IR and SkinTags
Including Impairment of the Nervous System
Paul A. Berez, M.D.
When examining a patient for insulin resistance, it is important to note that skin tags and acanthosis nigricans (slightly raised, smooth, moderately pigmented lesions found on the upper trunk) are physical signs of insulin resistance (1,2).
Also look for impairment of the entire nervous system (including hearing impairment, tinnitus, dizziness, cognitive effects, tremors, impaired Rhomberg test, and abnormal pinprick/filament testing, in a sock/glove distribution).
The latter is especially useful for insurance reasons, since peripheral neuropathy justifies glucose challenge testing (IDC-9 code 356.9). I estimate that 70% of my non-diabetic insulin resistance patients have peripheral neuropathy on exam.
(1) Shimaya et al, horm met res 30: 543-498, 1998
(2) Garcia, H. AMER J OF CLIN DERM 3(7): 497-506, 2002