Insulin Resistance: A Clinical Handbook

Insulin resistance, defined as a reduced biological action of insulin, has emerged as a major factor in the development and progression of a number of common non–communicable diseases in man. The role of insulin resistance in the aetiology of type 2 diabetes is particularly well–established. However, insulin resistance has also come to be regarded as a key component of a broader syndrome of common metabolic defects that conspire to increase the risk of atherosclerotic coronary heart disease. The ramifications of insulin resistance now embrace many different medical specialties.
This new book summarises the current state of knowledge on insulin resistance. Divided into three sections, the book first considers the development of current concepts of insulin resistance. This is followed by a critical review of techniques for the assessment of insulin action in humans. The section concludes with an outline of current hypotheses concerning the molecular defects responsible for insulin resistance. Section 2, Insulin Resistance in Clinical Medicine, broadens the discussion to include physiological and pathological conditions with which insulin resistance is associated; the effects of drug treatment on insulin sensitivity are also considered. The final section, Management of Insulin Resistance and Associated Conditions, focuses on the avoidance and treatment of insulin resistance in its clinical manifestations. A discussion of the potential benefits of non–pharmacological measures prefaces a review of the range of drugs used in the treatment of type 2 diabetes and related disorders. References are confined to key articles at the end of each section.

Spis treści:
Section 1. Pathophysiology of insulin resistance.
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1.1 Introduction.
1.2 Normal physiology.
1.2.1 Hormonal regulation of metabolism.
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1.2.2 The insulin receptor.
1.2.3 Post–binding events.
1.2.4 Glucose metabolism.
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1.2.5 Lipid metabo lism.
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1.2.6. Protein metabolism.
1.2.7. Ion transport.
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1.3 The concept of insulin resistance.
1.3.1 Early studies of insulin action.
1.4 Definitions of insulin resistance.
1.5 Assessment of insulin action in vivo.
1.5.1 Fasting insulin concentration.
1.5.2 Dynamic tests – endogenous insulin.
1.5.3 Dynamic tests – exogenous insulin.
1.5.4 Mathematical modelling techniques.
1.5.5 The insulin suppression test.
1.5.6 The hyperinsulinaemic euglycaemic clamp technique.
1.6. Mechanisms of insulin resistance.
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1.6.1 Genetic causes of insulin resistance.
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1.6.2 Acquired causes of insulin resistance.
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1.6.3.Fetal origins hypothesis.
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Further Reading.
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Section 2. Insulin resistance in clinical medicine.
2.1 Clinical features.
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2.2 Factors influencing insulin sensitivity.
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2.2.1 Normal variation in insulin action.
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2.2.2 Sex.
2.2.3 Age.
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2.2.4 Physical activity.
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2.2.5 Tobacco.
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2.2.6 Alcohol.
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2.3. Physiological states of insulin resistance.
2.3.1 Puberty.
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2.3.2 Pregnancy.
2.3.4 The menopause.
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2.4 Severe insulin resistance syndromes.
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2.5 Insulin resistance and cardiovascular risk.
2.5.1 Syndrome X.
2.5.2 Obesity.
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2.5.3 Regional adiposity.
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2.5.4 Impaired glucose tolerance.
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2.5.5 Type 2 diabetes.
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2.5.6 Essential hypertension.
2.5.7 Dyslipidaemia.
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2.5.8 Endothelial dysfunction.
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2.5.9 Microalbuminuria.
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2.5.10. Hyperuricaemia.
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2.5.11 Impaired Fibrinolysis.
2.5.12 Polycystic ovary syndrome.
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2.5.13 Non–alcoholic steatohepatitis.
2.6 Other disorders associated with insulin resistance.
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2.6.1 Counter–regulatory hormone secretion.
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2.6.2 Endocrinopathies.
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2.6.3 Chronic renal failure.
2.6.4 Cirrhosis.
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2.6.5 Cardiac failure.
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2.7 Miscellaneous inherited disorders.
2.8 Dr ug–induced insulin resistance.
Further Reading.
.
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Section 3. Management of insulin resistance and associated conditions.
3.1 Non–pharmacological measures.
3.1.1 Medical nutrition therapy.
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3.1.3 Alcohol.
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3.1.4 Tobacco.
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3.2 Drugs for type 2 diabetes.
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3.2.1 Biguanides.
3.2.2 Thiazolidinediones.
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3.2.3 Sulphonyulreas.
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3.2.4 Repaglinide.
3.2.5 a–glucosidase inhibitors.
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3.2.6 Insulin therapy.
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3.3 Anti–obesity drugs.
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3.4 Lipid–modifying drugs.
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3.5 Anti–hypertensive drugs.
3.6 Experimental therapies

Okładka tylna:
Insulin resistance, defined as a reduced biological action of insulin, has emerged as a major factor in the development and progression of a number of common non–communicable diseases in man. The role of insulin resistance in the aetiology of type 2 diabetes is particularly well–established. However, insulin resistance has also come to be regarded as a key component of a broader syndrome of common metabolic defects that conspire to increase the risk of atherosclerotic coronary heart disease. The ramifications of insulin resistance now embrace many different medical specialties.
This new book summarises the current state of knowledge on insulin resistance. Divided into three sections, the book first considers the development of current concepts of insulin resistance. This is followed by a critical review of techniques for the assessment of insulin action in humans. The section concludes with an outline of current hypotheses concerning the molecular defects responsible for insulin resistance. Section 2, Insulin Resistance in Clinical Medicine, broadens the discussion to include physiological and pathological conditions with which insulin resistance is associated; the effects of drug treatment on insulin sensitivity are also considered. The final section, Management of Insulin Resistance and Associated Conditions, focuses on the avoidance and treatment of insulin resistance in its clinical manifestations. A discussion of the potential benefits of non–pharmacological measures prefaces a review of the range of drugs used in the treatment of type 2 diabetes and related disorders. References are confined to key articles at the end of each section.