Allen E. Gale, Consultant Physician (Allergy)
PO Box 401
Case Reports: CFS Associated With Insulin Resistance
Case: H. O'D. Caucasian male aged 48years gives a 20 year history of multiple food allergies associated with depression, fatigue, malaise, spatial coordination, memory, concentration, alcoholism, food addiction, hypoglycaemia and finally insulin resistance.
Case: T.S.UR3916. Caucasian female aged 38 years with extreme weakness and chronic fatigue. Previously diagnosed as spinal muscular atrophy and labelled: "Welander - Kugelburg Syndrome". Cachectic on examination with extreme wasting of limb muscles; confined to wheelchair; significant "pot belly". Glucose tolerance revealed levels consistent with insulin resistance.
In view of the diversity of clinical features associated with insulin resistance, a diagnosis of metabolic syndrome can usually be made entirely on clinical features. Obesity is a frequent although not an essential component of insulin resistance; in long standing chronic fatigue, severe muscle wasting and general loss of weight may occur but the presence of a "pot belly" due to intra-abdominal fat should be noted. Whilst the performance of a 2 hour glucose tolerance test with concurrent insulin levels remains controversial, it is the only laboratory investigation available in the assessment of patients in whom metabolic syndrome is suspected.
An understanding of the pathophysiology of NIDDM provides an explanation of the diverse collection of clinical features associated with metabolic syndrome and provides a basis for implementing a management strategy in the control of insulin resistance/metabolic syndrome. At present the only treatment plan which can be offered is the triad of an insulin aware diet based on the insulin index of foods, a graduated exercise programme of rehabilitation and achieving an ideal weight.
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