Which clinical history findings are characteristic of 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

The presentation of insulin resistance depends on the type and stage of the insulin-resistant state. Most patients have one or more clinical features of the insulin-resistant state. Many patients do not develop overt diabetes despite extreme insulin resistance. Other patients present with cases of severe hyperglycemia that require large quantities of insulin (>200 units); these people may manifest the classic symptoms of diabetes mellitus, such as polyuria, polydipsia, polyphagia, and weight loss.

Patients may present with the following:

  • Metabolic syndrome (syndrome X) – Note that a patient with the metabolic syndrome may be asymptomatic in spite of the presence of some, or even most, of the components of insulin resistance syndrome.

  • Obesity (most common cause of insulin resistance) or history of excessive body weight.

  • Type 2 diabetes mellitus (chronic or acute [during severe decompensation] presentation [ie, the classic symptoms of diabetes]).

  • A diagnosis of IGT or of IFG levels.

  • History of biochemical abnormalities, such as dyslipidemia, detected during routine screening or workup for a cardiovascular disease.

  • History of hypertension.

  • Symptoms of coronary artery disease.

  • Symptoms related to other macrovascular disease (eg, stroke, peripheral vascular disease).

  • Microvascular angina.

  • Combination of hyperglycemia and virilization occurs in several syndromes of insulin resistance.

  • Type A, which affects young women, is characterized by severe hyperinsulinemia, usually present with obesity and features of hyperandrogenism.

  • Polycystic ovary syndrome (PCOS) - Patients usually present with infertility associated with anovulation; menstrual irregularity, typically chronic; and symptoms related to androgen excess, such as acne, frontal baldness, and hirsutism, but rarely features of virilization.

  • Type B syndrome - Some patients present with symptoms of hypoglycemia, such as sweating, tremulousness, irritability, and an altered level of consciousness. Hypoglycemia results from interaction between insulinomimetic antibodies and the insulin receptor. Some patients have insulin-binding antibodies directed against insulin, which, upon dissociation, can cause hypoglycemia. Symptoms related to immunologic disease (eg, arthralgia, swollen salivary glands, hair loss) may occur.

Other indicators of insulin-resistant states that may be elicited in the history include the following:

  • Leprechaunism - Abnormal facial appearance, early life growth retardation

  • Lipodystrophic states - Insulin resistance, usually during childhood, with progression to diabetes over several years

  • Werner syndrome - Features of premature aging

  • Rabson-Mendenhall syndrome - Dental and nail abnormalities, skin lesions

  • Pineal hypertrophic syndrome - Dental and nail abnormalities, sexual precocity

  • Alstrom syndrome - Childhood blindness, impaired hearing

  • Ataxia-telangiectasia - Movement disorder and symptoms related to immune deficiency, such as increased proneness to pulmonary infections

  • Myotonic dystrophy - Muscle weakness and visual symptoms (cataract)


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