“Diabetes.” We hear this word and our minds automatically think “too much sugar and too much carbs”. But there is more to having diabetes and prediabetes than just eating excess amounts of sugar and carbs, there is also a component called insulin resistance that plays an important role in this condition.
What is Insulin Resistance?
Insulin is a hormone that is made by the pancreas and its role is to bring glucose (sugar) molecules into the cells for storage to then later be utilized for energy when needed. Our main sources of glucose are either obtained from foods that we consume or from the conversion from fats in the liver when we need energy, which causes a rise in blood glucose levels. This rise results in the pancreas releasing insulin into the blood which later lowers the levels in order to keep it in normal range.
Insulin resistance occurs when the muscles, fat and liver cells do not respond well to insulin and cannot take up the glucose from the blood, therefore causing the pancreas to make more insulin in order to try to push it into the cells. The pancreas can sometimes produce enough insulin to overcome this resistance from the cells, therefore being able to keep levels in range. However, what happens when the pancreas isn’t able to meet the glucose demand anymore?
What are the results of Insulin Resistance?
When the pancreas gets to the point where it can no longer produce enough insulin to accommodate the rising levels of blood glucose, prediabetes is the first thing to occur. Prediabetes is defined as having higher than normal blood glucose level but not yet severe enough to be type 2 diabetes. It is estimated that 96 million American adults (more than 1 in 3) have prediabetes. And of this estimate, more than 80% probably do not even know that they have it. Those with prediabetes should take this seriously as they are at higher risk of developing type 2 diabetes, heart disease, strokes and more.
What are the factors that contribute to insulin resistance?
There are a variety of factors that can cause insulin resistance but the major factors are excess weight and physical inactivity.
- Excess weight. Having excess fat especially around the abdomen and organs, also called visceral fat, can cause insulin resistance. Visceral fat can make hormones and other substances contribute to chronic inflammation in the body. Inflammation actually plays an important role in the development of insulin resistance, type 2 diabetes, heart disease and other chronic conditions.
- Physical Inactivity. Not being physically active on a daily basis has been linked to numerous chronic conditions with insulin resistance and diabetes being the primary ones.
- Other factors.
- Being 45 years or older
- Having a close relative (parent, brother or sister) with type 2 diabetes
- Having gestational diabetes (diabetes during pregnancy) or giving birth to a baby weighing more than 9 pounds
- Having polycystic ovary syndrome (POS)-common female infertility
- Having African American, Hispanic/Latino American, American Indians and Pacific Islander background
How does obesity and chronic inflammation cause insulin resistance?
Inflammation is the body’s way of defending against infections, injuries, and toxins in order to heal itself. However, chaos can happen when our defense system works a little too well and has to work overtime. This leads to chronic inflammation which can wreak havoc on many organs of our body, especially ones that contribute to insulin resistance.
There is no question that obesity is becoming a major issue in today’s society with it being linked to a variety of chronic conditions, such as, diabetes, heart disease and even certain cancers. The proposed mechanism behind obesity causing inflammation is that the adipose tissues (or fat cells) produce a higher than normal amount of immune cells and defense markers which impair insulin communication and therefore helps to further promote insulin resistance.
How can you tell if you have insulin resistance or prediabetes?
Typically there are no major signs or symptoms if someone has insulin resistance or prediabetes. However, some people may present with darkened skin surrounding the armpits or on the back and sides of the neck which is called acanthosis nigricans. Sometimes, people may complain of excess thirst, hunger and urination and will have low energy. But the only way to be certain if someone has prediabetes is to take a blood test to measure both hemoglobin A1C (measures the percentage of glucose molecules on blood cells over the past 3 months) and fasting plasma (or blood) glucose levels. A1C and fasting blood levels for prediabetes will result in 5.7 to 6.4% and 100 to 125 mg/dL, respectively. Anything beyond these levels is indicative of type 2 diabetes and in this case, treatment will need to be started.
Insulin resistance is typically not measured in normal blood panels and is also a bit more complicated. It is best to incorporate several factors in determining if insulin resistance is present. High fasting insulin levels are strong indicators of insulin resistance along with high blood triglycerides, low HDL (good) cholesterol levels and excess belly fat.
Is Insulin Resistance reversible?
The good news about insulin resistance and prediabetes is that they can be reversed. This can be achieved mainly by ensuring that blood glucose levels are within normal range and the pancreas is not having to work overtime to produce high amounts of insulin. One major change that can lower insulin resistance is by getting more physical activity. Exercise can actually make cells more sensitive to insulin which will lower blood glucose levels. This in turn will also help to lose excess fat and weight which will reduce the chances of developing diabetes and other chronic conditions. Aim for at least 30 minutes a day for at least 5 days a week.
Although physical activity is important, another major change that will be needed to reverse insulin resistance and prediabetes is through diet modifications. Some tips on how incorporate this into your normal routine are:
- Cutting out processed foods and drinks that contain refined sugars and carbohydrates, such as cookies, cakes, chips, sodas and juices. (Specifically try to stay away from white refined sugars and carbohydrates such as white rice, pastas and bread).
- Eating more non-starch vegetables, such as dark green leafy vegetables.
- Eating more foods rich in fiber: almonds, black beans and oatmeal.
- Eating more lean proteins: chicken, turkey, fish and low fat diary.
Taking a medication called metformin, typically used in patients with type 2 diabetes, is also another way to help lower insulin resistance and delay diabetes. However, if patients want to actually reverse diabetes, they must also incorporate a healthy diet and physical activity to their daily routine while taking this medication.
Overall insulin resistance might seem like just a mere warning but can lead to a myriad of problems if not promptly corrected. Type 2 diabetes is not the only issue that can occur with insulin resistance. Heart, kidney and other organ diseases can also develop which can lead to further problems with needing to consume many different medications and accruing large healthcare costs as well. With a diet change, an increase in physical activity and the right mindset, insulin resistance can be treated and reversed for good.
*As pharmacists, once we start to have conversations with patients about lifestyle modifications, we can change the healthcare system for good.*
References:
- Zatterale, F., Longo, M., Naderi, J., Raciti, G. A., Desiderio, A., Miele, C., & Beguinot, F. (2020). Chronic adipose tissue inflammation linking obesity to insulin resistance and type 2 diabetes. Frontiers in Physiology, 10. https://doi.org/10.3389/fphys.2019.01607
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