Heads up… understanding insulin resistance is not hard but it does make for a very technical post. Not my favorite type of topic to cover. But with the increase in obesity and consequentially type 2 diabetes, we need to have a little chat about it. Understanding insulin resistance begins by learning a bit about insulin, insulin sensitivity, and how they all relate to a very real and widespread health issue our country is experiencing. So please don’t skip this post. It won’t be fun but it will be worth it.
Understanding Insulin Resistance: What is Insulin?
Understanding insulin resistance requires us to first understand insulin. Insulin is a hormone produced by the pancreas. It regulates the metabolism (the rate at which you burn) of carbohydrates. Insulin essentially allows carbohydrates to be used as energy by our body’s cells. And insulin helps keep your blood sugar level from getting too high (hyperglycemia) or too low (hypoglycemia). As blood sugar levels rise, the pancreas secretes more insulin.
People with type 1 diabetes cannot make insulin. These people need to inject insulin to allow their body to process carbohydrates and avoid complications from hyperglycemia. People with type 2 diabetes do not respond well or are resistant to insulin. Over time, high blood sugar levels due to insulin resistance and type 2 diabetes damages nerves and blood vessels, leading to complications such as heart disease, stroke, blindness, kidney failure, and lower limb amputations.
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Understanding Insulin Resistance: What is Insulin Sensitivity?
The next step to understanding insulin resistance is knowing the difference between it and insulin sensitivity. Insulin sensitivity is how our bodies respond to the insulin. In other words, how well our body allows blood sugar to be absorbed by the body’s muscle cells. But insulin sensitivity is NOT a diagnosis.
Think of it like blood pressure. Blood pressure is not a diagnosis, nor is it bad or good. If your blood pressure is consistently too high, your doctor will diagnosis you with high blood pressure. It’s a measurement and can be an indicator of other health concerns, but in and of itself, is not a diagnosis.
The same can be said of insulin sensitivity. A healthy person generally has “good” insulin sensitivity. With optimal insulin sensitivity, after a high sugar meal, insulin rises sharply pushing glucose into our body’s cells and then it rapidly declines.
With poor insulin sensitivity, however, insulin’s elevation is sustained due to an inability to force glucose into our body’s cells. That’s why a prediabetic or diabetic has “poor” insulin sensitivity Their system has become insensitive to insulin and poor insulin sensitivity results in, you guessed it, insulin resistance.
Understanding Insulin Resistance: What is It?
In a nutshell, “insulin resistance” is the term given to a person with poor insulin sensitivity. As we learned above, the cells of the body have simply become resistant to insulin. Therefore, blood sugar remains elevated and the pancreas will continue to produce more and more insulin in response to the continued elevated blood sugar. Eventually, the pancreas is unable to produce enough insulin for the body’s demands. Unfortunately, many people don’t know they have insulin resistance until they have been diagnosed with prediabetes, or worse, type 2 diabetes.
Insulin resistance and prediabetes are often seen together and precede the development of type 2 diabetes. In fact, it is much easier to diagnosis prediabetes than it is to diagnosis insulin resistance. The diagnosis of prediabetes is confirmed with a blood test. In prediabetes, blood sugar levels are higher than normal but not high enough for a diagnosis of diabetes. Once the diagnosis is confirmed, it is accepted that the person with prediabetes also suffers from insulin resistance.
Another indicator of insulin resistance is a high three month blood sugar level or hemoglobin A1c. Sometimes a fasting blood sugar level can be normal, but a three month blood sugar level is elevated. So it’s prudent to have it measured both ways.
Understanding Insulin Resistance: Who is at Risk?
Understanding insulin resistance also requires us to know who is at risk. Like many other chronic conditions, insulin resistance is a combination of risk factors that are both in our control, like our lifestyle, and some that are out of our control, like our genetics. Here are most of the risk factors:
- Overweight with a BMI of more than 25.
- Waist circumference of more than 40 inches for men and more than 35 inches for women.
- Over 40 years old.
- Is of Latino, African American, Native American, or Asian American heritage.
- Has close family members (parents or siblings) with type 2 diabetes, high blood pressure, or arteriosclerosis. Arteriosclerosis is commonly referred to as hardening of the arteries.
- Has had gestational diabetes.
- Has a history of high blood pressure, high blood triglycerides, low HDL cholesterol, or arteriosclerosis.
- Has polycystic ovarian syndrome, a hormonal disorder causing enlarged ovaries with small cysts on the outer edges.
- Has acanthosis nigricans (don’t ask me to pronounce it) identified by dark patches of skin on the elbows, knees, knuckles, and arm pits. Some people also have a dark ring around their neck.
Understanding insulin resistance and the risk factors involved allows us todetermine if we are at risk and need to make certain lifestyle changes as well as discuss our concerns with our physician.
Understanding Insulin Resistance: Managing Insulin Resistance
A diagnosis of insulin resistance or prediabetes can serve as a wake up call. It is a warning that lifestyle changes (and sometimes medications) need to be introduced in order to delay or even prevent the onset of type 2 diabetes. Once insulin resistance is suspected or prediabetes is diagnosed, there are some steps to prevent type 2 diabetes:
- Incorporating a healthy diet with an emphasis on vegetables, fruits, lean protein, and whole grain carbohydrates. Try to limit processed foods and rely more on whole foods. Instead of that “cheese” that comes in a jar, you know the kind, next to the Tostito chips, try your own homemade guacamole or salsa. It’s healthier and I am sure it will taste even better.
- Reaching and maintain a healthy weight. The easiest way to determine healthy weight is to attain a BMI of under 25. However, there are other methods such as waist circumference and body fat percentage that can determine what your specific healthy weight is.
- Increased physical activity. As little as a 30 minute walk a day can be beneficial.
- Stop smoking.
- Taking medications such as metformin that are prescribed by your physician.
The Diabetes Prevention Program study and its follow-up study, the Diabetes Prevention Program Outcomes Study, confirmed that people with prediabetes can often prevent or delay diabetes with a modest amount of weight loss and increasing physical activity.
Understanding Insulin Resistance: Conclusion
Understanding insulin resistance can be thought of like a line of dominoes. One domino tips over and starts the chain reaction. Insulin resistance is like that first domino. Insulin resistance occurs which kicks your body into a prediabetic state. Next comes full-blown type 2 diabetes with all of its complications. However, understanding insulin resistance can allow you to recognize the risk factors and make changes in your diet and lifestyle. When that happens the chain reaction is stopped dead in its tracks. You are not a helpless bystander. You have the power to make the necessary changes to set yourself up for success.