Managing highly insulin-resistant diabetes mellitus: weight loss approaches and medical management

Postgrad Med. 2010 Jan;122(1):163-71. doi: 10.3810/pgm.2010.01.2110.

Abstract

The prevalence of obesity and diabetes is epidemic. Severe insulin resistance (defined as the need for > or = 200 units of insulin per day to achieve glycemic control) is commonly seen with obesity and can complicate diabetes management. The management of patients with diabetes who have severe insulin resistance is difficult, and at times frustrating, and requires a multifaceted approach. Weight loss is the best treatment option, which can be a challenging task for patients to achieve and maintain. Medications that decrease insulin needs like metformin, thiazolidinediones, or pramlintide may help, but some patients also need high doses of insulin. This article reviews these different treatment options and provides practical advice on weight loss, use of insulin sensitizers, and use of U-500 insulin.

Publication types

  • Review

MeSH terms

  • Amyloid / therapeutic use
  • Bariatric Surgery
  • Diabetes Mellitus / drug therapy*
  • Diabetes Mellitus / prevention & control
  • Diabetes Mellitus / therapy
  • Diet, Reducing
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use
  • Exenatide
  • Exercise
  • Glucagon-Like Peptide 1 / analogs & derivatives
  • Glucagon-Like Peptide 1 / therapeutic use
  • Humans
  • Hypoglycemic Agents / therapeutic use
  • Insulin / therapeutic use
  • Insulin Resistance*
  • Islet Amyloid Polypeptide
  • Liraglutide
  • Metformin / therapeutic use
  • Obesity / complications*
  • Obesity / therapy
  • Peptides / therapeutic use
  • Thiazolidinediones / therapeutic use
  • Treatment Failure
  • Venoms / therapeutic use
  • Weight Loss*

Substances

  • Amyloid
  • Dipeptidyl-Peptidase IV Inhibitors
  • Hypoglycemic Agents
  • Insulin
  • Islet Amyloid Polypeptide
  • Peptides
  • Thiazolidinediones
  • Venoms
  • Liraglutide
  • Glucagon-Like Peptide 1
  • Metformin
  • Exenatide
  • 2,4-thiazolidinedione
  • pramlintide