Insulin resistance is a growing public health concern that affects a significant portion of the adult population. There’s also a lot of misinformation about insulin resistance, especially on social media.
Here’s the straight story on insulin resistance, what it is, how it affects us, and what we can do about it.
What is Insulin resistance?
Insulin resistance occurs when the body’s cells become less responsive to the effects of insulin. Insulin is a hormone produced by the pancreas, and its primary role is to regulate blood sugar levels.
When you eat foods that contain carbohydrates, your body breaks them down into glucose (sugar). The pancreas releases insulin to help move that glucose into your cells so you can use it for energy. It also signals the liver to store glucose for later use.
When our body’s cells become resistant to insulin, the pancreas has to pump out more to help get the glucose into your cells. If your pancreas can continue to release insulin, your blood sugar levels will remain normal. At some point though, it won’t be able to keep up, and then blood sugars will increase. This can eventually lead to type II diabetes and other serious medical conditions. Some people may have insulin resistance for years before diabetes is diagnosed.
Insulin resistance signs and symptoms
Insulin resistance can affect our health before it’s diagnosed, some people may not have any symptoms. However, if you have prediabetes or type II diabetes, you also have insulin resistance. Insulin resistance is a hallmark characteristic of type II diabetes.
Here are some common indicators of insulin resistance:
Elevated blood sugar levels: Increased thirst, frequent urination, unexplained hunger, blurred vision, and persistent fatigue can be signs of high blood sugar. If you have these, you should see your doctor and they can test you for diabetes.
Skin Tags: These are small, benign growths that can develop in skin fold areas of the body. Skin tags may be an external indicator of insulin resistance, and have been associated with impaired glucose tolerance and diabetes.
Acanthosis Nigerians: This condition is characterized by dark, thick, patches of skin, typically appearing on the neck and armpits.
Other Medical Complications: Insulin resistance is often accompanied by other health issues, including Polycystic Ovary Syndrome (PCOS), nonalcoholic fatty liver disease, and prediabetes. Addressing insulin resistance can have a positive impact on managing these related conditions.
PCOS continues to be a hot topic on social media. Not everyone with PCOS is overweight, however, if you are, weight loss can help improve insulin resistance. There is also no “best” diet for PCOS however a lower glycemic index diet may help (think higher fibre, slower digesting carbohydrates such as beans and lentils and whole grains), getting enough protein, and including healthy fats.
How to eat with PCOS? Read about it here.
What does insulin resistance do to our bodies?
The most well-known consequence of insulin resistance is type 2 diabetes.
Type 2 diabetes can lead to a variety of serious health conditions including heart disease and stroke, kidney failure, eye damage, and nerve damage. The best way to help reduce the risk of these is to keep your blood sugar within a healthy range.
What causes insulin resistance?
There are several causes of insulin resistance, some we can control and others we can’t:
Diet: diets high in unhealthy fats (such as saturated and trans fat), refined carbohydrates, and added sugar are associated with insulin resistance, although this may be due to an association with a highly refined diet and excess weight.
High blood triglycerides are often associated with insulin resistance and can damage the cells of the pancreas. Diets high in refined carbohydrates are often a cause of high triglycerides.
Obesity, Excess Visceral and Ectopic Fat: Accumulation of excess visceral fat (fat around the abdominal region and internal organs) and ectopic fat (fat stored in abnormal locations, such as around the liver) is strongly linked to insulin resistance. Fat tissues in the abdominal region release inflammatory signals that interfere with insulin signaling and contribute to resistance.
Sedentary lifestyle: lack of physical activity can contribute to insulin resistance. Being active helps your body use glucose and reduces the risk of insulin resistance.
Aging: as we age, our cells gradually become less responsive to insulin and thus are at risk for insulin resistance.
Sleep deprivation: not getting enough sleep or having poor sleep quality has been associated with insulin resistance. This may be due to changes in hormones that regulate our appetite and metabolism, which are impacted by sleep. I’ve written about sleep and nutrition here.
Genetics: Genetic factors play a role in predisposing some individuals to insulin resistance. For instance, the TCF7L2 gene is strongly linked to an increased risk of type 2 diabetes.
Hormonal Changes: Hormones like cortisol and growth hormone can influence insulin sensitivity. Elevated cortisol levels, often associated with illness, some medications, and chronic stress, can contribute to insulin resistance.
Medications: Some medications can induce insulin resistance. These include glucocorticoids, also known as steroids, antipsychotics, and certain antiretroviral drugs. It’s essential to be aware of the potential impact of certain drugs on insulin sensitivity and discuss alternatives with a healthcare provider when necessary.
The Glucose Goddess claims her ‘hacks’ can help with blood glucose spikes. What’s fact, and what’s fiction? Read about it here.
How can I prevent insulin resistance?
Preventing and managing insulin resistance depends on its underlying cause. If it is due to hormonal complications or medications, it’s essential to work closely with a medical doctor to explore potential alterations in treatment. However, for the vast majority of people, insulin resistance is rooted in dietary and lifestyle habits.
Here are some lifestyle changes that can help manage and prevent insulin resistance:
Dietary Changes: Losing weight helps to reduce the impact of free fatty acids in the bloodstream. A 2 year study was done on calorie restriction and found that weight loss can lead to improvements in insulin sensitivity, reductions in inflammatory markers (such as C-reactive protein), weight loss, and better management of lipid profiles and blood pressure.
If you have gained weight recently and have seen your blood glucose rise as a result, reversing that weight loss using a sustainable shift in habits may help. Note: fasting is often touted as the ‘answer’ to insulin resistance. It’s not any more effective than normal calorie restriction.
Regular Exercise: engaging in physical activity helps improve glucose uptake and increases insulin sensitivity. Regular exercise also decreases visceral fat, independent of calorie intake.
Limit Saturated Fat Intake: Consuming high amounts of saturated fat can be harmful to the liver and worsen insulin resistance. A study was done on weight-stable, overweight and obese adults increasing their saturated fat intake. A diet high in fat and saturated fat was found to decrease insulin sensitivity, even without weight gain. Replacing saturated fats with unsaturated fats from sources like avocados, nuts, and olive oil is advisable.
Choose fibre-rich carbohydrates: you don’t need to go low-carb to improve insulin resistance. Instead, focus on choosing carbohydrates that are higher in fibre like whole grains, legumes, and fruits and vegetables. Most people don’t get enough fibre, aim for 25g or more per day. Fibre also helps aid in satiety and appetite regulation, which can make it easier to manage your weight.
Minimize added sugars: Most people eat too much added sugar. Foods high in added sugar are often low in fibre and other nutrients and can lead to weight gain if overconsumed which can lead to insulin resistance.
Sugar itself does not cause diabetes or insulin resistance. The myth that pancreatic beta cells get ‘exhausted’ is unfounded.
Smoking: Smoking increases inflammation and introduces harmful chemicals that can affect insulin function. It also impacts how the body provides nutrients to our tissues.
Optimal Sleep: Ensuring you get enough high-quality sleep is vital. Poor sleep can disrupt hormones that regulate blood sugar and increase insulin resistance.
Manage Stress: Chronic stress can negatively impact insulin resistance. Engage in stress-reduction techniques like reading, yoga, regular workouts, spending time with friends and family, walking, and meditation.
Medications for insulin resistance
Metformin: Metformin is a widely prescribed medication for individuals with insulin resistance and pre-diabetes. It primarily works by increasing peripheral glucose uptake, which means it helps your cells use glucose more effectively. Metformin also reduces hepatic (liver) glucose production. It’s often the first-line treatment for those at risk of or with type 2 diabetes.
GLP-1 Agonists: Glucagon-like peptide-1 (GLP-1) agonists are a class of medications that can be used to treat insulin resistance. They work by mimicking the effects of GLP-1, a hormone that stimulates insulin secretion, inhibits glucagon production (which raises blood sugar), and slows down stomach emptying. These actions help regulate blood sugar levels. GLP-1 agonists are usually administered via injection.
Berberine: Berberine is a natural supplement derived from certain plants, and some studies suggest it may have a positive impact on insulin sensitivity. It was found that berberine may effectively regulate blood glucose and reduce insulin resistance and inflammatory responses.
Supplementation with berberine has been reported to cause some gastrointestinal side effects in some people. This includes diarrhea, constipation, and stomach pain. In addition to GI discomfort berberine may inhibit several enzymes involved in drug metabolism, so there can be risk of drug interactions when taken with other medications or supplements. More long term studies are needed to evluate the safety and efficacy of berberine.
However, it’s important to talk to your doctor before trying any new medications or supplements, including berberine, to ensure it’s safe and appropriate for your specific situation.
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What is insulin resistance, bottom line:
Insulin resistance is a growing problem that can be attributed in large part to an unhealthy lifestyle. Prevention is always the best course of action. Having a healthy lifestyle with a balanced diet, regular physical activity, not smoking, and managing stress is the best thing you can do to prevent insulin resistance.