Do you have difficulty losing abdominal fat? Do you crave sweets and carbohydrates on a daily basis? Do you feel sleepy after eating, or shaky when you go without food for several hours? Do any of your first-degree relatives (parents, siblings, children) have diabetes or escalating levels of central obesity? If you answered “yes” to one or more of these questions, there’s a high probability that you’re one of the 80 million Americans with insulin resistance, also known as pre-diabetes.
What is insulin? How does it work?
Insulin is, by its very nature, an anabolic hormone. This means its primary job is to build and store. It’s important to the body because it allows blood sugar (or glucose) to get into your cells and provide them with energy. When we eat, our bodies break down food into glucose in the small intestine.
Glucose travels through the bloodstream looking for cells that need energy. To get inside those cells, insulin is needed. It’s the key that unlocks your cells so glucose can get inside and deliver energy. When it arrives, it tells the cells to activate transporters that pull the glucose through cell walls. When the glucose moves into the cells, it creates energy that we need for everything we do – from exercising to thinking to working.
What is insulin resistance?
Insulin resistance occurs when your body becomes less able to use the insulin produced by your pancreas. When glucose moves into your bloodstream, your pancreas matches it with the right amount.
This “resistance” means although there may be insulin in the blood stream, it’s not enough to unlock the cells and even more insulin is required to maintain normal glucose levels. Once your body is unable to compensate completely, your glucose levels become elevated and diabetes ensues. Insulin resistance develops in at least one out of every three American adults.
Unfortunately, for most Americans, the principal effect of high insulin is the storage of fat (central adiposity). Simply put, the higher your circulating insulin levels, the higher your chances of developing the dreaded “tire” around your midsection.
Insulin also plays a central role in all of the components of the metabolic syndrome, namely elevated fasting glucose, high blood pressure, high triglycerides, low HDL (good) cholesterol and increased waist circumference. High insulin levels also contribute to elevated testosterone levels and irregular menstruation in women (PCOS), low testosterone levels (hypogonadism) in men and low blood sugar (hypoglycemia).
How it be identified?
The best way to diagnose insulin resistance, or pre-diabetes, is to actually measure insulin in the blood (normal fasting level is < 5 uIU/ml). Other helpful laboratory measurements include fasting glucose (normal < 100 mg/dl), HgbA1c (three month average of glucose levels; normal < 5.7%), and Glycomarkâ (which approximates glucose peaks over the past two weeks). Finally, a darkening of the skin creases in the neck, armpits and/or groin (so-called acanthosis nigricans) is a reliable clinical sign of insulin overproduction.
Can it be treated?
Fortunately, high insulin levels can be normalized with a combination of lifestyle optimization (Low Glycemic Load Diet and exercise as tolerated) and may or may not include a medication called metformin. By aggressively treating at this early stage, you can prevent, or at least postpone, the progression to diabetes.