Insulin Resistance (IR)

Insulin Resistance is a proatherogenic state.

Diagnosing IR:

• Moderate Elevation of GTT and ALT
• Metabolic Syndrome (also called Insulin Resistance Syndrome)
• Fasting blood sugar level: 100-125.
• TG/HDL > 3.5 (Caucasians); >3 (Mexican Americans); >2.0 (non-Hispanic Blacks).
• A1c >6.5%
• GTT is the gold standard.
  • 2 Hour GTT 120-139: 66% loss of Beta cell function.
  • 2 Hour GTT <140 but One hour GTT >125, high probability of IR.

1. IR damages arteries regardless of blood sugar levels
   1. IR increases arterial inflammation
   2. IR immediately and progressively drives endothelia inflammation
   3.  Majority of MI (myocardial infarction) have IR.
   4. Majority of ACS (acute coronary syndrome) patines are Insulin Resistant.
   5. IR significantly increases ischemic stroke risk in non-diabetic adults.
   6. GGT and ALT predict new onset DM and identify underlying IR
      1. These levels of GGT and AT doubled the risk:
         1. GGT women >/=21 units/L vs. </= 6 units/L;
         2. GGT men >/=47 units/L vs. </=10 units/L
         3. ALT women >/= 20 units/L vs. </=10 units/L
         4. ALT men >/= 34 units/L vs <15 units/L
   7. Ethnicity:
      1. TG (triglycerides)/HDL >/= 3.5 = IR in Caucasians
      2. TG/HDL >/= 3.0 = IR in Mexican Americans
      3. TG/HDL >/= 2.0 = IR in Non-Hisanic Blacks.
   8. Abnormal fasting blood glucose identifies IR
      1. ADA definition: 100-125 mg/dl is abnormal and is a strong indicator of IR
      2. 2 Hour GTT:
         1. Increased risk for IR if >/= 125 mg/dl
         2. If >150, 13x greater risk of IR.
      3. ADA: A1c 5.7 – 6.4% = Pre-diabetes = IR

Source: Dr. Jeff Life, A4M Convention 12. 2015, Las Vegas