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Insulin Resistance in Non-Insulin Dependent (Type II) and Insulin Dependent (Type I) Diabetes Mellitus

  • Chapter
Comparison of Type I and Type II Diabetes

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 189))

Abstract

Insulin resistance is a characteristic feature of non-insulin dependent diabetes mellitus (NIDDM) due to target tissue defects in insulin action. Abnormalities of cellular insulin action can be divided into receptor and post-receptor defects. Patients with impaired glucose tolerance are insulin resistant due to decreased insulin receptors resulting in decreased insulin sensitivity and rightward shifted in vivo dose response curves. Patients with NIDDM are insulin resistant due to a combination of receptor and post-receptor defects. The greater the severity of the diabetes (greater fasting hyperglycemia) the greater the post-receptor defect, and in those patients with more significant fasting hyperglycemia the post-receptor defect is the predominant abnormality leading to the insulin resistant state. At least one of the abnormalities underlying this post-receptor defect involves a decrease in glucose transport system activity in freshly isolated adipocytes. This defect in glucose transport, is not expressed in cultured fibro-blasts, indicating that the abnormality in glucose disposal seen in vivo and in glucose transport seen in freshly isolated cells is an acquired phenomenon. Consistent with this, the post-receptor defect is partially reversible by insulin therapy, which leads to a 50–70% reversal of the reduced rates of in vivo glucose disposal and in vitro glucose transport. Insulin resistance also exists in poorly controlled IDDM patients, due to a postreceptor defect in insulin action. This insulin resistance is not present in well controlled IDDM patients, and is completely reversible when poorly controlled patients are treated with intensive insulin therapy.

Insulin is produced in the pancreatic beta cell as the primary biosynthetic product preproinsulin. This peptide is rapidly converted to proinsulin (MW ~ 9000). Proinsulin is converted to insulin (MW ~ 6000) plus C-peptide in the secretory granule with a small amount (~ 5 percent) of the proinsulin remaining unconverted. After a brief time in the peripheral circulation (half-life six to 10 minutes), insulin interacts with target tissues to exert its biologic effects. One of insulin’s major biologic effects is the promotion of overall glucose metabolism, and abnormalities of this aspect of insulin action can lead to a number of important clinical and pathophysiologic states including Type II diabetes, also known as non-insulin-dependent diabetes mellitus (NIDDM).35,38–40 Since insulin travels from the beta cell through the circulation to the target tissues, abnormalities at any of these loci can influence the ultimate action of the hormone.38 These abnormalities, all of which lead to decreased insulin effect, are referred to as insulin-resistant states.

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Authors and Affiliations

  1. Department of Medicine/Endocrinology M-023E, University of California San Diego, La Jolla, California, USA, 92093

    Jerrold M. Olefsky, Robert R. Revers, Mel Prince, Robert R. Henry, William T. Garvey, John A. Scarlett & Orville G. Kolterman

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  1. Jerrold M. Olefsky
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  2. Robert R. Revers
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Editors and Affiliations

  1. Departments of Physiology and Medicine and Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada

    Mladen Vranic  & George Steiner  & 

  2. Department of Medicine and Banting and Best Diabetes Centre, University of Toronto, Toronto, Canada

    Charles H. Hollenberg

  3. Division of Endocrinology and Metabolism, Toronto General Hospital, Toronto, Canada

    George Steiner

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Olefsky, J.M. et al. (1985). Insulin Resistance in Non-Insulin Dependent (Type II) and Insulin Dependent (Type I) Diabetes Mellitus. In: Vranic, M., Hollenberg, C.H., Steiner, G. (eds) Comparison of Type I and Type II Diabetes. Advances in Experimental Medicine and Biology, vol 189. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-1850-8_11

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  • DOI: https://doi.org/10.1007/978-1-4757-1850-8_11

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