Case Report

Extreme Insulin Resistance in a Patient with Diabetes Ketoacidosis and Acute Myocardial Infarction

Table 2

Conditions associated with insulin resistance [2, 3, 5, 814].

Characteristics/clinical features

Type A syndromeInsulin receptor gene mutations or IRS-1 mutation or defect in other signaling intermediates/GLUT
Type B syndromeAutoantibodies to insulin receptor. Associated with autoimmune disease or malignancy
Type C syndrome (HAIR-AN)Hyperandrogenism, insulin resistance, and acanthosis nigricans
LipodystrophyCongenital or acquired (HIV lipodystrophy)
Excess of counter-regulatory hormones or endocrine disordersAcromegaly, glucagonoma, Cushing’s syndrome
Phecochromocytoma, thyrotoxicosis
Insulinoma or hyperinsulinemic states
Pathophysiological statesPuberty, pregnancy, and advanced age
Obesity, metabolic syndrome, cirrhosis, MI, and ketoacidosis
Uremia, sepsis
Others
 Pseudoinsulin resistance Human or technical errors
 Hypersensitivity (anti-insulin antibodies) Anti-insulin antibodies with high capacity and low affinity
 Subcutaneous insulin resistance (SIR)Increased insulin degrading activity in sub-Q tissue
 Increased insulin clearance Increased degradation of insulin in the circulation
 MedicationsNiacin, steroid, IFN-alpha, atypical antipsychotics, PI, and NRTI

IRS: insulin receptor substrate; GLUT: glucose transporter; HIV: human immunodeficiency virus; MI: myocardial infarction; sub-Q: subcutaneous; IFN: interferon; PI: protease inhibitor; NRTI: nucleoside reverse transcriptase inhibitor.