Insulin resistance

by Dr Fatma Almarashi on Sunday, 23 November 2008

Insulin resistance is a condition in which your fat, muscle and liver cells have stopped responding to normal amounts of insulin.

This causes increased levels of glucose and insulin in the blood. High levels of insulin and glucose in the blood often lead to metabolic syndrome and type 2 diabetes.

Symptoms of insulin resistance

1. Fatigue.

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2. Brain fogginess and inability to focus Sometimes the fatigue is physical, but often it's mental.

3. Low blood sugar Mild, brief periods of low blood sugar are normal during the day, especially if meals aren't eaten on a regular schedule. Prolonged hypoglycaemia, with symptoms of physical and mental fatigue, isn't normal. Feeling agitated, jittery, moody, nauseous, or having a headache is common in insulin resistance, but this is usually relieved when food is eaten.

4. Intestinal bloating Most intestinal gas is produced from carbohydrates in the diet. Insulin resistance sufferers who eat carbohydrates sometimes suffer from gas.

5. Sleepiness Many people with insulin resistance get sleepy immediately after eating a meal consisting of over 20% or 30% carbohydrates.

6. Weight gain, fat storage, difficulty losing weight The fat in insulin resistance is generally stored in and around abdominal organs in men and women. It's currently suspected that hormonal effects from such fat contribute to causing insulin resistance.

7. High blood triglyceride levels.

8. High blood pressure Many people with high blood pressure are either diabetic or pre-diabetic and have high insulin levels due to insulin resistance.

9. Depression Because of the disrupted metabolism resulting from insulin resistance, psychological effects are common. Depression is said to be the main psychological symptom.

Causes of insulin resistance

1. High-carbohydrate diet Researchers believe that insulin resistance is linked to consumption of a high-carbohydrate diet.

2. Sugar High amounts of sucrose (table sugar) in the diet is also believed to contribute to the development of insulin resistance.

3.Glucosamine A US study has shown that glucosamine (often prescribed for joint problems) may cause insulin resistance.

4. PCOS Insulin resistance has also been linked to polycystic ovarian syndrome (PCOS) - either causing it or being caused by it.

5. Fructose Studies have shown that consuming high amounts of fructose (eg, fruit sugar, also found in "high fructose corn syrup" on manufactured food labels), causes changes in blood lipid profiles, which leads to weight gain and insulin resistance.

6. Genes Sharply increased rates of insulin resistance and type 2 diabetes are found in those with close relatives who have developed type 2 diabetes.

7. Lack of exercise In this day and age many people are physically inactive. Most of their time is spent on computers, or watching TV, which all leads to weight gain and insulin resistance.

8. Weight gain from decreased activity and improper eating behaviour, and sometimes caused by having inherited genes that can lead to obesity, is one of the main causes of insulin resistance or metabolic syndrome.

Do you have insulin resistance or pre-diabetes?

If you're overweight and aged 45 or older, it's strongly recommended that you get tested. You should also consider getting tested if you're younger than 45, overweight, and have one or more of the following risk factors:

• A family history of diabetes.

• Low HDL cholesterol and high triglycerides.

• High blood pressure.

• A history of gestational diabetes (diabetes during pregnancy) or gave birth to a baby weighing over 9lb.

• Your origins are Asian (Arab, Persian, Indian, Pakistan), Hispanic American/ Latino, Asian American, or African.

Can you reverse insulin resistance?

Yes. Exercise and weight loss make the body respond better to insulin. By losing weight and being more physically active, you may avoid developing type 2 diabetes. In fact, a major study has verified the benefits of healthy lifestyle changes and weight loss.

In 2001, the National Institutes of Health completed a study called the Diabetes Prevention Program, which found that lifestyle changes reduced the risk of diabetes by 58%. Also, many people with pre-diabetes returned to normal blood glucose levels.

The main goal in treating insulin resistance and pre-diabetes is to help your body relearn to use insulin normally. You can do several things to help reach this goal:

3 ways to reverse insulin resistance

• Exercise & eat well

Exercise helps your muscle cells use up the glucose in the blood because they need it for energy - and it makes your cells more sensitive to insulin.

The Diabetes Prevention Program confirmed that people who follow a low-fat, low-calorie diet and who walk briskly or ride a bike for 30 minutes, 5 times a week, have a far lower risk of developing diabetes than people who don't exercise regularly.

• Lose weight

The Diabetes Prevention Program also found that people who lost weight were far less likely to develop diabetes than those who kept an unhealthy weight. So if you have metabolic syndrome or insulin resistance, your doctor may recommend a weight-loss diet and exercise.

• Stop smoking

Smoking contributes to insulin resistance.

Quitting isn't easy, but it would help you reduce your risk for respiratory problems, lung cancer, and diabetes.

Additional risk factors

Insulin resistance is often found in people who also have some of the following conditions, which places them at high risk for heart disease:

• A high degree of fat beneath their abdominal muscle wall.

• High blood pressure.

• High blood sugar (hyperglycaemia) and high levels of fat in the blood (dyslipidaemia).

• Small dense, low-density lipoprotein particles. These are small particles of the "bad" type of cholesterol (LDL) that can penetrate the walls of the arteries. The blood levels of LDL might be within the normal range but the size of these molecules is a problem.

• Decreased HDL ("good") cholesterol levels.

• An abnormally high tendency toward blood clotting.

Treatment recommendations

It's recommended that doctors treat the components of insulin resistance individually. So while advising you how to reverse your insulin resistance, your doctor may treat you for high blood pressure and bad cholesterol as well, if you have those conditions.

This is because people with insulin resistance have a 2-fold increased risk for a cardiovascular event while people with diabetes have a 3-fold increased risk for a cardiovascular event.

Dr Fatma Almarashi, MD, F.A.C.E., American Board-certified Diplomate in Endocrinology, Diabetes and Metabolism, Medical Director, University Hospital.

What is insulin resistance?

Your body breaks carbohydrates down into sugar (glucose), which then enters your bloodstream. The more carbohydrates you eat, the higher your blood sugar rises. In return, your body produces insulin. Insulin's job is to push the blood sugar into your cells so that it can be metabolised and turned into energy. An inability to metabolise sugar is the result of having insulin resistance - and it's one of the reasons why people with insulin resistance often feel tired.

On the surface of your body's cells are insulin "receptors", which act like "doors" that open and close to manage the incoming blood sugar. If you eat a high carbohydrate diet for many years, your cells receive so much insulin that these receptors eventually stop working and shut down. With fewer receptors available, your body needs to produce even more insulin to push the glucose into the cells. More insulin causes even more receptors to close and as this cycle continues, a condition called "insulin resistance" occurs.

When your body can finally no longer produce enough insulin to push the blood sugar into the cells, type 2 diabetes develops. The solution to your condition is to find a way to increase the sensitivity of your cells to insulin and help your body get the sugar out of the blood and into the cells, so it can be metabolised and turned into energy.

Summary

• Glucose is the main source of energy for the body's cells.

• Insulin helps cells absorb glucose and convert it to energy.

• If you're insulin resistant, your body's cells don't respond well to insulin.

• Insulin resistance is a stepping-stone to type 2 diabetes.

• Lack of exercise and excess weight contribute to insulin resistance, while moderate exercise and keeping a healthy weight can help prevent it.

• Insulin resistance can lead to the development of cardio-vascular disease.

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