1. Insulin Resistance Progression to Diabetes Part 3

2. Metabolic Markers - Adiponectin Optimal insulin sensitivity and protection against diabetes and CVD. Note: Normal adiponectin can co-exist with glucose intolerance in very lean individuals. False–normal adiponectin can occur with renal railure or insulin receptor mutations. Visceral obesity and high BMI ( visceral adipose suppresses adiponectin secretion). Insulin resistance and hyperinsulinemia. Dyslipidemia (high TGs & LDL-C, low HDL-C) Inflammation and increased risk of DM and coronary heart disease (TNG-a inhibits adiponectin.) Stress (Symathetic stimulation reduces adiponectin.) Low Adiponectin associated with:

3. Metabolic Markers - Adiponectin

4. Metabolic Markers - Insulin

5. Metabolic Markers - Proinsulin

6. Metabolic Markers – Hemoglobin A1c

7. Metabolic Markers-HOMA-IR High HOMA-IR associated with: Hepatic insulin resistance—a result of ineffective suppression of hepatic glucose production by insulin, declining beta-cell function, or both. Increased risk (or presence) of CVD and diabetes (high HOMA-IR may precede DM for several years). 3 Increased risk of hypertension, dyslipidemia, coagulation,and vascular endothelial dysfunction, even in the absence of glucose intolerance. 4 Normal HOMA-IR associated with: Optimal insulin sensitivity Low fasting glucose or insulin, since HOMA-IR closely associates with both. Refer to glucose and insulin measurements for pertinent information. Note: A false-normal HOMA-IR score may occur in DM when impaired beta-cell function causes greater secretion of pro-insulin than insulin in the fasting state. (See section for Pro-insulin).

8. Metabolic Markers-Leptin To reduce Leptin Resistance (and Leptin):

9. Metabolic Markers: Pattern Recognition

10. Therapeutic Options