National severe insulin resistance service


The National Severe Insulin Resistance Service provides services for investigation and management into severe insulin resistance and associated conditions in both adults and children at the Wolfson Diabetes and Endocrine Clinic within the Institute of Metabolic Science. There is a weekly multidisciplinary clinic which consists of a consultant, nurse specialist, dietitian, genetic counsellor in some cases, and paediatric endocrine consultant for children (up to the age of 18). The aim of the service is to provide diagnostic, therapeutic and educational support for both patients and their local clinical carers, and to establish and disseminate evidence-based recommendations for the therapy of this severe group of conditions.


Key personel

Professor Sir Stephen O’Rahilly - Professor of Clinical Biochemistry and Medicine

Referal information

The service is targeted at patients with lipodystrophy and/or extreme insulin resistance. The referral criteria are as follows: Donohue Syndrome or Rabson Mendenhall Syndrome with confirmed extreme hyperinsulinaemia, Clinically diagnosed lipodystrophy (generalised or partial), Unexplained severe insulin resistance with: BMI<30kg/m2 (BMI Z score <=+3 in children) AND acanthosis nigricans AND/OR severe hyperinsulinaemia*, *fasting insulin>150pM or peak plasma insulin on oral glucose tolerance testing >1,500p

Extra information

​We are happy to accept referrals or to discuss any patients whom it is felt have severe insulin resistance and/or lipodystrophy. We can provide diagnostic (both genetic and biochemical) support in addition to access to funded treatment options including GLP1 agonists, U500 insulin, leptin and IGF-I in some patients. We also provide specialist dietetic input and diabetes nursing input. Ongoing care is usually shared closely with the referring clinician.


Wolfson diabetes and endocrine clinic