What does the insulin resistance index mean? What is insulin resistance: signs and diet (menu) when increasing the analysis. Additional preparation requirements

Korolenko G.G.,
endocrinologist
head of endocrinology
branch,
Candidate of Medical Sciences

The World Health Organization has recognized that obesity has become an epidemic worldwide. Obesity-related insulin resistance launches a cascade of pathological processes leading to the defeat of almost all organs and systems of a person.

Back in the mid-1990s, in the course of numerous studies, the role of insulin resistance in the development of diabetes mellitus Type 2, cardiovascular disease, female infertility and other diseases.

Insulin resistance is a decrease in the sensitivity of body tissues to the action of insulin.

Normally, insulin is produced by the pancreas in an amount sufficient to maintain physiological blood glucose levels. Insulin promotes the entry of glucose (the main source of energy) into the cell.

With insulin resistance, the sensitivity of tissues to insulin is reduced, so glucose cannot enter the cells, its concentration in the blood increases, while the cells experience energy hunger ("hunger with abundance"). The brain, having received the SOS signal from the starving cells, sends a command to the pancreas to increase the production of insulin.

Over time, the reserves of the pancreas are depleted. The cells responsible for the secretion of insulin, working for a long time with overload, die - diabetes develops.

Excess insulin has an effect on cholesterol metabolism, enhances the formation of free fatty acids, atherogenic lipids. This leads to the development of atherosclerosis, as well as damage by free fatty acids to the pancreas itself.

Causes of insulin resistance

Insulin resistance happens physiological , i.e. occurring in quite healthy people at certain periods of life, and pathological .

Reasons for physiological insulin resistance :

• pregnancy;
• teenage years;
• night sleep;
• elderly age;
• the second phase of the menstrual cycle in women;
• a diet rich in fat.

Causes of pathological insulin resistance :

• genetic defects in the insulin molecule;
• hypodynamia;
• obesity;
• excessive intake of carbohydrates;
• endocrine diseases (thyrotoxicosis, Itsenko-Cushing's disease, etc.);
• taking certain medications (hormones, adrenergic blockers, etc.);
• smoking.

Signs and symptoms

The main sign of developing insulin resistance is abdominal obesity, in which excess adipose tissue is deposited mainly in the abdomen and upper body.

Especially dangerous internal abdominal obesity, when fatty tissue builds up around organs and interferes with their proper function.

The fatty tissue in the abdomen is very active. A large number of biologically active substances promoting development:

• atherosclerosis;
• oncological diseases;
• arterial hypertension;
• joint diseases;
• thrombosis;
• ovarian dysfunction.

Abdominal obesity can be determined by yourself at home. To do this, you need to measure your waist circumference and divide it by your hip circumference. Normally, this figure should not exceed 0.8 for women and 1.0 for men.

The second important symptom of insulin resistance is acanthosis nigricans. These are changes in the skin in the form of hyperpigmentation and peeling in the natural folds of the skin (neck, armpits, mammary glands, groin, intergluteal fold).

In women, insulin resistance is manifested by polycystic ovary syndrome. (PCOS), which is accompanied by menstrual irregularities, infertility and hirsutism, male-pattern excess hair growth.

Insulin resistance syndrome

Due to the presence a large number pathological processes associated with insulin resistance, it was customary to combine them all into insulin resistance syndrome ( metabolic syndrome, syndrome X).

Metabolic syndrome includes:

• abdominal obesity (waist circumference> 80 cm in women and> 94 cm in men);
• arterial hypertension (persistent increase blood pressure above 140/90 mm Hg);
• diabetes mellitus or impaired glucose tolerance;
• violation of cholesterol metabolism, an increase in the level of its "bad" fractions and a decrease in the "good" ones.

The danger of metabolic syndrome is in a high risk of vascular catastrophes (strokes, heart attacks, etc.). They can be avoided only by reducing weight and controlling the levels of blood pressure, glucose and cholesterol fractions in the blood.

Diagnostics

There are several methods for determining insulin resistance. The most accurate is euglycemic hyperinsulinemic clamp (EGC, clamp test), which is currently only used for scientific purposes because it is complex, requires special training and intravenous access.

The rest of the diagnostic methods are called indirect, they assess the effect of their own, and not insulin introduced from outside, on glucose metabolism.

Oral glucose tolerance test (OGTT) is performed as follows. The patient donates blood on an empty stomach, then drinks a concentrated glucose solution and re-tests after 2 hours. The test measures the levels of glucose, insulin and C-peptide (C-peptide is the protein to which insulin is bound in its depot).

Impaired fasting glucose and impaired glucose tolerance are regarded as prediabetes and in most cases are accompanied by insulin resistance. When glucose levels are correlated with insulin and C-peptide levels during the test, a faster rise in the latter also indicates insulin resistance.

Intravenous glucose tolerance test (IVGTT) similar to OGTT, but in this case, glucose is administered intravenously and after short periods of time, the same parameters are repeatedly assessed as with OGTT. This analysis is more reliable when the patient has a gastrointestinal tract disease that interferes with glucose absorption.

Insulin resistance indices

The simplest and most affordable way to identify insulin resistance is to calculate its indices. To do this, it is enough for a person to donate blood from a vein. Insulin and glucose levels in the blood will be determined and the HOMA-IR and caro indices are calculated using special formulas. They are also called insulin resistance tests.

Index NOMA -IR (Homeostasis Model Assessment of Insulin Resistance) is calculated using the following formula:

HOMA = (glucose level (mmol / L) * insulin level (μIU / ml)) / 22.5

Normally, the HOMA index does not exceed 2.7, and this indicator is the same for men and women, and after 18 years it does not depend on age either. During adolescence, the HOMA index slightly increases due to physiological insulin resistance at this age.

Reasons for the increase in the HOMA index:

• insulin resistance, which indicates the possible development of diabetes mellitus, atherosclerosis, polycystic ovary syndrome, more often against the background of obesity;
• gestational diabetes mellitus (pregnancy diabetes);
• endocrine diseases (thyrotoxicosis, pheochromacytoma, etc.);
• taking certain medications (hormones, adrenergic blockers, drugs to lower cholesterol);
• chronic liver disease;
• sharp infectious diseases.

Caro index - also the calculated indicator:

caro index = glucose level (mmol / L) / insulin level (μIU / ml)

Caro index healthy person is at least 0.33. A drop in this rate is a sure sign of insulin resistance.

How to get tested correctly

Diagnosis and determination of insulin resistance occurs subject to the following rules:

• smoking is prohibited for half an hour before the study;
• prohibited physical exercise half an hour before the test;
• blood from a vein is given in the morning on an empty stomach, after a 10-14-hour break in eating.
• the attending physician must be informed about the medications being taken.
• it is undesirable to donate blood for analysis after severe stress, during the period of acute diseases and exacerbation of chronic ones.

Insulin resistance treatment - diet, sports, drugs

Before talking about the treatment of insulin resistance, it is important to remind once again that insulin resistance is a physiological norm at certain periods of life. It has evolved as a way of adapting to periods of prolonged food shortages. And there is no need to treat physiological insulin resistance during adolescence or pregnancy.

Pathological insulin resistance, which leads to the development of serious diseases, needs correction.

It is possible to reduce insulin resistance by the most in a simple way- by reducing weight. A decrease in the amount of adipose tissue leads to an increase in the sensitivity of cells in the body to insulin.

In losing weight, 2 points are important: constant physical activity and adherence to a low-calorie diet.

Physical activity should be regular, aerobic, 3 times a week for 45 minutes. Running, swimming, fitness classes, dancing are well suited. During classes, muscles are actively working, namely, they contain a large number of insulin receptors. By actively exercising, a person opens up insulin access to its receptors on the cell surface, i.e. helps the hormone to overcome resistance.

Eating well with a low-calorie diet is just as important a step in treating insulin resistance as sports. It is necessary to drastically reduce the consumption of simple carbohydrates (sugar, candy, chocolate, baked goods). The menu should consist of 5-6 meals, portions should be reduced by 20-30%, try to limit animal fats and increase the amount of fiber in the food.

In practice, it often turns out that losing weight is not so easy for a person with insulin resistance. If weight loss is not achieved with a diet and sufficient exercise, drugs are prescribed.

The most commonly used drug is metformin. It increases the sensitivity of tissues to insulin, reduces the deposition of glucose stores in the form of glycogen in the liver and muscles, increases the consumption of glucose by the muscles, and reduces its absorption in the intestine. This drug is taken as prescribed by a doctor and under his control, since it has a number side effects and contraindications. Nevertheless, today metformin is considered the gold standard for the treatment of insulin resistance, uncorrected lifestyle changes, and type 2 diabetes mellitus all over the world.

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, this leads to a decrease in the consumption of glucose by tissues and an increase in its amount in the blood.

Insulin resistance is not considered an independent disease, but it is a factor that creates conditions for the appearance of a number of ailments:

• Development of cardiovascular diseases: hypertension, angina pectoris, arrhythmias, ischemia and myocardial infarction;
• Development of type II diabetes mellitus;
• Development of vascular atherosclerosis;
• Development of erectile dysfunction in men;
• Polycystic ovary syndrome;
• Alzheimer's disease;
• Hyperglycemia;
• Hyperinsulinemia;
• Hypothyroidism;
• Steatohepatitis;
• Obesity.

Factors in the formation of insulin resistance

According to the theory of "thrifty genotype" V. Neil (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:

• Eating carbohydrates, foods high in soda neighing fat - IR can be a sign of a violation of carbohydrate metabolism.
• Overweight- Adipose tissue cells are the least sensitive to insulin; high content body fat insulin resistance acts as a concomitant symptom.
• Long-term smoking, alcoholism.
• Impaired glucose tolerance.
• Hypodynamia- inactivity, lack of physical activity provoke insulin resistance.
• Postoperative period, burn injuries, sepsis.
• Inflammatory processes of a chronic nature.
• - disease of the pituitary gland associated with impaired growth.
• Hypertension- accompanied by insulin insensitivity, can also be caused by IR.
• Hypercortisol syndrome- the disease causes metabolic disorders, while the blood sugar level increases and an active supply of adipose tissue occurs;
• Rheumatoid arthritis.
• Prolonged hypokinesia- lack of mobility negatively affects the human body, irreversible changes occur, insulin resistance develops.
• Maturation period in adolescents and the menstrual cycle on hormonal level causes temporary insulin resistance. This also applies to the nighttime sleep period.

Insulin resistance symptoms

Insulin resistance of cells appears without obvious signs, which is difficult to diagnose.

The main symptoms of insulin resistance are:

• Active deposition of adipose tissue, mainly in the abdomen;
• Increased blood sugar levels;
• High blood triglyceride levels;
• High blood pressure;
• The presence of protein in the urine;
• Bloating;
• Fatigue;
• Depression, apathy;
• Frequent feeling of hunger.

With IRI, obtaining an accurate diagnosis using 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:

1. This is abdominal obesity;
2. High blood pressure.

Genetic causes of insulin resistance

Heredity as a factor of predisposition to occurs quite often. 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 .

Important!

• Genetic disorders in insulin resistance play a secondary role;
• The development of insulin resistance can be avoided through preventive measures: an active lifestyle and regular nutritional control.

What is the difference between insulin resistance and metabolic syndrome?

Insulin resistance and metabolic syndrome, also called insulin resistance syndrome, are fundamentally different from each other:

1. In the first case, we are dealing with a separate cell resistance to insulin,
2. In the second, there is a whole complex of pathological factors that underlie the occurrence of diseases of the cardiovascular system and type II diabetes mellitus.

This series of pathological disorders of hormonal and metabolic metabolism include:

• Abdominal obesity;
• Arterial hypertension;
• Insulin resistance;
• Hyperlipidemia.

The mechanism of occurrence of negative manifestations in syndrome X is based on the effect of resistance and hyperinsulinemia on the human body.

Diagnosis of resistance

Primarily, the symptoms of insulin resistance are observed externally:

• The percentage of body fat increases;
• To a greater extent, it accumulates in the abdominal region.

But this is not always the case. Sometimes the insulin resistance index is increased in people who are not overweight. Then the main indicator is an analysis to determine the level of sugar and insulin in the blood.

Resistance diagnostic methods:

• Euglycemic insulin clamp or EGC test;
• Insulin suppression test;
• Oral glucose tolerance test (OGTT);
• The minimal model method, which is based on an intravenous glucose tolerance test;
• The simplest method for diagnosing insulin resistance is to study fasting sugar and insulin levels: the CARO index or.

Risk factors

The main risk factors for the development of insulin resistance are:

• Sedentary lifestyle;
• Overweight;
• Age;
• The presence of diabetes, hypertension in the family, atherosclerosis, Alzheimer's disease;
• Genetic disorders in the transmission and production of insulin;
• Chronic infectious diseases.

Body mass index to determine the risks of insulin resistance

One of the indicators indicating an increase or normal in the insulin resistance index is the ratio of body weight and height.

Body mass index is calculated according to the Quetelet formula: I = m / h2 , where is the data m- mass, and h- 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) = 22.3kg / m².

This means that the body mass index is within the normal range and indicates that there is no risk of insulin resistance.

Insulin resistance index: how to take and count?

The concept of the norm of the insulin resistance index has no specific meanings. Therefore, for an accurate diagnosis, it is better to conduct several studies. Methods for assessing fasting glucose and insulin levels are the most popular. The CARO and HOMA IR tests are simple and effective, and their lead time is minimal.

In this case, it is very important to properly prepare before taking a blood test:

• For the study, it is necessary to take blood on an empty stomach, the last meal should be at least 8 hours before the procedure.
• The time is in the morning.
• Do not smoke before donating blood.
• Eliminate stress and physical activity before the procedure.

HOMA IR 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 increased insulin resistance index or norm.

If the HOMA value is more than 2.5-2.7, it means that the insulin resistance index is increased.

CARO test

Carrying out the CARO test to determine insulin resistance index similar to HOMA IR, the calculation formula and norm values ​​differ.

Resistance index rate according to the test, it is within the value of 0.33.

Consequences of insulin resistance

After eating, the glucose level rises, for its transport into cells it is necessary large quantity insulin.

With insulin resistance, the load on the pancreas increases, which needs to produce more hormone to maintain blood sugar levels within the normal range. As a result, hyperinsulinemia occurs, which has a particularly negative effect on the human body.

The risk of developing dangerous diseases of the cardiovascular system, type II diabetes and vascular atherosclerosis increases.

Cardiovascular diseases

An increased level of insulin in the blood triggers various disorders:

• Blood clotting is activated;
• Dyslipidemia progresses;
• Increased blood cholesterol levels;
• Increased sympathetic tone and abnormal release of norepinephrine

Insulin resistance results in:

1. Violation of lipid metabolism in tissues.
2. This negatively affects the blood vessels.
3. Over time, they become thinner and blood clots form.
4. Atherosclerosis develops.

This process is slow; 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:

• Arterial hypertension
• Tachycardia
• Ischemic heart disease
• And also myocardial infarction.

Diabetes

Insulin resistance is a harbinger of type II diabetes.

With prolonged hyperinsulinemia:

• The tissues of the pancreas are damaged.
• Their secretory function is suppressed.
• There is a deficiency of insulin and an increase in plasma sugar levels to critical values.
• This marks the onset of diabetes.

Factors provoking the development of the disease:

• Hypertension.
• Obesity.
• Elderly age.
• Insulin resistance.
• Heredity.

Treatment and diet

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:

• Continuous monitoring of food.
• Physical health.
• Human activity.

Weight loss

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.

Nutrition

The development of insulin resistance is directly related to food preferences. Foods containing simple carbohydrates, sweets, starchy foods, alcohol provoke insulin resistance. Such a diet is distinguished by its calorie content, which means a significant increase in glucose levels immediately after a meal.

This leads to the need for the release of additional insulin, which triggers various metabolic disorders in the body and other pathologies.

Nutritional guidelines for lowering insulin resistance:

• Eating 5 times a day;
• Small portions;
• Sufficient water intake;
• Eating vegetables, fruits and protein;
• Exclusion from food of semi-finished products, sweet, fatty, flour, alcoholic and carbonated drinks with sugar;
• Inclusion in the diet of foods that lower sugar levels and increase insulin sensitivity: ginger, fresh berries, turmeric, cinnamon, spirulina, caraway seeds, barberry root.

Medications

Medicines that regulate blood sugar are only prescribed for severe insulin resistance by a doctor. Self-treatment with medication can lead to serious consequences in the form of deterioration in health and clinical picture diseases.

Complex drugs aimed at increasing insulin sensitivity and lowering glucose levels are Diaformin, Insufor, Metamin, Metformin.

It can be noted that although IR can lead to serious illness, it also has positive side... The first symptoms of insulin resistance can warn of a predisposition to diseases of the cardiovascular system, diabetes, and obesity in several years.

Therefore, it is possible in advance to reduce the risk of their development through prevention. Compliance healthy eating, regular physical activity at least 3 times a week, an active lifestyle will help get rid of insulin resistance and other related conditions .

Insulin is a hormone that helps glucose to enter the tissues of the body and create energy. If this process is disrupted, insulin resistance develops - one of the main reasons for the development of type 2 diabetes mellitus.

To determine the pathology, there is the so-called HOMA index (HOMA). What is it and how is it calculated?

Disease development

Insulin sensitivity is thought to decrease due to excess weight... But it happens that insulin resistance develops with normal weight... More often, pathology occurs in men after 30 years, and in women after 50.

The condition was previously thought to only affect adults, but in last years the diagnosis of insulin resistance in adolescents increased 6 times.

There are several stages in the development of insulin resistance:

1. In response to the intake of carbohydrate food into the body, the pancreas secretes insulin. It keeps the blood sugar level at the same level. The hormone helps muscle and fat cells to admit glucose and convert it into energy.
2. Abuse of junk food, lack of exercise, as well as smoking reduces the work of sensitive receptors, and tissues stop interacting with insulin.
3. The level of glucose in the blood rises, in response to this, the pancreas begins to produce more insulin, but it still remains unused.
4. Hyperinsulinemia leads to a constant feeling of hunger, metabolic disorders and increased blood pressure.
5. Hyperglycemia, in turn, leads to irreversible consequences. Patients develop diabetic angiopathy, renal failure, neuropathy.

Causes and symptoms

The causes of insulin resistance include:

• obesity;
• pregnancy;
• severe infections.

Predisposing factors:

• heredity - if the family has relatives with diabetes, then its occurrence in other family members increases sharply;
• sedentary lifestyle;
• frequent consumption of alcoholic beverages;
• nervous strain;
• elderly age.

The insidiousness of this pathology lies in the fact that it does not have any clinical symptoms. Human long time may not be aware of his insulin resistance.

Usually, this condition is diagnosed during a medical examination or when obvious signs of diabetes appear:

• thirst;
• increased urination;
• constant feeling of hunger;
• weakness;
• irritability;
• change in taste preferences - people constantly want sweets;
• the appearance of pain in the legs, a feeling of numbness, cramps;
• vision problems may appear: goose bumps, black spots in front of the eyes, or decreased vision.

Calculation of the HOMA index

The HOMA Index (HOMA) is the most common method for measuring insulin resistance. It consists in the ratio of the amount of glucose and insulin in the blood. Determine it using the formula strictly on an empty stomach.

HOMA IR index = insulin (μU / ml) * plasma glucose (mmol / l) / 22.5.

Preparation for the test:

• the analysis must be taken strictly on an empty stomach;
• the last meal should be 12 hours before the analysis;
• dinner the night before should be light;
• the time for the analysis is from 8:00 to 11:00 in the morning.

Normally, the test results for people from 20 to 60 years old should be from 0 to 2.7. The numbers in this range mean that the tissue sensitivity to the hormone is normal. If the indicator is increased, then the patient is diagnosed with insulin resistance.

Depending on the level of glucose in the blood, the following are distinguished: prediabetes and diabetes. Prediabetes is not yet a disease, but a serious reason to think about your diet and lifestyle.

The condition is reversible, meaning that diabetes can be avoided by changing the lifestyle. Without effective treatments, prediabetes will progress to type 2 diabetes.

Insulin insensitivity treatment

What to do if insulin resistance is detected, the doctor will tell you. Treatment should be comprehensive.

These include:

• low carbohydrate diet;
• taking medications;
• physical activity.

Nutrition with impaired glucose tolerance should be low-carb. Obese patients are advised to eat 12 grain units per day. It is necessary to take seriously the choice of products for your own diet - dishes with a high glycemic index, as well as fatty and fried foods, should completely disappear from the diet.

What is allowed to eat?

• vegetables and fruits;
• low fat dairy products;
• nuts;
• a fish;
• lean meat;
• cereals.

In the life of a patient, there must be a place for physical education. It could be a hike in gym, swimming pool, jogging before bed. Race walking can be done for overweight people. Yoga may also be helpful. Her asanas will help calm the nerves, normalize sleep, and improve digestion. In addition, the patient needs to make it a rule not to use the elevator, and when using public transport, get off 1 - 2 stops earlier and walk home.

Video about diabetes, its complications and treatment:

Drug therapy

For the treatment of a pathological condition, the doctor may prescribe the following drugs:

ethnoscience

At an early stage in the development of insulin resistance, you can use drugs based on folk recipes:

1. Blueberry... Pour 200 ml of boiling water over one teaspoon of chopped blueberry leaves. After 30 minutes, strain and divide the glass into 3 doses per day. Such a decoction will help lower blood sugar, but only by early stages diseases.
2. Crimean stevia... Take 1 tablespoon of chopped Crimean stevia and pour 200 ml of boiling water. Leave for 15 minutes, then strain. Drink all day instead of tea. Plants can lower glucose and cholesterol levels, improve liver and pancreas function.
3. Bean decoction... Pour 1 liter of water into a saucepan and add 20 grams of beans to it. Put on fire and boil. Then strain the mixture. The course of treatment is 1 - 2 months. Take every day in the morning, at lunch and in the evening. The decoction is used to maintain normal blood sugar.
4. Nettle infusion... Take 800 g of nettles and fill them with 2.5 liters of alcohol. Insist for 7 days, then strain. Take three times a day, half an hour before meals, 1 tablespoon.

V modern world every person is susceptible to the development of insulin resistance. If this pathology is found in oneself, a person needs to change his life as soon as possible. It is impossible to restore the sensitivity of cells to insulin with drugs alone.

The patient must do a tremendous job on himself: force himself to eat right, play sports, give up bad habits... Unfortunately, people do not want to change their own lives and do not pay attention to the recommendations of doctors, thereby provoking the development of diabetes mellitus and other formidable complications of this disease.

Insulin resistance index HOMA-IR- a diagnostic method used to quantify tissue insulin resistance and pancreatic beta cell function. The HOMA diagnostic concept was developed by Robert Turner and Rury Holman in 1976.

Insulin resistance is a reduced cellular response, especially of insulin-dependent organs, to their own or externally supplied insulin. Overweight is a leading risk factor for the development of insulin resistance, which occurs in metabolic syndrome and is a marker of developing non-insulin dependent diabetes.

Insulin is a polypeptide hormone that is produced in the beta cells of the pancreas. The regulation of blood sugar concentration is carried out with the help of two hormones - glucagon and insulin. The former increases blood sugar, while the latter decreases it.

The decreased sensitivity leads to a compensatory increase in insulin secretion. The initial indicator of insulin resistance may be an increase in body weight as a result of an increase in insulin levels in the blood. HOMA-IR is used to assess the sensitivity of peripheral tissues and organs to the action of glucose-lowering hormone.

Analysis steps

The HOMA-IR index is calculated according to a special formula by the doctor. In terms of accuracy, HOMA-IR is comparable to the hyperinsulinemic euglycemic clamp test. HOMA-IR cut-off values ​​for diagnosing insulin resistance cannot be easily applied to all populations and vary from race to race.

Decoding analyzes

Normal values

• The normal value of the HOMA-IR index for a healthy person ranges from 0.5 to 2.8.

Increasing values

An increased value indicates an increased blood sugar concentration and therefore increased tissue insulin resistance. Possible reasons:

insulin dependent diabetes;

more than 25 points on body mass index;

Stein-Leventhal syndrome;

cardiovascular diseases;

viral inflammation of the liver;

chronic illness kidney;

gestational diabetes;

disorders of the hypothalamic-pituitary system;

infectious diseases;

malignant neoplasms.

Lowering values

Decreased values ​​of the HOMA-IR index indicate the absence of insulin resistance.

Insulin resistance is a violation of the metabolic reaction of tissue cells to insulin, provided there is a sufficient amount of it in the body. As a result, a pathological process is provoked - insulin resistance, the result of which may be the development of type 2 diabetes mellitus.

The main risk group is people who suffer from obesity and high blood pressure. Also, clinicians suggest that the development of such pathological process can be genetically determined.

Today, insulin resistance syndrome is not a separate disease, therefore, according to ICD-10, it does not have a separate code. This pathological process is identified by four diseases that develop almost simultaneously:

In medicine, this condition bears another unofficial name - the "deadly quartet", as the manifestation of this syndrome leads to extremely serious consequences.

Most often, this syndrome is diagnosed in men over the age of 30, however, over the past decade, the number of cases of diagnosing pubertal insulin resistance in adolescents has increased by 6.5%, which may be due to malnutrition. In women, the risk of developing metabolic syndrome increases 5 times after 50 years.

It is completely impossible to cure insulin resistance, however, the pathological changes caused by it are completely reversible.

Etiology

The development of this pathological process may be due to the following etiological factors:

• genetic predisposition - if there are cases of diagnosis in the patient's family history, then the risk of its development in descendants increases significantly;
• excessive amounts of insulin during treatment;
• a diet that contains a large amount of fats and carbohydrates;
• that has not been treated;
• sedentary lifestyle;
• long-term adherence to low-calorie diets;
• sleep apnea;
• excessive alcohol consumption;
• disturbances in the work of hormonal levels;
• prolonged nervous tension and frequent stress.

In addition, the development of this pathological process may be due to the intake of certain drugs, namely:

• corticosteroids;
• oral contraception;
• glucagon;
• thyroid hormones.

These medications lead to the fact that the absorption of glucose by the tissues decreases and, as a result, insulin sensitivity decreases.

In addition, in men, insulin resistance may be due to age-related changes - testosterone production decreases.

Pathogenesis

The danger of this disease lies in the fact that in most cases, the development mechanism is not accompanied by any symptoms.

The pathogenesis of this process is presented as follows:

• improper diet and an almost complete lack of physical activity leads to the fact that the sensitivity of the receptors that are responsible for interacting with insulin is disturbed;
• as a consequence of this, the pancreas begins to produce more insulin in order to overcome the low sensitivity of the cells and fully supply them with glucose;
• because of this, much more insulin accumulates in the blood than is required, that is, hyperinsulinemia develops. This leads to obesity, impaired lipid metabolism and increased blood pressure;
• glucose, which cannot be absorbed normally, accumulates in the blood, which leads to with all the ensuing consequences.

Classification

The following forms of this pathological process are distinguished:

• physiological insulin resistance;
• metabolic;
• endocrine;
• non-endocrine.

It is possible to establish the exact form of the disease only through diagnostic measures.

Symptoms

Diagnosis of this pathological process is difficult, since for a long time it can be completely asymptomatic. In addition, the clinical manifestations present are rather nonspecific, therefore many patients do not apply in a timely manner for medical care, attributing poor health to fatigue or age.

Nevertheless, such a violation in the work of the body will be accompanied by the following clinical signs:

• dry mouth, despite constant thirst and drinking a lot of fluids;
• selectivity in food - in most cases, such patients change their taste preferences, they are "drawn" to sweet food;
• headaches for no apparent reason, occasionally dizziness;
• increased fatigue, even after a long rest;
• irritability, aggressiveness, which will be due to an insufficient amount of glucose in the brain;
• cardiopalmus;
• frequent, which are not due to the diet;
• increased sweating, especially at night;
• in women - menstrual irregularities;
• abdominal obesity - the accumulation of fat around the shoulder girdle and in the abdomen;
• red spots on the chest and neck, which may be accompanied by itching. There are no peeling and similar dermatological symptoms.

In addition to the external etiological picture, the presence of such a symptom will also be evidenced by deviations from the norm of indicators in the LHC:

• the concentration of "good" cholesterol decreases;
• the amount of triglycerides is 1.7 mmol / l higher than normal;
• the amount of "bad" cholesterol is 3.0 mmol / l higher than the norm;
• the appearance of protein in the urine;
• the amount of glucose in the blood on an empty stomach exceeds the norm by 5.6-6.1 mmol / l.

In the presence of the above-described clinical picture, you should immediately seek medical help. Self-medication, in this case, is not only inappropriate, but also extremely life-threatening.

Diagnostics

In this case, first of all, you should contact an endocrinologist. However, due to the fact that insulin resistance syndrome leads to disruption of the work of other body systems, additional consultation may be needed:

• gynecologist;
• cardiologist;
• doctor general practice;
• gastroenterologist or nutritionist.

First of all, a physical examination of the patient is carried out, during which the doctor must establish the following:

• how long ago the first clinical signs began to appear, what is their frequency, intensity of manifestation;
• whether there were any cases of this pathological process in the family history;
• the patient's lifestyle, diet and menu;
• whether the patient took drugs that are included in the etiological list;
• whether there is a history of chronic diseases.

Diagnostic measures include:

• general and biochemical detailed blood test;
• calculation of body mass index;
• Ultrasound of internal organs;

In addition, an analysis for insulin resistance is mandatory. This procedure involves taking blood from a vein in the morning, on an empty stomach. For 8-12 hours before the analysis, you should refuse food.

The insulin resistance index is calculated using a special formula.

Diagnostics allows you to determine the pathological process and choose the most effective treatment tactics. Unfortunately, however, it is impossible to completely eliminate this syndrome.

Treatment

With such a disease, a complex treatment is prescribed, which includes not only taking medications, but also observing the optimal diet and sports training regimen. Since such a pathology is not completely eliminated, the patient should adhere to such a mode of vital activity constantly.

Drug therapy includes taking the following drugs:

• statins and fibrates;
• substances to reduce insulin resistance;
• insulin sensitivity agents;
• to normalize metabolism;
• to stabilize blood pressure;
• fat absorption inhibitors;
• drugs that, by acting on the central nervous system, reduce appetite.

A vitamin and mineral complex is selected separately for the patient.

It is especially important to adhere to a diet for insulin resistance, which implies the formation of a diet on such products:

• dietary varieties of fish and meat;
• dairy products with a low percentage of fat, including cottage cheese;
• seafood;
• hard boiled eggs, but not more than 2 pieces per day;
• vegetables - 25% raw, the rest are thermally processed;
• small amount of boiled sausage no more than 2 times a week;
• wholemeal bread;
• small amounts of dark chocolate;
• green vegetables and herbs;
• unsweetened varieties of fruits and berries, no more than 400 grams per day;
• buckwheat and pearl barley porridge, brown rice.

The amount of liquid consumed should be reduced to 1.5 liters per day.

In addition, it is imperative to include in the physical activity mode:

• power training;
• gymnastic exercises;
• morning exercises.

It should be noted that physical exercises should only be written by a competent person. Load the body on its own strength exercises with such a pathological process, it is impossible, it can be dangerous to health.

The answer to the question "is it possible to completely eliminate the disease" will definitely be negative. However, with timely and correct therapeutic measures, adherence to a diet for insulin resistance, it is possible to eliminate the consequences of pathology and minimize the risk of relapse.

Possible complications

If untreated, the risk of developing the following complications increases significantly:

• infertility;
• cardiovascular diseases;
• kidney disease;
• diseases of the musculoskeletal system;
• pathology from the gastrointestinal tract.

Also, lethal outcome is not excluded.

Prevention

Prevention of such a pathological process consists in the simplest recommendations:

• balanced nutrition - the diet should have a sufficient amount of fresh vegetables, fruits, herbs;
• exclusion of excessive alcohol consumption;
• moderate physical activity and physical activity, especially for those who spend most of their time in a sedentary mode;
• preventive massage;
• preventive medical examinations.

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