Which specific conditions or agents may cause insulin resistance?

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

Specific conditions and agents that may cause insulin resistance include the following:

  • Aging: This may cause insulin resistance through a decreased production of GLUT-4.

  • Increased production of insulin antagonists: A number of disorders are associated with this effect, such as Cushing syndrome, acromegaly, and stress states, such as trauma, surgery, diabetes ketoacidosis, severe infection, uremia, and liver cirrhosis.

  • Medications: Agents associated with insulin resistance syndrome include glucocorticoids (Cushing syndrome), cyclosporine, niacin, and protease inhibitors. Glucocorticoid therapy is a common cause of glucose intolerance; impairment of glucose tolerance may occur even at low doses when administered long term. [33]

  • Sodium: High sodium intake has been associated with increased glucocorticoid production and insulin resistance. [34]

  • Anti-HIV therapy [35] : Protease inhibitor–associated lipodystrophy is a recognized entity. [36] Nucleoside analogues have also been implicated in the development of insulin resistance.

  • Androgen-deprivation therapy: This therapy causes severe hypogonadism with unfavorable metabolic changes. [37]

  • Insulin therapy: Low-titer immunoglobulin G (IgG) anti-insulin antibody levels are present in most patients who receive insulin. Rarely, the antibodies result in significant prereceptor insulin resistance. Patients with a history of interrupted exposure to beef insulin treatment are particularly prone to this resistance. Clinically significant resistance usually occurs in patients with preexisting, significant tissue insensitivity to insulin. Enhanced destruction of insulin at the subcutaneous injection site has also been implicated in resistance.


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