At a molecular level cellular factors have been identified that can markedly influence insulin action either directly or indirectly. These include tumour necrosis factor (TNF) a, glucose transporters (GLUT) and peroxisome proliferator activated receptor (PPAR)g, while increased glucose flux has been shown to induce insulin resistance in skeletal muscle. For a more detailed review see Garvey and Birnbaum (16). There is also likely to be a genetic predisposition to insulin resistance (17).
Current treatments of Type 2 diabetes have little impact on reducing insulin resistance and this may explain why treating diabetes has only marginal benefits on reducing CHD mortality. It is hoped that with the introduction of thiazolidinediones, a novel class of oral agents that reduce insulin resistance, this may change.
Environmental influences on insulin sensitivity are not yet completely understood. Exercise has a strong beneficial effect (18) and obesity a strong adverse effect. The effects of diet on insulin sensitivity are discussed later.
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Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...