Insulin resistance. An often unrecognized problem accompanying chronic medical disorders.

Insulin resistance is associated with a number of risk factors for atherosclerosis, including glucose intolerance, hypertension, and dyslipidemia. Management of these disorders should include an attempt to reduce insulin resistance and certainly not to increase it. For example, when possible, thiazide diuretics and beta blockers should be avoided for treating hypertension, because they increase insulin resistance and, in diabetic patients, adversely affect glycemic control. Since exercise, weight loss, and cessation of smoking reduce insulin resistance, they are often helpful components of a treatment regimen for patients who have chronic medical disorders that are associated with insulin resistance.