How are the causes of insulin resistance classified?

Updated: Aug 07, 2019
  • Author: Samuel T Olatunbosun, MD, FACP, FACE; Chief Editor: George T Griffing, MD  more...
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Answer

The underlying causes of insulin-resistant states may also be categorized according to whether their primary effect is before, at, or after the insulin receptor (see below).

Prereceptor causes of insulin resistance include the following:

  • Abnormal insulin (mutations)

  • Anti-insulin antibodies

Receptor causes include the following:

  • Decreased number of receptors (mainly, failure to activate tyrosine kinase)

  • Reduced binding of insulin

  • Insulin receptor mutations

  • Insulin receptor–blocking antibodies

Postreceptor causes include the following:

  • Defective signal transduction

  • Mutations of GLUT4 (in theory, these mutations could cause insulin resistance, but polymorphisms in the GLUT4 gene are rare.

Combinations of causes are common. For example, obesity, the most common cause of insulin resistance, is associated mainly with postreceptor abnormality but is also associated with a decreased number of insulin receptors.

Other conditions that are categorized as receptor or postreceptor insulin-resistant states include the following:

  • Type A syndrome

  • Type B syndrome

  • Leprechaunism

  • Lipodystrophic states

  • Ataxia-telangiectasia

  • Werner syndrome

  • Rabson-Mendenhall syndrome

  • Pineal hypertrophic syndrome


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