[Insulin resistance and pathogenesis of non-insulin-dependent diabetes mellitus (I)]

The authors present a review of current knowledge of insulin mechanism on cellular level and of the defects leading to diminished cellular insulin sensitivity and to development of insulin resistance (IR). Attention is focused primarily on IR in subjects with non-insulin dependent diabetes mellitus (NIDDM) with main stress on the postreceptor level of insulin effect which includes glucose transport, storage (glycogen-synthesis) and glycolysis. The defects of these mechanisms (namely the decrease in glycogen-synthase activity) are considered the main causes of IR in patients with NIDDM. Beside the above mentioned factors the authors discuss some of the less well-known mechanisms that can be found in the background of IR in patients with NIDDM (tissue blood flow, capillary density, transport of insulin across the endothelial barrier, glucose toxicity, role of intracellular calcium and others.