TABLE 1.

Causes of Severe Insulin Resistance (3)

Syndromes of severe insulin resistance
  • Type A, due to defects in the insulin receptor gene

  • Type B, due to insulin receptor antibodies

  • Type C, cause unknown (also known as HAIR-AN [Hyperandrogenism, Insulin Resistance, and Acanthosis Nigricans] syndrome)

Medications
  • Glucocorticoids

  • Atypical antipsychotics

  • Calcineurin inhibitors

  • Protease inhibitors

  • Oral contraceptives

Endocrine disorders
  • Acromegaly

  • Glucagonoma

  • Thyrotoxicosis

  • Cushing’s syndrome

  • Pheochromocytoma

Anti-insulin antibodies
HIV-associated lipodystrophy
Physiological causes
  • Severe stress

    • Trauma

    • Sepsis

    • Surgery

    • Diabetic ketoacidosis

  • Pregnancy

  • Puberty

Pseudoresistance
  • Poor administration technique

  • Incorrect storage of insulin

  • Malingering for secondary gain