Dr. Damon Tanton, Medical Director of Clinical Practice for the Florida Hospital Diabetes Institute and Florida Diabetes and Endocrine Center, explains insulin resistance and the importance of early diagnosis and treatment.
Do you have difficulty losing abdominal fat? Do you crave sweets and carbohydrates on a daily basis? Do you feel sleepy after eating, or shaky when you go without food for several hours? Do any of your first-degree relatives (parents, siblings, children) have diabetes or escalating levels of central obesity? If you answered “yes” to one or more of these questions, there’s a high probability that you’re one of the 80 million Americans with insulin resistance, also known as pre-diabetes.
What is insulin? How does it work?
Insulin is, by its very nature, an anabolic hormone. This means its primary job is to build and store. It’s important to the body because it allows blood sugar (or glucose) to get into your cells and provide us with the energy that we need for everything we do – from exercising to thinking to working.
What is insulin resistance?
Insulin resistance occurs when your body becomes less able to use the insulin produced by your pancreas. Once your body is unable to compensate completely, your glucose levels become elevated and diabetes ensues. Insulin resistance develops in at least one out of every three American adults.
What are the effects of insulin resistance?
Unfortunately, for most Americans, the principal effect of high insulin is the storage of fat (central adiposity). Simply put, the higher your circulating insulin levels, the higher your chances of developing the dreaded “tire” around your midsection.
Insulin also plays a central role in all of the components of the metabolic syndrome, namely elevated fasting glucose, high blood pressure, high triglycerides, low HDL (good) cholesterol and increased waist circumference. High insulin levels also contribute to elevated testosterone levels and irregular menstruation in women (PCOS), low testosterone levels (hypogonadism) in men and low blood sugar (hypoglycemia). Insulin resistance has even been linked to many forms of cancer!
How can insulin resistance be identified?
The best way to diagnose insulin resistance, or pre-diabetes, is to actually measure insulin in the blood (normal fasting level is < 5 uIU/ml). Other helpful laboratory measurements include fasting glucose (normal < 100 mg/dl), HgbA1c (three month average of glucose levels; normal < 5.7%), and 1,5-AG (which approximates glucose peaks over the past two weeks). Finally, a darkening of the skin creases in the neck, armpits and/or groin (so-called acanthosis nigricans) is a reliable clinical sign of insulin overproduction.
Can insulin resistance be treated?
Fortunately, high insulin levels can be normalized with lifestyle optimization (Low Glycemic Load Diet and exercise as tolerated) and may or may not include a medication called metformin. By aggressively treating at this early stage, you can prevent, or at least postpone, the progression to diabetes.