April 17, 2015

Insulin Resistance – Part 1

Many do not consider this a diabetes complication, but I am including it as one.  Diabetes and insulin resistance are well linked and generally, insulin resistance precedes diabetes or metabolic syndrome. You can prevent or stop insulin resistance in its tracks by being physically active, losing extra pounds, and, in some cases, taking the prescription drug metformin.

If you have insulin resistance, your body doesn't respond as well as it should to the insulin it makes. That leaves your blood glucose levels higher than they should be. As a result, your pancreas has to make more insulin to manage your blood glucose.

Insulin resistance is a condition in which the cells of the body become resistant to the hormone insulin.
  • Insulin resistance may be part of the metabolic syndrome, and it has been associated with higher risk of developing heart disease.
  • Insulin resistance precedes the development of type 2 diabetes.
  • Insulin resistance is associated with other medical conditions, including fatty liver, arteriosclerosis, acanthosis nigricans, skin tags, and reproductive abnormalities in women.
  • Individuals are more likely to have insulin resistance if they have any of several associated medical conditions. They also are more likely to be insulin resistant if obese or of Latino, African-American, Native American, or Asian-American heritage.
  • While there are genetic risk factors, insulin resistance can be managed with diet, exercise, and proper medication.
You may also have heard of "insulin resistance syndrome," as being called metabolic syndrome. It includes:
  • Waist size of 40 inches or more in men and 35 inches or more in women.
  • High levels of triglycerides (a type of fat in the blood): Your levels are 150 units or higher, or you're taking medicine to control your triglycerides.
  • Low levels of "good" (HDL) cholesterol: Less than 40 units for men and less than 50 units for women.
  • High blood pressure: Your blood pressure is 130/85 or higher, or you're taking medicine to treat high BP.
  • Blood glucose levels that are above normal: Your fasting blood glucose levels are 100 mg/dl or above, or you're taking medicine to treat high blood glucose levels.
  • Pregnancy is also a cause in insulin resistance
  • Infection or severe illness promotes insulin resistance
  • Stress also promotes insulin resistance
  • Inactivity and excess weight will activate insulin resistance
  • During steroid use insulin resistance rises to the extreme
You can't tell that you have insulin resistance by how you feel. You'd need to get a blood glucose meter that checks your blood glucose levels. Likewise, you wouldn't know if you have most of the other conditions that are part of insulin resistance syndrome (high blood pressure, low "good" cholesterol levels, and high triglycerides) without seeing your doctor.

If you already have insulin resistance, you can take actions that will help your health.
  • Exercise. Go for at least 30 minutes a day of moderate activity (like brisk walking) 5 or more days a week. If you're not active now, work up to that if you are medically able.
  • Get to a healthy weight. If you're not sure what you should weigh or how to reach a weight loss goal, ask your doctor. You may also want to talk with a nutritionist and a certified personal trainer.
  • Eat a healthy diet. Think fruits, vegetables, nuts, beans, fish, legumes, and other protein.
Some people with insulin resistance may also need to take the prescription drug metformin to help control it.

Warning: Another source says this - Thiazolidinediones (TZDs) comprise another class of diabetes drugs which increase sensitivity to insulin, including pioglitazone (Actos) and rosiglitazone (Avandia). These medications are no longer used routinely, in part because of liver toxicity that requires monitoring of liver blood tests. This class of diabetes drugs is known for increasing or causing weight increase.

The person's body may not be producing enough insulin to meet their needs, so some glucose can't get into the cells. Glucose remains in the bloodstream, causing high blood glucose levels. In many cases, the person may actually be producing more insulin than one might reasonably expect that person to need to convert the amount of food they've eaten at a meal into energy. Their pancreas is actually working overtime to produce more insulin because the body's cells are resistant to the effects of insulin. Basically, the cells, despite the presence of insulin in the bloodstream, don't become unlocked and don't let enough of the glucose in the blood into the cells.

Scientists don't know exactly what causes this insulin resistance, and many expect that there are several different defects in the process of unlocking cells that cause insulin resistance. Medications for type 2 diabetes focus on different parts of this insulin-cell interaction to help improve blood glucose control. Some medications stimulate the pancreas to produce more insulin. Others improve how the body uses insulin by working on this insulin resistance. Physical activity also seems to improve the body's ability to use insulin by decreasing insulin resistance, which is why activity is so important in diabetes management.

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