[The insulin resistance syndrome].

I Klimes, J Hrnciar

Vnitr Lek 1995, 41(2):75

[Cellular and molecular mechanisms of insulin resistance].

E Seböková, I Klimes, P Stolba

Vnitr Lek 1995, 41(2):76-83

In the submitted review the authors give an account of contemporary knowledge regarding the mechanism of insulin action, including a brief account of pathological conditions associated with insulin resistance. The development of knowledge of problems of insulin resistance syndromes was always very dynamic, and due to the introduction of techniques of molecular biology and genetics at the turn of the eighties and nineties, a further very marked step forward was made. Despite this it will take some time before molecular mechanisms which will confirm (or rule out?) the etiopathogenetic importance of insulin resistance not only for diabetes but also for...

[Review of in vivo technics in the quantification of insulin sensitivity].

M Mokán

Vnitr Lek 1995, 41(2):84-91

The ability to measure insulin sensitivity plays important role mainly in investigation of pathogenesis of noninsulin-dependent diabetes mellitus. The measurement of insulin sensitivity means to measure the insulin's effect on glucose metabolism--on hepatic glucose production and peripheral glucose uptake. From all in vivo techniques for measurement of insulin sensitivity are considered for most suitable at the present time next 2: clamp technique (euglycemic hyperinsulinemic and hyperglycemic hyperinsulinemic clamp) and Bergman's minimal model technique. Clamp methods and minimal model method are significantly correlated in vivo methods for measurement...

[Clinical manifestations of the insulin resistance syndrome. The hormonal-metabolic syndrome X, the 5H syndrome and their etiopathogenesis].

J Hrnciar

Vnitr Lek 1995, 41(2):92-98

The author summarizes mechanisms by which insulin resistance and compensatory hyperinsulinism are manifested in the clinical picture. He divides the mechanisms into prereceptor, receptor and postreceptor mechanisms. The latter dominate in the population quantitatively and thus also by their impact because they create the so-called 5H syndrome (association of hyperinsulinism with hyperglycaemia (NIDDM), hyperlipoproteinaemia, hypertension, hirsutism and the polycystic ovary syndrome) or the so-called hormonal metabolic syndrome X, lethal tetrad, metabolic syndrome, syndrome of insulin resistance). The term syndrome X does not appear suitable as it is...

[Insulin resistance and non-insulin dependent diabetes mellitus].

T Pelikánová

Vnitr Lek 1995, 41(2):99-103

Normal glucose tolerance depends primarily on 1) the ability of the body to secrete insulin, 2) the normal insulin action in target tissues, it means the ability of insulin to inhibit hepatic glucose production and to promote glucose uptake, 3) and the ability of glucose to enter the cells in the absence of insulin. Clinically overt non-insulin-dependent diabetes mellitus (NIDDM) is characterized by abnormality of insulin secretion combined with insulin resistance in glucose metabolism of all major target tissues. While the fasting hyperglycaemia depends primarily on decreased insulin ability to inhibit hepatic glucose production, in the postabsorptive...

[Insulin resistance and hyperlipoproteinemia].

J Skrha

Vnitr Lek 1995, 41(2):105-109

Insulin resistance is part of the so-called plurimetabolic syndrome where it was observed in association with various signs among which the association with impaired serum lipids is very frequent. The most frequent deviations are hypertriacylglycerolaemia (in particular VLDL), low HDL-cholesterol and elevated serum levels of non-esterified fatty acids. Some hitherto assembled findings suggest a close relationship between glucose and lipid metabolism. Enhanced oxidation of non-esterified fatty acids leads to inhibition of glucose oxidation and this may participate in the development of insulin resistance. Changes in cholesterol and triacylglycerol levels...

[Insulin resistance and arterial hypertension].

M Hrnciarová, J Hrnciar, K Jakubíková

Vnitr Lek 1995, 41(2):111-116

The hypothesis of insulin resistance in the pathogenesis of arterial hypertension as part of the hormonal metabolic X syndrome and our 5H syndrome resp. (association of hyperinzulinism with hyperglycaemia-NIDDM-hyperlipoproteinaemia, hypertension and a hyperandrogenic state in women) is based on sympathomimetic, sodium retention and trophic effects of insulin. In the submitted paper the authors review opinions supporting and refuting the validity of this hypothesis. Based on the results of different studies in recent years another genetic predisposition comes also to the foreground, i.e. reduced vascularization of the skeletal muscles which on the...

[Ischemic heart disease with significant coronary stenosis and insulin resistance].

J Okapcová, P Meciar, J Skamla, S Koróny

Vnitr Lek 1995, 41(2):117-120

The authors examined a group of 22 patients with significant stenoses revealed on coronarographic examination. None of the patients were diabetic. Hyperinsulinaemia was found in 12 patients (54.5%). The hyperinsulinaemic and normoinsulinaemic groups differed significantly as to the type of obesity expressed by the W/H ratio, the incidence of hypertension and triglyceride levels. The authors discuss the direct participation of insulin resistance and compensatory hyperinsulinism in the pathogenesis of atherosclerosis and its participation in the manifestation of associated risk factors (dyslipidaemia, hypertension, obesity and NIDDM).

[Microvascular angina pectoris and insulin resistance].

G Kaliská, M Szentiványi, I Nedělová, A Kreze

Vnitr Lek 1995, 41(2):121-125

The authors examined 29 patients with the syndrome of microvascular angina pectoris. In 12 patients (41.4%) they recorded hyperinsulinaemia as a manifestation of insulin resistance. The body weight, HDL cholesterol level, LDL cholesterol and triglycerides did not differ significantly in the two groups and were at the upper borderline of the range of reference values. The authors analyze mechanisms common to the pathophysiology of the syndrome of microvascular angina pectoris and the syndrome of insulin resistance.

[Hyperandrogenic states in women (polycystic ovary syndrome) and insulin resistance].

A Kreze, J Hrnciar, M Dobáková

Vnitr Lek 1995, 41(2):126-128

In the submitted paper the authors try to explain the relationship between hyperinsulinism as the cause and the polycystic ovary syndrome as the consequence of hyperinsulinism. This takes place via the insulin like growth factor I, the luteinizing hormone, sex binding hormone globulin, insulin like growth factor I binding protein and growth hormone. By varying interactions of the regulatory hormones gradually the granulosa cells are destroyed and replaced by androstendione producing thecal and stromal cells with impaired folliculogenesis. Chronic hyperestrogenism interferes also with hypothalamic regulation in the nucleus arcuatus. As almost identical...

[Insulin resistance in kidney diseases].

V Spustová, K Stefíková, L Husťavová, R Dzúrik

Vnitr Lek 1995, 41(2):129-135

Insulin resistance (IR) is found in different kidney diseases in almost half the patients with mild to medium severe disorders of renal functions; in advanced renal failure it is almost constant. In addition to pathogenetic mechanisms known in other diseases of Reaven's syndrome it has some specific features: Already in the early stages calcitriol production is impaired, and if the calcium intake is not increased and calcitriol is not substituted, secondary hyperparathyroidism with osteodystrophy develops. The intracellular concentration of free Ca increases and the intracellular concentration of free Mg declines. Activation of the renin angiotensin...

[The importance of diet therapy in the prevention and treatment of manifestations of metabolic syndrome X].

I Klimes, E Seböková

Vnitr Lek 1995, 41(2):136-140

The authors present an account of dietetic principles in the treatment of the metabolic syndrome X (Reaven 1988). Principles valid til recently are compared with the most recent views based on experimental and clinical investigations, using molecular methods. The authors explain in detail the importance of monounsaturated and polyunsaturated fatty acids in the oil of marine fish which are important not only for reducing the blood lipid level but also to improve the insulin resistance and they reduce slightly the blood pressure.

[Insulin resistance and combined therapy with sulfonylurea and insulin in non-insulin dependent diabetics].

J Vozár

Vnitr Lek 1995, 41(2):141-145

The author explains the mechanisms of insulin resistance and impaired insulin secretion which are the main signs in the pathogenesis of non-insulin-dependent diabetics. Both reasons are the basis of secondary failure of sulphonylurea treatment or the necessity to administer large doses of insulin to achieve a normal blood sugar level in these patients. By combined treatment, i.e. by adding small amounts of insulin to the original treatment with sulphonylurea antidiabetics or by adding sulphonylurea to large insulin doses, it is possible to compensate the patient as effectively as with insulin treatment alone. The author analyzes the procedure of changing...

[Anti-insulin antibodies and insulin resistance].

D Wichterle, P Stolba, B Bendlová, A Krnáková

Vnitr Lek 1995, 41(2):146-150

The submitted review deals with the phenomenon of immunological insulin resistance in insulin dependent diabetics which develops as a result of the presence of circulating anti-insulin antibodies as a response of the organism to administered insulin. This phenomenon is a liminal situation when anti-insulin antibodies exceed as to their concentration and affinity a certain arbitrary limit and the increasingly impaired pharmacokinetics of insulin cause a clinically manifest metabolic decompensation of the disease with the necessity of large daily doses of exogenous insulin. The authors discuss factors ensuing from the type of the administered insulin...

[Patient education in the metabolic syndrome].

B Krahulec, K Raslová

Vnitr Lek 1995, 41(2):151-155

In the treatment of the metabolic syndrome which comprises the most serious risk factors of atherosclerosis education is a basic prerequisite of treatment and prevention of complications. In the submitted review the authors analyze basic procedures of education from the general aspect as well as in individual disorders and diseases which characterize the metabolic syndrome (dyslipoproteinaemia, obesity, diabetes mellitus and impaired glucose tolerance, hypertension). They emphasize that a comprehensive change of the patient's life style and the life style of his whole family is necessary. This cannot be achieved within a short time and therefore motivation...