Insulin Resistance

I nsulin resistance is when the cells in your muscles and liver which should normally be “friendly” and inviting towards insulin start leaving insulin on “read”--no matter how many times the cells are nudged by insulin, they continue clearing glucose very slowly, if at all, from the blood. This results in persistently elevated blood glucose levels which has widespread effects on the whole body. 

This could initially manifest as a prediabetic state in your body and then go on to result in Diabetes Mellitus. 

Who’s at risk?

• Those with a family history of diabetes
• Those with a high BMI
• Those with central obesity (waist size 40 inches or more for men and 35 inches or more for women)
• Those with syndrome X/metabolic disorder
• Those with a family history of syndrome X/metabolic disorder
• Those belonging to Asian American ethnicity 
• People with PCOS 
• Those taking corticosteroids for long periods
• Those with Cushing Syndrome/or family history of Cushing Syndrome
• Those with hypertension

Most Reported Symptoms of Insulin Resistance

Extreme thirst and extreme hunger

In insulin resistance, glucose cannot be transported to hungry cells effectively because cells no longer respond to insulin and cannot consume glucose to produce energy. This makes cells send nerve impulses to the hypothalamus which is the part of the brain responsible for making us feel “hungry”. 

Patients with insulin resistance feel hungry as a result, which is one of the earliest symptoms of the disease.

Increased urination

As the glucose levels rise in the extracellular compartment of the body, there is another imbalance that comes into play. The water content outside and inside the cells becomes unequally distributed. Due to a higher concentration of glucose outside the cells, water gets drawn out of cells, leaving them dehydrated and “thirsty”.

Urinary frequency increases because kidneys now have to work harder to remove the excess water from the extracellular compartment. This starts initially with increased urination at night(nocturia) and then goes on to polyuria during the daytime.

“Pins and needles” sensation in hands and feet

This is one of the signs that appear in those who have had insulin resistance for a long period of time as it involves the impairment of nerves. This symptom correlates with the term “Diabetic Neuropathy” and while it happens in insulin resistance, it may not be the first symptom caught by the patient. 

This usually presents in patients who have never been tested for Diabetes and living with the disease for many years before presenting with this complaint or in patients who know they have Diabetes when it is time to reevaluate and increase medication dosage to have the same level of glycemic control. 

Prevention 

• Aerobic exercise at least 30 minutes every day 

Among the most effective methods to control hypertension as well as increase insulin sensitivity is brisk walking 30 minutes every day. 

• Lifestyle modification to an active lifestyle

Many people are reluctant to exercise because they can’t take out time separately for it. Just as effective as exercise is making sure you build a lifestyle that pushes you to be active rather than sedentary. 

• Weight loss/BMI reduction

This is the quickest way to increase insulin sensitivity in the body. Accumulation of fat and deranged BMI causes not just poor cellular response to high insulin levels but also decreases insulin production from the pancreas. 

• Intermittent fasting

The effects of intermittent fasting on increasing insulin receptors in the body are well researched. Having an early dinner and late breakfast can automatically help you switch your body to intermittent fasting. It’s an easy hack for those who can’t keep their hands off food during wake hours.

• Reduce stress-inducing factors

Stress releases cortisol in the body which is known to cause weight gain and insulin resistance. As cortisol is also made when you take oral corticosteroids; it has the same effect on increasing insulin resistance. Eliminating things that cause you stress, or taking stress management therapy are effective ways of preventing Diabetes.   

• Replace sugar with zero-calorie sweeteners 

While carbohydrates are an essential part of the diet due to their role in providing energy; eating natural sources of carbohydrates, especially low glycemic index foods is an effective way to reduce chances of diabetes in the future. 

Replacing sugar in desserts and beverages with zero-calorie sweeteners like Candrell, Splenda or Equal has also proven to be beneficial.

Diagnosis of Prediabetes and Diabetes 

No single test can confirm the diagnosis for insulin resistance syndrome but if advances to prediabetic stage or diabetic then a diagnosis can be made through the following tests:

• Fasting Blood Glucose 
• HbA1C
• Plasma Glucose Level or OGTT
• Random plasma glucose

In a nutshell, the incidence of insulin resistance is on the rise with a greater number of people being diagnosed with diabetes every year. Insulin resistance is a syndrome that may last for a short while, progress to diabetes, or remain as simple “insulin resistance” that may or may not advance to a more critical disease.