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	James L. Holly, M.D.

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EPM Tools - Progression to Diabetes - Insulin Resistance

Insulin resistance increases the secretory function of the B-cell.

The idea that this leads to B-cell exhaustion may not be a fact. The following argue against that.
First, insulin resistance is common, occurring in almost all obese subjects. Even so, only a small proportion of obese individuals ultimately develop diabetes.
Second, the Pima Indian study highlights the fact that B-cell function is enhanced in apparently health subjects as insulin resistance progresses.
Third, induction of short-term experimental insulin resistance with nicotinic acid is associated with adaptive increase in B-cell function manifested as increased insulin release and a decrease in proportion of proinsulin in plasma.
Therefore, it would seem that a failure to adequately adapt to insulin resistance may be due to a genetically programmed B-cell abnormality associated with an inability of the normal B-cell to adapt to insulin resistance and increased secretory demand thus uncovering a defect in B-cell function.
On the other hand, the B-cells in those without such a genetic issue would adapt and prevent the development of hyperglycemia.

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