La resistencia a la insulina

insulina

Continuamos hablando de diabetes. Al hablar de diabetes mellitus nos estamos refiriendo a un grupo de enfermedades del metabolismo caracterizadas por la existencia de hiperglucemia, un aumento de los niveles de glucosa en sangre. Se debe a defectos en la secreción y/o en la acción de la insulina. La hiperglucemia crónica se asocia a largo plazo con daño, disfunción e insuficiencia de diferentes órganos especialmente de los ojos, riñones, nervios, corazón y vasos sanguíneos. A lo largo de este post explicaremos qué es la resistencia a la insulina.

¿Qué es la insulina?

La insulina es una hormona que produce nuestro páncreas, en concreto la producen las células beta del páncreas. En algunos tipos de diabetes lo que ocurre es que el páncreas no produce suficiente insulina.

¿Cómo actúa la insulina y qué función tiene?

La insulina que libera el páncreas circula por la sangre y cuando llega a las células de nuestros órganos se una a ellas para que la glucosa pueda entrar en dichas células. Es como si las células de nuestro organismo tuviesen la puerta cerrada a la glucosa que está en la sangre. Cuando la insulina llega y se une a las células, actúa de llave abriendo la puerta de las células a la glucosa para que la glucosa entre y la célula pueda usarla para obtener energía o almacenarla para cuando la necesite. Al entrar la glucosa en la célula, disminuyen los niveles de glucosa en sangre.

Si no hubiese insulina, la glucosa no podría entrar en las células. Esto produciría por un lado un aumento de la glucosa en sangre (hiperglucemia) y por otro que las células no obtendrían energía para poder trabajar.

Para que la insulina sea efectiva deben cumplirse dos requisitos:

  1. Que el páncreas segregue insulina en cantidad suficiente
  2. Que las células la identifiquen y permitan su acción.resistencia-insulina

¿Qué es y qué consecuencias tiene la resistencia a la insulina?

Al hablar de resistencia a la insulina nos estamos refiriendo a que existe en las células de nuestros órganos una resistencia a la acción de la insulina. Es decir, existe resistencia a la acción que ejerce la insulina para la captación de la glucosa de la sangre, a la acción de la insulina para que la célula obtenga energía de la glucosa que capta o a la acción de la insulina para que la célula pueda almacenar la glucosa si en ese momento no necesita energía.

La resistencia a la insulina es lo que caracteriza a los diabéticos tipo 2. Además, es muy frecuente también en todos los diabéticos que asocian obesidad.

Cuando aparece resistencia a la insulina, las células de los diferentes tejidos de nuestro organismo no captan la glucosa que está en la sangre. Si la glucosa no entra en las células, permanece circulando en la sangre. Esto da lugar a una hiperglucemia.

Cuando la insulina se une a las células del hígado, la insulina hace que las células del hígado frenen la producción de glucosa. Si hay resistencia a la insulina, esto no ocurre. Como consecuencia, aunque los niveles de glucosa en sangre sean elevados, no hay nada que mande la señal al hígado para que deje de producir glucosa y éste continua produciendo glucosa.

¿Por qué se produce la resistencia a la insulina?

La resistencia a la insulina puede ser de origen genético o adquirida.

En el caso de ser genética se sabe que su heredabilidad es alta a través de un patrón de carácter poligénico. Quiere decir que si hay alguien en la familia con resistencia insulínica, tienes más probabilidades de desarrollarla pero no es seguro. No se trata de un gen que se hereda y ya te hace aparecer la resistencia insulínica. Se trata de muchos genes que se pueden heredar y si heredas ciertas combinaciones de estos genes, pueden hacer que desarrolles resistencia a la insulina.

No siempre se hereda. También puede ser adquirida. Entre las causas adquiridas, probablemente las más importantes son la obesidad, la distribución de la grasa corporal (obesidad central) y la actividad física reducida (sedentarismo). Además hay ciertas patologías que pueden producir insulinorresistencia como la desnutrición y las enfermedades hepáticas crónicas.


Marta Cano Pazos
Médico de familia, C. S. Puebla de Sanabria

REFERENCIAS:

Revisado: julio 2016

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