Insulin resistance occurs at the tissue (or cell?) level and leads to the
state of hyperinsulinemia (high insulin levels).

http://woundcare.org/newsvol1n3/ar1.htm

The Insulin Resistance Syndrome
Jennifer B. Marks,MD
University of Miami
School of Medicine 

Reprinted with permission from: The Monitor, Vol 1. Number 3, Spring 1996. A
publication of the American Diabetes Association/Florida Affiliate,
Inc./Southeast Region. 

Abnormalities in glucose and lipid (blood fats) metabolism, obesity, and
high blood pressure occur together commonly enough in the same individuals
as to suggest that they are somehow interrelated. In fact, this cluster of
abnormalities has come to be known as a syndrome, going by a variety of
names, including Syndrome X, the Deadly Quartet, and the Insulin Resistance
Syndrome. What seems to connect the various features of the syndrome
together is something called insulin resistance: that is, a reduced
sensitivity in the tissues of the body to the action of insuln, which is,
importantly, to bring glucose into those tissues to be used as a source of
energy. When insulin resistance, or reduced insulin sensistivy, exists, the
body attempts to overcome this resistance by secreting more insulin from the
pancreas. This compensatory state of hyperinsulinemia (high insulin levels
in the blood) is felt to be a marker for the syndrome. The development of
Type II, or non-insulin dependent, diabetes occurs when the pancreas fails
to sustain this increase insulin secretion. It is not clear how insulin
resistance contributes to the presence of high blood pressure, but it is
clear that the high insulin levels resulting from insulin resistance
contribute to abnormalites in blood lipids—cholesterol and triglycerides. 

The importance of the Insulin Resistance Syndrome, or perhaps more
accurately, "The Pluri-Metabolic Syndrome", lies in its consequences. The
syndrome is typically characterized by varying degrees of glucose
intolerance, abnormal cholesterol and/or triglyceride levels, high blood
pressure, and upper body obesity, all independent risk factors for cardiac
disease. If one includes along with the classic four features the commonly
associated conditions of aging, sedentary lifestyle, stress, smoking, and a
dose of genetic susceptibility, then a deadly web of increased
cardiovascular (heart and blood vessels) disease risk is woven. In fact, the
presence of any one major feature alone substantially increases the risk of
heart disease, but when they occur together the risk is magnified way out of
proportion at the contribution of any one single factor. 

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