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Insulin Resistance in Children & Adolescents (Hardcover, Illustrated Ed)
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Insulin Resistance in Children & Adolescents (Hardcover, Illustrated Ed)
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Insulin resistance is a simple concept with complex ramifications.
The notion that insulin action differs in different people and
under different circumstances has been known for a considerable
period of time. For example, it has long been recognised that young
children with type 1 diabetes are 'sensitive' to small changes in
insulin dosage, while obese adults with type 2 diabetes may require
huge doses of insulin to establish metabolic control. What is more
recent is the finding that insulin action differs in a number of
different and very common conditions and may in fact be a central
contributor to the pathogenesis of some or all of these, including
obesity, atherogenesis, type 2 diabetes, the metabolic syndrome,
hypertension, hyperandrogenism, polycystic ovarian syndrome and
perhaps some types of malignancy. The increasing burden of obesity
and its ramifications has firmly and increasingly focused the
spotlight on insulin resistance in recent years. Yet most of this
attention has been paid to adults and much less to the consequences
and causes of insulin resistance in children and teens. This is
despite the fact that many of the adult diseases associated with
insulin resistance, such as obesity, type 2 diabetes,
atherosclerosis, have their origins in childhood. Furthermore,
insulin resistance has long been documented in certain
circumstances in children and teens with type 1 diabetes (e.g. at
disease onset, with episodes of ketoacidosis or poor metabolic
control), and is likely an adaptive response contributing to the
growth spurt of puberty. More recently, in utero contributions to
programming of insulin resistance and its consequences have been
brought to light, initially by Barker and his colleagues who have
championed the field of foetal origins of adult disease'. Given the
rapid explosion in research in insulin resistance and its
increasing importance throughout the life span, we felt it timely
to bring together in one place a thorough analysis of the field.
The objectives of this book are two-fold: first, to educate the
reader about the importance and spectrum of insulin resistance in
the childhood population, and, second, to help stimulate and focus
further investigation in this exciting area. We have attempted to
gather the contributions of leaders in the field of insulin
resistance in the paediatric population. The sequence of the
chapters moves from basic mechanisms, to measurement of insulin
sensitivity, to description of specific disorders, to prevention
and management.
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