What You Need to Know About Insulin Resistance

The epidemic of diabetes is affecting a significant number of Americans, causing irreversible changes in their bodies that will result in a lifelong battle with a chronic disease. The American Diabetes Association estimates that in the United States alone, 96 million people were living with prediabetes last year, and over 1.4 million Americans were diagnosed with diabetes. One invisible change that often acts as a precursor to diabetes is insulin resistance. While insulin resistance often precedes a diabetes diagnosis, it can be managed and even reversed.

What is insulin?

Insulin, a hormone produced by the pancreas, works by directly binding to our cells. This binding enables cells to absorb glucose from our bloodstream. The effects of insulin vary depending on the specific type of cell it is bound to. In circulating cells, insulin allows glucose to enter for energy utilization. In pancreatic cells, it prevents glucagon release (a process in which your body regulates your glucose levels by increasing glucose in the bloodstream, causing the liver to release stored energy). In muscle cells, insulin aids in the production glycogen and supports protein synthesis, thereby preventing the release of glucose into the bloodstream. Additionally, in fat cells, insulin promotes the accumulation of fat for energy storage and prevents the breakdown of existing fat reserves.

While insulin has a wide range of effects on the body, its primary goal remains the same: to effectively utilize the glucose in our bloodstream. This is accomplished through the synthesis of proteins or the storage of glucose for future use. Without insulin, glucose will continue to circulate in our bloodstream, unutilized.

What is insulin resistance?

Insulin resistance is when our cells no longer appropriately respond to insulin. This results in excess glucose being left in our bloodstream and not properly utilized by our cells. Consequently, our body compensates by producing more insulin to maintain normal bodily functions. When glucose is not being properly utilized by our cells and instead is left circulating through our vasculature, it can become harmful to the body.

Are insulin resistance and diabetes the same thing?

Insulin resistance is often a precursor to diabetes. Prediabetes and diabetes can only be diagnosed with an elevated fasting blood glucose (FBG) level or an elevated hemoglobin A1c. An FBG level of 126 or higher is an indication of diabetes. An A1c greater than 5.7% indicates prediabetes and an A1c greater than 6.4% indicates diabetes. Your doctor can determine your FBG and A1c using a simple blood test.

Insulin resistance directly leads to elevated FBG and A1c because your cells are not correctly responding to insulin, thus unable to take the glucose your cells require from your blood. However, until you reach the threshold for the criteria for diabetes or prediabetes, you will not have a diagnosis. Other conditions, including Cushing’s Disease and steroid use, can predispose someone to insulin resistance as well. Genetics is also a factor that can contribute to prediabetes.

How do I know if I have insulin resistance?

Some tests can be used to look for insulin resistance. A Glucose Tolerance Test (GTT) is a test that screens individuals with a high FBG level which may not register high enough to meet a diagnosis for diabetes or prediabetes. However, this test is not commonly performed in clinical settings. Instead, most clinicians assess insulin resistance by considering the patient’s medical history, conducting a physical exam, and periodic A1c testing. While testing is the only definitive way to determine insulin resistance, there are some associated signs or symptoms that may be indicative of this condition:

1) Weight Gain
Those who are insulin-resistant might experience an increase in weight that is hard to lose.

2) Excessive thirst or frequent urination
The body will naturally try to urinate out the excess glucose in your system.

3) Fatigue
Because the body can’t properly utilize the glucose in your blood for energy, you may feel tired or lethargic without strenuous activity.

4) Acanthosis nigricans
Also known as the darkening of the skin at the folds of the body (particularly the armpits and neck). The skin is classically described as “velvety.”

How can I prevent/reverse insulin resistance?

“Insulin resistance can be a frustrating diagnosis for a patient to tackle,” said board certified physician assistant, John Goodwin of TPMG Coastal Endocrinology. Through education, patients can begin to look for ways to make healthy decisions for their bodies. Taking a proactive approach is essential when dealing with an insulin resistance diagnosis. Catching it early will give you a better chance to halt or reverse insulin resistance. Waiting until a prediabetes or diabetes diagnosis occurs may have lasting consequences.

Lifestyle modifications are the most effective way to prevent or reverse insulin resistance. If you’re struggling with insulin resistance or worried you may develop insulin resistance, try these lifestyle changes:

• Get Active
Exercise can drastically reduce your insulin resistance. Building muscle mass can also help your body absorb blood glucose, helping your muscle cells take in glucose from the bloodstream and initiate protein synthesis.

• Eat Healthy
A diet that promotes complex carbohydrates, such as brown rice, whole grains, sweet potatoes, and quinoa. Complex carbohydrates take longer for the body to digest, which lowers the amount of glucose that enters the bloodstream at once.
Some medications like Metformin or GLP1  receptor agonists (such as Trulicity, Ozempic, Mounjaro) help to increase cells’ sensitivity to insulin. Talk with your primary care provider to see if you may be a good candidate for these medications.

Small decisions have the potential to lead to significant changes over time. Choosing to go for a daily walk can help the body to utilize the excess glucose in the bloodstream. Choosing a glass of water over a can of soda can drastically reduce the carbohydrates in your bloodstream. Little, everyday lifestyle changes will eventually add up to healthy living. If you’re looking to reduce your insulin resistance, don’t delay. Be proactive today by scheduling an appointment to talk to a provider about your health.

John Goodwin, Endocrinology Physician Assistant in Virginia Beach VA

About John Goodwin, PA-C

John Goodwin, PA-C is a board-certified physician assistant with TPMG Coastal Endocrinology in Virginia Beach. As a provider who also has type 1 diabetes, John has a unique understanding and empathy for the challenges faced by his patients with chronic conditions. He is a proponent of adjusting care to the lives of his patients and believes that a series of small, healthy choices can add up to a meaningful impact on patients’ lives.

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