Paul Kolodzik, MD, FACEP, FASAM
Medical Director – Midwest Metabolic MD
Founding Member – Society of Metabolic Health Physician
There is more discussion then there has ever been in the medical field, among health enthusiasts and dieters, on the internet, and even on TV about “insulin resistance”. As the epidemic of obesity and diabetes has progressed in the United States in recent years, the real underlying reason for these health conditions, and the vascular diseases they cause, is finally getting its due recognition. The culprit is insulin resistance. Insulin resistance is the forerunner of prediabetes and diabetes, and in most cases can be stopped dead in it’s tracks with proper testing, medical guidance, and diet. Prediabetes can be eradicated, diabetes can be delayed or put in remission, pounds come off, and metabolic health restored by assessing, confronting, and reversing insulin resistance.
What is Insulin Resistance?
Insulin resistance occurs when the cells in the organs of your body (for example your muscles, fat, and liver) become less effective at removing sugar (glucose) from your blood. The pancreas is the organ in your body that makes insulin. When blood glucose levels in the body rise from excessive sugar and carbohydrate intake, your muscles, fat, and liver, etc. can’t absorb all the glucose in your blood. The pancreas makes and releases more insulin in an attempt to help the organs remove the excess glucose from the blood. This pancreatic response leads to higher insulin levels in your blood and is called insulin resistance. However, over time, the insulin receptors on the organs also become progressively less sensitive to the insulin being released, causing both the insulin level to rise further, and blood glucose to rise. The result is progressively increased blood glucose, then prediabetes, and eventually diabetes. High blood glucose levels then damage the inner lining of blood vessels, ultimately leading to such problems as heart disease, congestive heath failure, kidney disease, blindness, peripheral vascular disease, dementia, and stroke.
This feedback loop (the organs requiring more and more insulin, the pancreas trying to produce more and more insulin) is why diabetics require insulin injections. The pancreas’s ability to produce more “endogenous” insulin reaches a ceiling. Consequently “exogenous” insulin, (insulin shots) are required or else blood glucose will rise to life- threatening levels. Sometimes the pancreas becomes irreparably exhausted and “burns out” (becomes scarred down) from its long-term attempts to make lots of insulin. Then the pancreas contributes very little or even no inulin to the effort. A person in this position becomes 100% dependent on administered exogenous inulin.
How can I find out if I have insulin resistance?
Insulin resistance can be assessed in anyone with simple blood tests. These blood tests are then used in a calculation to determine the current level of insulin resistance in a person. Unfortunately, most primary care physicians are not familiar with how to perform this testing or calculation. Instead, they utilize a simple fasting blood glucose, usually once a year, as a measure of insulin resistance. The usual fasting blood glucose level accepted as normal is 100mg/dl, which is also the cutoff level for prediabetes. However, insulin resistance can be present with fasting blood glucose levels as low as 85 mg/dl, or even lower. There is no way to know if insulin resistance is present using the routine once a year testing of fasting blood sugar, until it is to late, and prediabetes is already present.
So, insulin resistance can be present for years prior to the time a fasting blood glucose picks up its presence. In fact, insulin resistance can be detected up to 8 to 10 years before the onset of prediabetes. This information can then be used to reverse insulin resistance, prevent prediabetes, and eliminate the possibility of diabetes in most patients. If you are overweight or have prediabetes or diabetes in your family, even if your fasting blood glucose is in what is considered a “normal range”, you are at risk for the presence of insulin resistance and prediabetes, and eventually diabetes.
If I Have of Insulin Resistance, What Can I Do About It?
Insulin resistance is reversed with focused medical guidance, dietary changes, and frequent monitoring of insulin resistance levels and other metabolic health parameters. At times, medications may be helpful, but the first line of treatment is medical monitoring, medical management, and dietary changes. The use of a continuous glucose monitoring (CGM) can be of great help in monitoring progress. This is because blood glucose levels reflect corresponding levels of insulin resistance. If a patient is making progress in lowering their average blood glucose levels, and reducing post meal blood glucose spikes, they are also reducing insulin resistance. We have found that the use of a CGM, associated with remote physician/nutritionist monitoring of blood glucose levels is tremendously helpful in achieving diet modification, and in turn reducing blood glucose and insulin levels.
In addition to Insulin resistance can be present many years before prediabetes is diagnosed, early management of actual prediabetes is sometimes not addressed by patients or physicians. This is because many patients do not know they are prediabetic. The Center for Disease Control estimates that up to 80% of prediabetics don’t know they are prediabetic. And currently in the US, one in three adults are prediabetic. That is 88 million people, and nearly 70 million do not know they are prediabetic. Knowing you have insulin resistance (or finding out you are prediabetic) early on presents a great opportunity to prevent progression to diabetes and eventual diabetic complications.
What Are The Real-Time And Future Benefits of Reversing Insulin Resistance?
I’ve mentioned that an early recognition of insulin resistance, and taking action to eliminate it, can make a world of difference for a person in terms of getting healthy and preventing prediabetes, and ultimately, diabetes. And, of course, preventing diabetes means a much higher likelihood of avoiding heart disease, congestive heath failure, kidney disease, blindness, peripheral vascular disease, dementia, and stroke as a person ages.
Insulin resistance almost inevitably leads to prediabetes if not managed proactively. Up to 30 % of people with prediabetes developed diabetes within 5 years. That risk increases 10% every year after the first five years. This means that around 80% of prediabetics, without intervention, will be full blown diabetics within 10 years. Remember, however, that progression from prediabetes to diabetes is not inevitable. If insulin resistance is reversed, prediabetes can be cured, and the risk of progression to diabetes eliminated in a vast majority of patients.
But what does reversing insulin resistance do for patients in the short term? The benefits are multiple. Weight loss almost always occurs when insulin resistance is reduced. Endogenous inulin levels fall, and the body begins to burn fat instead of blood glucose for fuel. Weight fist comes off around the middle of the body – in the abdominal and hip areas. This allows patients to achieve significant weight loss. We have had patients in our practice lose up to 60 pounds in their first six months of treatment.
But weight loss is not the only benefit. When insulin resistance falls, so do cholesterol and triglyceride levels. Hypertension is frequently reduced or eliminated. Patients can often come off their cholesterol and blood pressure medications. Diabetics can sometimes reduce or eliminate altogether their diabetic medications, as insulin resistance reduction can put diabetes in remission. (Note, however, that diabetes is not cured, it is put in remission for long periods of time, up to many years.) Prediabetes, on the other hand can be permanently reversed.
Finally, patients almost universally experience higher levels of energy with in several weeks of dietary changes. Increased mental clarity accompanies this increase in energy, as spikes and plunges in blood glucose (called reactive hypoglycemia) are eliminated.
How Do I Learn More About Insulin Resistance, If I Have It, And What To Do About It?
As we mentioned at the beginning of this discussion, there is an increasing amount of information available (Internet, books) on insulin resistance. However, finding a primary care medical provider who is knowledgeable on this subject may not be that easy. Fortunately, a little personal research and sitting down with a physician who is knowledgeable regarding insulin resistance, metabolic health, and the use a CGMs can be very beneficial. It may even be life changing from the perspective of eliminating the risk of diabetes and the eventual complications of diabetes. This, and the more short-term benefits of losing weight, reversing current medical problems and just feeling and thinking better can make the effort of finding a physician knowledgeable about insulin resistance very worthwhile. There is not a lot to lose . . . except more than a few pounds and the risk of serious disease.