J Korean Endocr Soc.  2009 Jun;24(2):75-83. 10.3803/jkes.2009.24.2.75.

Assessment of Insulin Resistance and Its Clinical Application

• Kim J
• Lee LY
• Lee S

• KMID: 1468500
• DOI: http://doi.org/10.3803/jkes.2009.24.2.75

Abstract

No abstract available.

MeSH Terms

Insulin
Insulin Resistance
Insulin

Figure

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  Fig. 1 Hyperinsulinemic Euglycemic Glucose Clamp Technique. After an overnight fast, insulin is infused intravenously at a constant rate that may range from 5~120 mU/m2/min (dose per body surface area per minute). This constant insulin infusion results in a new steady-state insulin level that is above the fasting level (hyperinsulinemic). As a consequence, glucose disposal in skeletal muscle and adipose tissue is increased while hepatic glucose production is suppressed. Under these conditions, a bedside glucose analyzer is used to frequently monitor blood glucose levels at 5~10 min intervals while 20% dextrose is given intravenously at a variable rate in order to "clamp" blood glucose concentrations in the normal range (euglycemic). An infusion of potassium phosphate is also given to prevent hypokalemia resulting from hyperinsulinemia and increased glucose disposal. After several hours of constant insulin infusion, steady-state conditions can typically be achieved for plasma insulin, blood glucose, and the glucose infusion rate (GIR). Assuming that the hyperinsulinemic state is sufficient to completely suppress hepatic glucose production, and since there is no net change in blood glucose concentrations under steady-state clamp conditions, the GIR must be equal to the glucose disposal rate (M). Thus, whole body glucose disposal at a given level of hyperinsulinemia can be directly determined (Adopted from Muniyappa R, et al. Am J Physiol Endocrinol Metab 294:E15-26, 2008).

• 

  Fig. 2 Brachial artery measurements and insulin-stimulated capillary recruitment measured by contrast enhanced ultrasonography. A. Brachial artery measurements are made ~10 cm proximal to the antecubital fold while the patient is in the supine position using a high frequency L12-5 linear array transducer interfaced to an HDI5000 ultrasound (Philips Medical Systems, Andover, MA). Artery diameter is measured using 2-D imaging of the longitudinal artery as the distance between each inside edge of the arterial intima. Velocity is determined using pulse-wave Doppler and brachial flow calculated from the diameter and velocity measurements. Contrast ultrasound measurements are performed using an HDI5000 (Philips Medical Systems) while the patient is sitting upright. A P4-2 phased array transducer (Philips Medical Systems) is positioned with a ring stand and clamp to image the flexor muscles of the forearm in cross section. Microbubbles (Bristol-Myers Squibb, Princeton, NJ) are delivered intravenously at a rate that produced moderate opacification (below saturation level) at the longest pulsing interval used (16s). Microbubbles are detected by power Doppler imaging using a mechanical index capable of destroying all bubbles in the ultrasound beam. After an initial equilibration period, a pulsing interval (time) versus video-intensity curve is generated. The pulsing interval is the time between successive ultrasound pulses, which destroy microbubbles, and video intensity is the intensity of signal generated from the microbubbles. At a low pulsing interval (e.g., 500 ms) only microbubbles in the larger arteries and arterioles are filled before another destructive pulse is delivered, hence all of signal intensity is secondary to filling of these vessels. At a longer pulsing interval (e.g., 16 s) the microbubbles will again have filled larger arteries and arterioles but will have also entered the microvasculature. Subtracting images obtained at 500 ms from those taken at 16 s eliminates signals generated from the background tissue or larger vessels, leaving a measure of MBV. B. Images are recorded onto SVHS videotape, captured using Adobe Premiere software (Version 6.0) and analyzed using MCE software (University of Virginia) (Adopted from Clerk LH, et al. Diabetes 55:1436-1442, 2006).

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  Fig. 3 New standardized therapeutic model in Korean patients with type 2 diabetes mellitus. Patients are allocated to one of six groups based on the reference value of C-peptide and the rate constant for plasma glucose disappearance (Kitt) as follows: (i) diet and exercise only; (ii) patients treated with metformin (Met) and/or thiazolidinediones (Met/TZD); (iii) patients treated with sulphonylurea only (SU); (iv) patients treated with SU + Met/TZD; (v) patients treated with insulin only; and (vi) patients treated with insulin + Met. Kitt (%/min), rate constant for glucose disappearance by the insulin tolerance test (ITT); FPG, fasting plasma glucose concentration; PP2hG, postprandial 2-h plasma glucose concentration (Adopted from Choi SH, et al.. Clin Endocrinol (Oxf.) 69:549-555, 2008).

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