When Your Body Stops Listening to Insulin

 Before The Sugar Rises

Your Blood sugar may be normal - but is your sugar?  

In the past week, three newly detected diabetics walking into the clinic:

·       Rakesh, a 39-yer-old corporate consultant with a leading MNC who has been on thyroid medication since the past 9 years. Despite his 30-minute morning walks, his abdominal circumference is increasing

·       Nikhil, a 28-year-old busy IT professional with a sedentary lifestyle and poor sleep schedule. Lean but with central obesity (abdominal fat)

·       Megha, a 38-year-old overweight, Call Centre employee with irregular sleep and meal timings and a completely sedentary lifestyle, Add to that, stress; both in her personal and professional life

Actually this diabetes begins much before it is detected. At times, people ignore the warning signs and symptoms (knowingly or unknowingly), while some have no major symptoms. The metabolic changes preceding it may start years earlier. One of the earliest and most important changes is Insulin Resistance. 

So what exactly is Insulin Resistance? This topic deserves a lot more attention than it has because of the increasingly sedentary lifestyles and changing dietary habits. And it is not just a problem of obese people or those with high sugar levels. It can develop even when body weight is normal and blood glucose appears normal even while the body requires progressively more insulin to maintain that normal level. Over time, this stress can lead to prediabetes, fatty liver disease and cardiovascular complications.

This awareness is particularly of importance in India where metabolic disease is increasingly prevalent and can occur even in those with comparatively low BMI.

  Let us first understand what is Insulin and Insulin Resistance

Insulin is a hormone that helps to remove glucose (sugar) from the bloodstream and move it into the cells to be used for energy.

 Why do blood sugar levels rise?

Sometimes, the insulin is no longer effective at transporting glucose into the cells. The body becomes resistant to insulin, particularly the way it functions to keep blood sugar levels within normal range. This is Insulin Resistance. Glucose (sugar) builds up in the bloodstream and causes blood sugar levels to rise. The pancreas then produces more insulin in an effort to reduce glucose, but most of it is ineffective. So the patient may have both high blood sugar and high Insulin levels. Insulin resistance often appears along with or as a component of other metabolic problems, such as diabetes, high blood pressure, high cholesterol, heart disease, and polycystic ovarian syndrome. It often develops long before any of these diseases appear.

 

 Causes of Insulin Resistance

The exact cause of insulin resistance is not known. However, researchers have identified Genes that may increase the likelihood of developing Insulin Resistance and type 2 Diabetes.

·       Ethnicity

·       Lifestyle and

·       Certain medications could also be responsible

·       Smoking

·       High-fat diet

                     Risk Factors of Insulin Resistance

·       Family History of type 2 diabetes

·       History of Gestational Diabetes

·       Polycystic Ovarian Syndrome (PCOS)

·       Obesity (especially abdominal obesity) with a BMI of 30 or more

·       Waist-to-hip ratio or waist circumference in the high-risk range (Central Obesity)

 

 Insulin Resistance Symptoms

There are usually no symptoms. However, severe insulin resistance can cause acanthosis nigricans, which is seen as velvety dark patches of skin, usually around folds, such as the neck, armpits, elbows, knees, knuckles, and groin area. If blood sugar levels are high, the symptoms may be similar to those for type 2 diabetes.

  Clues that Suggest Insulin Resistance

·       Polycystic Ovarian Syndrome (PCOS)

·       Waist-to-hip ratio or Waist Circumference in the high-risk range

·       Elevated Triglycerides

·       Low HDL

·       High Blood Pressure

·       Fatty liver

·       Polycystic Ovarian Syndrome (PCOS)

·       Acanthosis Nigricans

·       Family History of type 2 Diabetes

·        Smoking

·       Aging because we accumulate excess fat around our middle, become less active and lose muscle mass as we age

 Metabolic Syndrome

Insulin Resistance causes blood sugar levels to rise and increases the risk for developing Prediabetes or type 2 Diabetes. When a patient has insulin resistance and three or more of the problems listed below, they are considered to have Metabolic Syndrome (formerly called Syndrome X). Metabolic syndrome is the name given to the combination of risk factors that increases risk for cardiovascular disease and diabetes.

·       Waist circumference of 40 inches or more for men and 35 inches or more for women

·       Triglyceride level 150 mg/dL or higher

·       HDL or ‘good’ cholesterol less than 40 mg/dL for men and less than 50 mg/dL for women

·       Blood pressure of 130/85 or higher

·       Fasting Glucose of 100 mg/dL or higher

 

Insulin Resistance Treatment

There are no FDA-approved medications for Insulin Resistance. The American Diabetes Association recommends the drug Metformin for people who are at very high risk or who have had impaired results for both the fasting glucose and glucose tolerance tests. Insulin resistance and pre-diabetes may be reversed or avoided with lifestyle changes, and these are usually tried first.

·       Moderate physical activity, at least 30 minutes a day for 5 to 7 days per week. Physical activity makes muscle cells more sensitive to insulin.

·       A 5 to 7% weight loss can prevent or delay diabetes by almost 60%. Studies have shown people over the age of 60 could lower their risks by 70% with same amount of weight loss.

·       Eating natural foods high in fiber helps to decrease risk.

 

Hyperinsulinemia (Elevated Insulin levels) leads to:

•  Sodium Retention – this can lead to high BP and hence increased risk of heart disease
• Elevated levels of LDL and Triglyceride – low levels of HDL – increasing risk of heart disease and stroke further increasing risk of heart disease and stroke
• More blood clotting. Can trigger release of compounds in blood that make it clot more readily.
• In women, it leads to increased levels of testosterone – can prompt growth of excess facial and body hair and ovarian cysts that increases chances of uterine cancer and fertility problems
• Weight gain. Insulin stimulates appetite and encourages fat storage.  Excess body fat causes insulin resistance
• Affects memory, learning
• Breathing related sleep disorder or snoring linked to insulin resistance

Note: You can have significant Insulin Resistance but normal fasting glucose and HbA1C. Conversely, a high fasting insulin doesn’t necessarily indicate diabetes