Insulin Resistance And Diabetes
Insulin regulates the amount of glucose that circulates in the bloodstream. It induces the cells to absorb glucose, which comes from the food people eat.
Insulin is also the chemical messenger that instructs the liver to store some glucose, rather than release it into the bloodstream. The liver packages glucose for storage in the form of glycogen.
Insulin usually helps the body maintain a good balance of energy, not allowing the level of blood glucose to spike for too long.
The reasons for insulin resistance remain complex, and researchers continue to investigate.
The following outline the current understanding of how insulin resistance develops:
A number of tests can help diagnose prediabetes and diabetes:
Doctors usually request more than one of these tests to ensure an accurate diagnosis.
If blood sugar levels consistently fall outside of a normal range, it might indicate that the body is becoming resistant to insulin.
However, a person can take some steps to reduce the likelihood of developing insulin resistance.
Motivated To Change Your Numbers
What to do about insulin resistance is the next question and the answer is to reduce the stimulus that tells your body to make more insulin, or, in other words, Eat less sugars.
Sugars are not only what makes food taste sweet, but considered nutritionally, they are the components any food considered a carbohydrate, which covers everything from brussel sprouts to cotton candy and everything in between: all types of vegetables and fruits, grains, and all sweets and desserts. The sweeter the food, the more insulin your body makes when you eat that food.
The first recommendation I make to my patients is to follow the Weight Loss Eating Plan described in detail in the Real Food Section of this site. I urge them to follow the plan precisely for at least a month to get a good idea of their physiological responsiveness and to reduce food cravings. Some of the most tempting foods provide a double whammy. Sweet sodas and juices, for instance, are rich in fructose, which is hard on the liver, and as liquids spike blood sugar and insulin faster than whole fruits. Bread usually contains gluten, and gluten is irritating to the gut lining and inflammatory to some degree for almost everyone. Inflammation and weight gain are closely linked and reciprocal: increase either one and you’ll likely increase the other.
Endocrine Issues Caused By Insulin Resistance
The CDC reports that an excess amount of glucose in the bloodstream can be very damaging to the body. This can also lead to an increase in insulin, which signals to the liver and muscles that they should start storing glucose. The liver sends excess glucose to fat cells, which can lead to weight gain. At this stage, the bodys impaired insulin response sets the foundation for other health concerns to possibly develop.
Your healthcare team may order an insulin resistance test to check for the following:
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Your A1c Value Is An Incomplete Marker Of Insulin Resistance
Your A1c is used as a biometric marker of your average blood glucose control, and is typically used to diagnose type 1 diabetes, type 1.5 diabetes, prediabetes or type 2 diabetes.
Technically speaking, when your A1c drops below 5.7% your diabetes diagnosis can be removed from your medical record. At Mastering Diabetes, we recommend maintaining an A1c value less than 5.7% without the use of oral medications or insulin for 365 days to claim that you have reversed either prediabetes or type 2 diabetes.
Its very important to understand that your A1c value is simply an indicator of your blood glucose control, and only provides you with information about your level of insulin resistance when interpreted in the context of other biomarkers.
Understanding your level of insulin resistance can be challenging because it requires examining multiple biomarkers, each of which is a continuum. Since the amount of stored fat inside your muscle and liver cannot adequately be measured at any given time, other laboratory biomarkers are necessary to provide context.
What Are The Signs Of High And Low Blood Sugar
Change your medication with doctor supervision. according to the British Diabetes AssociationGet plenty of sleep.According to recommendations published March 2015 in Sleep Health, according to the Sleep FoundationManage stress well.cortisolstress hormoneaccording to Harvard Health Publishingaccording to the ADA
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How Do I Know If I Have Insulin Resistance
The stats say that insulin resistance and PCOS often go hand in hand. A blood test can tell you whether you have insulin resistance. This should measure fasting blood glucose, fasting insulin, and HbA1c .
Its important that you dont just accept them telling you that your levels are normal. Make sure that you ask for the actual results. The normal range for fasting blood glucose is 3.61-5.50 mmol/L. Your level could be deemed normal even when its 5.49mmol/L. Get the actual figure and then make an informed decision about how normal it actually is.
Here are some more indicators that you should get your levels checked:
How Is Insulin Resistance Diagnosed
Insulin resistance is difficult to diagnose because there isnt routine testing for it, and as long as your pancreas is producing enough insulin to overcome the resistance, you wont have any symptoms.
As theres no single test that can directly diagnose insulin resistance, your healthcare provider will consider several factors when assessing insulin resistance, including your:
- Medical history.
- Test results.
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Why Does Insulin Resistance Happen
Genetic risk factors, environmental risk factors, and lifestyle factors have all been found to contribute to the development of insulin resistance.8
While some people may be genetically more likely to develop insulin resistance, the biggest impact has perhaps come from the change in our food environment in recent decades. Greater availability of cheap, energy-dense food and drinks may have led whole populations to adopt an unhealthy lifestyle, characterized by consumption of high levels of sugar and other refined carbohydrates. These simple carbohydrates are converted into large amounts of glucose that we may not need for energy, often resulting in much of it being stored in our cells or stored as fat.
Scientists have elucidated many mechanisms and pathways that contribute to the development of insulin resistance. Interestingly, although we often think of insulin resistance in terms of the effect of insulin on glucose metabolism, one of the major causes is actually disordered fatty acid metabolism.
Scientific evidence suggests that fatty acids inappropriately accumulate in muscle and liver which then interferes with their cells ability to respond to insulin and take up glucose.9 One of the main questions, therefore, is how do excess fatty acids invade muscle and liver cells?
Preventing Insulin Resistance Problems
If you have prediabetes, you may be able to prevent the condition from developing into diabetes with these health-promoting behaviors:
- Work toward including exercise as a part of your daily routine, preferably getting in 30 minutes at least 5 days a week.
- Try to eat a nutrient-rich, balanced diet as often as possible.
- If you have overweight, consider losing weight even reducing your body weight by just 7 percent can help lower your risk of developing diabetes.
Making health-promoting lifestyle choices is the best way to help get your blood glucose levels in the desired range.
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Insulin Takes Sugar Out Of Your Blood And Stores It In Muscles Fat Cells And The Liver For Later Use
Even though its helpful for your cells to take in blood sugar for energy, they dont need immediate access to that sugar all the time. In fact, insulin will take any extra blood sugar that your cells cant use right away and send it to your muscle cells, fat cells, and liver to be stored for later use. When its stored, the original form of sugar, glucose, becomes another form of sugar known as glycogen.
How To Treat Insulin Resistance
The good news is that there is a lot of lifestyle changes you can make to improve or completely reverse your insulin resistance ultimately lowering your blood sugar levels.
Exercise Exercise is one of the most effective ways to reduce insulin resistance.
Eat a healthy diet Eat a healthy diet full of whole grains, fruits, vegetables, oily fish, nuts and seeds. Avoid having too much processed and sugary foods. You could also try intermittent fasting alternate between periods of fasting and periods of eating. Theres a number of ways to do this so its important to research this method of eating first and speak with a health professional.
Avoid smoking If you smoke, quitting can really help to reduce your insulin resistance.
Get enough sleep
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Theorizing About Insulin Resistance
We could chat quite a while about the physiological role of insulin and insulin resistance, but let me just say a few things. There is clearly some physiological advantage to insulin resistance: it keeps our cells from being literally suffocated with fat. No more sugar can get in, no more fat can be stored.
Another word to introduce into the conversation about blood sugar and insulin is cancer. There’s no blood test that can tell you whether you have cancer, but current cancer research into physiology of solid tumor cancers suggest that they are dependent on insulin-mediated glucose fuel for their development. Insulin is an important stimulant of growth for body tissues, including cancer cells. Insulin and insulin’s big brother are at increased risk for certain cancers. Another good reason to lower insulin resistance and allow your insulin production to calm back down to normal levels.
P: Pressurea: A1cf: Fasting Blood Glucose
Please note, with each of these biomarkers, being free of oral medication to achieve these results is a key piece in understanding how insulin resistant you are. On the checklist, youll see free of oral medication as a checklist item, and one goal is to check that box for every biomarker.
Lets dive in to each of these letters individually:
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How Diet Relates To Prediabetes
There are many factors that increase your risk for prediabetes. Genetics can play a role, especially if diabetes runs in your family. However, other factors play a larger role in the development of disease. Inactivity and having overweight are other potential risk factors.
In prediabetes, sugar from food begins to build up in your bloodstream because insulin cant easily move it into your cells.
People think of carbohydrate as the culprit that causes prediabetes, but the amount and type of carbohydrates consumed in a meal is what influences blood sugar. A diet filled with refined and processed carbohydrates that digest quickly can cause higher spikes in blood sugar.
For most people with prediabetes, the body has a difficult time lowering blood sugar levels after meals. Avoiding blood sugar spikes by watching your carbohydrate intake can help.
When you eat more calories than your body needs, they get stored as fat. This can cause you to gain weight. Body fat, especially around the belly, is linked to insulin resistance. This explains why many people with prediabetes also have overweight.
You cant control all risk factors for prediabetes, but some can be mitigated. Lifestyle changes can help you maintain balanced blood sugar levels and stay within a healthy weight range.
How Insulin Resistance Leads To Diabetes
As insulin resistance develops, your body fights back by producing more insulin. Over months and years, the beta cells in your pancreas that are working so hard to make insulin get worn out and can no longer keep pace with the demand for more and more insulin. Then years after insulin resistance silently began your blood sugar may begin to rise and you may develop prediabetes or type 2 diabetes. You may also develop non-alcoholic fatty liver disease , a growing problem associated with insulin resistance that boosts your risk for liver damage and heart disease. 5
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Preventing & Treating Insulin Resistance
The NIDDK notes that a lack of physical activity can be linked to insulin resistance and prediabetes. The Diabetes Prevention Program , a National Institutes of Health-funded research study, found that people who are at a high risk of developing diabetes could reduce this risk by losing 5% to 7% of their weight through physical activity and a change in diet.
A Registered Dietitian Nutritionist can work with you to create an individualized meal plan to help lower insulin resistance. The meal plan can take into consideration your food preferences, work schedule, weight, health goals, and more. Medicare and most insurance plans cover visits with an RDN. Ask your healthcare professional for a referral, or visit eatright.org to find a dietitian near you.
If your healthcare team recommends increasing physical activity and losing weight, adding a mild-moderate exercise to your routine may help your body improve how it balances blood glucose levels and responds to insulin. Your healthcare team may also recommend a move toward eating healthier to help you lose weight, reverse insulin resistance, and prevent or delay the onset of type 2 diabetes if you currently have prediabetes.
The DPP also reports that taking metformin, a medicine used to treat diabetes, can delay the onset of diabetes. Metformin was found to work best for younger adults, people with obesity, and women with a history of gestational diabetes.
What Are The Clinical Features Of Insulin Resistance
Insulin resistance is associated with a wide variety of clinical presentations. Factors to consider include:
- Obesity, particularly abdominal obesity: obesity can lead to insulin resistance through increased production of free fatty acids and adipocytecytokines, which modulate insulin sensitivity and are pro-inflammatory.
- Abnormal glucose metabolism: this spectrum may range from hyperinsulinaemia with average glucose concentrations, to insulin-dependent type 2 diabetes mellitus requiring large doses of insulin to control blood glucose.
- Metabolic syndrome: the metabolic syndrome is the combination of obesity, hypertension, dyslipidaemia and hyperglycaemia.
- Hyperandrogenism and reproductive abnormalities: women with severe tissue resistance to insulin may present with virilisation, hirsutism, amenorrhoea or infertility often associated with polycystic ovarian syndrome.
- Musculoskeletal changes: some patients report muscle cramps unrelated to exercise.
- Autoimmunity: when insulin resistance is a consequence of autoantibodies, patients may also have other autoimmune disorders, such as systemic lupus erythematosus or systemic sclerosis.
Insulin resistance is thought to induce skin changes through hyperinsulinaemia, which activates insulin growth factor-1 receptors in fibroblasts and keratinocytes and stimulates their proliferation. Hyperinsulinaemia can also influence sex steroid production and increase free testosterone.
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Just Need One Blood Test
The optimal way to diagnose insulin resistance would be to have a biochemically smart little camera inside your blood stream that can watch the insulin failing to bind with insulin receptors on your cells and open the doors for sugar to exit the blood stream and go into your cells. Since that is not going to happen, we make presumptions about insulin resistance from abnormal blood tests showing that insulin levels are inappropriately high.
Our blood sugar is lowest in the morning after an overnight fast. In the fasting state, a normal blood sugar should be ideally be below 90, or at least below 100 mg/dL. A fasting insulin level should be below 5 iU/ml, or ideally below 3 iU/ml. Levels over 10 are worrisome, despite what the so-called normal lab values are.
While you’re having your blood drawn, however, you might want to look at the other tests that can be associated with insulin resistance and raise the level of my concern and hopefully your motivation to change! Such tests look for the often associated increase in cardiovascular disease and include
- standard and sophisticated lipid tests: even the simplest test will tell you whether you have the problematic findings of high triglycerides and low HDL .
- Hemoglobin A1C will estimate what your average blood sugar runs
- Uric acid, fibrinogen and iron levels will tell you how complicated your problem has become, or how healthy you still are. All those tests you want on the low end of the normal range.
How Blood Sugar And Insulin Work In The Body
Whenever you eat food that contains carbohydrates, your blood sugar increases, and elevated blood sugar is very harmful to the body. Its damaging to your organs, tissues, and blood vessels, so the body has to have a mechanism to bring blood sugar back down when it gets elevated. It does this through a hormone called insulin, which is developed in your pancreas and released whenever your body senses that it needs to lower its blood sugar.
The more sugar you eat, the more insulin you need. Many people have an exaggerated insulin response as a result of eating too many simple carbohydrates. When the pancreas shoots out too much insulin, you can end up with hypoglycemia, which is low blood sugar.
What are simple carbohydrates?
There are two categories of carbohydrates that convert to sugar in your body: simple carbs and complex carbs.
Complex carbohydrates are the good ones because they include nutrients such as fiber, which slows the breakdown of the carbs in your body and results in less of an effect on blood sugar. Fiber also feeds the good gut bacteria, which play an important role in balancing blood sugar levels!
Simple carbohydrates, on the other hand, have been stripped of nutrients and fiber. They have larger amounts of sugar molecules arranged in really simple structures. This means they break down easily into sugar that absorbs directly into your bloodstream.
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