Insulin resistance: What you need to know

The condition called insulin resistance is often confusing to many people.  Some may ask, “is it the same thing as having prediabetes?”  The answer to this no but it certainly does increase the risk of developing prediabetes which could eventually turn into type 2 diabetes.  This is why being aware of and understanding insulin resistance can help you make necessary lifestyle changes turning the situation around or better yet, preventing it to begin with. 

What is insulin?

To fully understand why many individuals have the silent condition of insulin resistance, it is important to have a good understanding of what insulin is. 

Insulin is a hormone made in the pancreas.  Within the pancreas are beta cells responsible for making insulin.  Insulin’s job within our body is to help our muscle, fat, and liver cells absorb glucose, a form of sugar that foods containing carbohydrates break down into. Glucose on its own is unable to go from the bloodstream into the cells of the body.  But insulin is able to unlock the doors to the cells allowing glucose to go from the bloodstream into the cells. 

In people who have neither diabetes or insulin resistance, eating a typical meal will cause blood glucose levels to rise triggering the pancreas to release insulin. The hormone travels through the body and causes fat and muscle cells to absorb excess glucose from the blood for use as energy.  As the cells take up the glucose, blood glucose levels fall and flatten out to a normal range.

What is happening during insulin resistance?

When a person is insulin resistant, the cells of our muscles, fat, and liver are not responding properly to insulin making it hard for glucose to go from the bloodstream into the cells.  People with insulin resistance have built up a tolerance to insulin, making the hormone less effective.  As a result, the body needs higher levels of insulin to help glucose enter the cells.  When this happens, the beta cells in the pancreas which make insulin try their best to keep up with this increased demand for insulin by producing more.  If the beta cells are able to produce enough insulin, then a person’s blood glucose levels stay in a healthy range. 

But over time, the beta cells may struggle to keep up with the body’s increased demand for insulin.  As the insulin resistance gets worse, the pancreatic beta cells that make insulin can wear out to where the pancreas is no longer producing enough insulin to overcome the cells’ resistance.  As this continues to go on, eventually, without enough insulin, excess glucose will build up in the bloodstream precipitating the development of prediabetes and ultimately, type 2 diabetes.

What raises your risk for insulin resistance?

It is somewhat of a mystery as to what causes insulin resistance but scientists are beginning to get a better understanding of how it develops or increases the risk for it.  Here are risk factors that can be at the cause of why a person may develop insulin resistance:

·      Being overweight or obese

·      Being physically inactive

·      Having a parent or sibling with type 2 diabetes

·      Being African American, Hispanic/Latino, American Indian, Asian American, or Pacific Islander

·      Having polycystic ovary syndrome, also called PCOS

·      Having had gestational diabetes or diabetes that develops during pregnancy

·      Having delivered a baby weighing more than 9 pounds

·      Are 45 years of age or older

·      Have had above-normal blood glucose levels

·      Having high blood pressure

·      Having a low HDL (good) cholesterol

·      Having high levels of blood fats called triglycerides

·      Having had heart disease, a stroke, or disease of the blood vessels in your neck or legs

How is it diagnosed?

There is no definitive test to say a person has insulin resistance but a physician can identify people likely to have insulin resistance by taking a detail history, performing a physical examination, and conducting simple lab testing based on individual risk factors.  The more risk factors a person has, the more likely they have insulin resistance. 

Usually, the fasting blood glucose and insulin levels are usually adequate to determine whether insulin resistance and/or diabetes is present.  The exact insulin level for diagnosis varies by assay or by laboratory.  However, a fasting insulin level above the upper quartile in a non-diabetic patient is considered abnormal. 

Usually people with insulin resistance do not have any symptoms.  Generally, your physician will review your risk factors and then consider whether you are likely to have diabetes.  They will want to check your blood glucose levels to see if you might have prediabetes or diabetes. 

How can insulin resistance be prevented?

This is the best question of all to ask.  Luckily, there are many things one can do to prevent their risk of developing insulin resistance.  By making some lifestyle changes, this can go a long way in preventing or even reversing insulin resistance which means you can then avoid being given a diagnosis of prediabetes or of type 2 diabetes.  While it may not be possible to defeat insulin resistance entirely, there are ways to make the body cells more receptive to insulin.  Here are the steps you need to do:

·      Become more physically active.  Exercise dramatically reduces insulin resistance by making the body more sensitive to insulin and building muscle that can absorb glucose.  Become more active by:

·      Getting up and moving at least every 60 minutes throughout the day if you sit for long periods of time. 

·      Take the stairs instead of an elevator. 

·      Walk around while talking on the phone or during TV commercials. 

·      Find an activity you enjoy such as dancing, gardening, or playing with the kids. 

·      Walk everyday working up to at least 30 minutes and add in some strength training too.

·      Lose weight if overweight to obese

·      Eat smaller portions sizes

·      Drink calorie-free beverages such as water instead of regular soda or juices

·      Choose baked, grilled, and steamed foods instead of fried

·      Use a smaller plate – 8” or 9” instead of 10” or 12”

·      Fill half your plate with greens and veggies.  Fill ¼ with meat or other protein, and ¼ with carbs, such as brown rice or whole grain pasta

·      Eat more veggies, whole grains, and fruit

·      Use nonstick pans or cooking sprays

·      Eat small portions of low-calorie, low-fat snacks

·      Ask your doctor about taking certain medications for insulin resistance

·      Even though there are no specifically approved medications to treat insulin resistance, diabetes medications such as metformin and thiazolidinediones, or TZDs,  are insulin sensitizers that can lower blood glucose by reducing insulin resistance.