerance (diagnosis), glucose intolerance, Glucose: [intolerance] or [malabsorption] (disorder), impaired glucose tolerance, impaired glucose tolerance (diagnosis), prediabetes, Glucose tolerance impaired, Impaired glucose tolerance, Glucose Intolerance [Disease/Finding], chemicals diabetes, chemical diabetes, glucose impaired tolerance, Intolerance;glucose, malabsorption of glucose, diabetes chemical, latent diabetes, glucose malabsorption, Chemical diabetes, Latent diabetes, Prediabetic nonclinical diabetes, Glucose intolerance, IGT - Impaired glucose tolerance, Malabsorption of glucose, Impaired glucose tolerance (disorder), Malabsorption of glucose (disorder), chemicals; diabetes, diabetes; chemical, diabetes; latent, glucose; intolerance, glucose; malabsorption, intolerance; glucose, latent; diabetes, malabsorption; glucose, Glucose: [intolerance] or [malabsorption], Impaired;glucose tolerance
Italian Tolleranza al glucosio alterata, Diabete chimico, Diabete latente, Intolleranza al glucosio
Dutch chemische diabetes, latente diabetes, glucose-intolerantie, chemisch; diabetes, diabetes; chemisch, diabetes; latent, glucose; intolerantie, glucose; malabsorptie, intolerantie; glucose, latent; diabetes, malabsorptie; glucose, glucosetolerantie aangetast, Glucose-intolerantie, Intolerantie, glucose-
French Diabète latent, Diabète chimique, Intolérance au glucose
German chemischer Diabetes, latenter Diabetes, eingeschraenkte Glukosetoleranz, Glukoseintoleranz
Portuguese Intolerância à glucose, Diabetes química, Diabetes latente, Tolerância à glucose alterada, Intolerância à Glucose
Spanish Diabetes química, Intolerancia a la glucosa, Diabetes latente, Glucose: [intolerance] or [malabsorption], Glucose intolerance, Malabsorption of glucose, Impaired glucose tolerance, diabetes latente, diabetes química, mala absorción de glucosa (trastorno), mala absorción de glucosa, seudodiabetes, trastorno de la tolerancia a la glucosa (trastorno), trastorno de la tolerancia a la glucosa, Alteración de la tolerancia a la glucosa, Intolerancia a la Glucosa
Japanese 化学的糖尿病, 耐糖能障害, 潜在性糖尿病, ブドウ糖不耐性, ﾀｲﾄｳﾉｳｼｮｳｶﾞｲ, ｾﾝｻﾞｲｾｲﾄｳﾆｮｳﾋﾞｮｳ, ﾌﾞﾄﾞｳﾄｳﾌﾀｲｾｲ, ｶｶﾞｸﾃｷﾄｳﾆｮｳﾋﾞｮｳ
Swedish Glukosintolerans
Czech glukosa - tolerance porušená, Intolerance glukózy, Latentní diabetes, Porušená glukózová tolerance, Chemický diabetes
Finnish Glukoosi-intoleranssi
Russian GLIUKOZY NEPERENOSIMOST', ГЛЮКОЗЫ НЕПЕРЕНОСИМОСТЬ
Croatian GLUKOZA, INTOLERANCIJA
Polish Nietolerancja glukozy
Hungarian Glucose intolerantia, Latens diabetes, Kémiai diabetes, Csökkent glucose tolerancia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Metabolic syndrome (C0948265)

Definition (MEDLINEPLUS)

Metabolic syndrome is a group of conditions that put you at risk for heart disease and diabetes. These conditions are

Not all doctors agree on the definition or cause of metabolic syndrome. The cause might be insulin resistance. Insulin is a hormone your body produces to help you turn sugar from food into energy for your body. If you are insulin resistant, too much sugar builds up in your blood, setting the stage for disease.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases
Definition (CSP) a multifaceted syndrome characterized by clustering of insulin resistance and hyperinsulinemia, associated with dyslipidemia, essential hypertension, abdominal obesity, glucose intolerance or noninsulin dependent diabetes mellitus, and an increased risk of cardiovascular events.
Concepts Disease or Syndrome (T047)
ICD10 E88.81
Italian Sindrome metabolica
Japanese 代謝症候群, ﾀｲｼｬｼｮｳｺｳｸﾞﾝ
English Metabolic Syndrome, metabolic syndromes, syndrome metabolic, Metabolic syndrome, metabolic syndrome
Czech Metabolický syndrom
Hungarian Metabolikus syndroma
Portuguese Síndrome metabólico
Spanish Síndrome metabólico
Dutch metabolisch syndroom
French Syndrome métabolique
German metabolisches Syndrom
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Impaired fasting glycaemia (C1272092)

Concepts Finding (T033)
ICD9 790.21
ICD10 R73.01
SnomedCT 390937007, 389984002, 390731003, 390951007
Italian Glicemia a digiuno alterata
English [D]Impaired fasting glycaemia (context-dependent category), impaired fasting glucose (diagnosis), impaired fasting glucose, [D]Impaired fasting glycaemia (situation), [D]Impaired fasting glucose, Impaired fasting glycaemia (disorder), Impaired fasting glycaemia, Impaired fasting glycaemia -RETIRED-, [D]Impaired fasting glycaemia, Impaired fasting glucose
Japanese 空腹時血中ブドウ糖不良, ｸｳﾌｸｼﾞｹｯﾁｭｳﾌﾞﾄﾞｳﾄｳﾌﾘｮｳ
Spanish [D]glucemia en ayunas alterada (categoría dependiente del contexto), [D]Impaired fasting glycaemia, Impaired fasting glycaemia -RETIRED-, Impaired fasting glycaemia, [D]glucemia en ayunas alterada (situación), [D]glucemia en ayunas alterada, glucemia en ayunas alterada (trastorno), glucemia en ayunas alterada, Alteración de glucosa en ayunas
Czech Porušená glykemie na lačno
Hungarian Kóros éhomi glucose
Portuguese Alteração da glucose em jejum
Dutch verminderde nuchtere glucose
French Diminution du glucose à jeun
German Nuechternglukose krankhaft
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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