What is Insulin Resistance | Pre-diabetes

Many people know about normal blood sugar levels, and that insulin plays a role in regulating blood sugar. But they do not know about “insulin resistance.” Insulin resistance is a condition present in many people with diabetes, as well as borderline diabetes, also known as prediabetes.

When you say that someone is insulin resistant you are saying that their hormone insulin does not work well. The body becomes “resistant” to insulin’s job of keeping your blood sugar level healthy, among the many other things that it is does.  If you are not familiar with how insulin works, check out this article, then come on back and read on.

insulin resistanceIf you have prediabetes, you should know that insulin resistance can be reversed. If you have prediabetes you need to fix your insulin resistance and get your body sensitive to insulin once again. Learn from this article and talk to your doctor about taking the necessary steps to reverse insulin resistance so you can stop prediabetes and avoid full type 2 diabetes along with its potentially devastating complications that can keep you from leading a functional independent life, not to mention the medical costs that could send you to the poorhouse.

What is Insulin Resistance?

Insulin is a very important hormone in the body. It has many functions including signaling the movement of sugar out of your blood and into your muscles, liver and fat cells. You do not want sugar lingering around in your blood stream. Sugar is “sticky” and it will start to bind onto different parts of your system causing disease. I have written about the formation of so-called advanced glycation end products in the past. It is this process that causes many of the side effects of diabetes that I see on a regular basis, namely foot wounds and ulcers due to loss of feeling. This can lead to amputation…you do not want to go there.

One of the main functions of insulin is to lower blood sugar levels by enabling blood sugar to enter into the cells of your body, where it is used for energy, or stored for future use. Someone who is very sensitive to the effects of insulin will only need a small amount to get the job done. Someone who is resistant to the effects of their insulin is said to be insulin resistant. A person who is insulin-resistant needs a lot more insulin to get the same amount of blood sugar out of their bloodstream.

This causes the body to make more and more insulin to get enough potentially harmful glucose sugar out of the bloodstream. People who are insulin resistant start to have constant high levels of insulin. Doctors refer to this condition as hyperinsulinemia. Too much insulin in the blood is associated with high blood pressure, heart disease and heart failure, obesity (particularly abdominal obesity), osteoporosis (thinning bones), and certain types of cancer, such as colon, breast, and prostate cancer. Having low fasting insulin levels has been associated with longer life.

insulin resistance diagram

 

Symptoms of Insulin Resistance

Insulin resistance is found most commonly in Type 2 diabetes, but it can begin when you are only borderline diabetic or prediabetic. In many cases, borderline diabetes begins when your insulin sensitivity starts to decrease and your body starts to become resistant to insulin’s ability to move sugar out of your blood and into your cells.

In most cases there are not any symptoms when this starts to happen. Increased blood sugar levels, decreased insulin sensitivity and increased insulin resistance typically occur silently as your metabolism becomes more and more quietly corrupted by this process.

There are blood tests that your doctor can do to check your blood sugar and insulin levels. If you have high blood pressure, an increased waistline, increased triglyceride and/or increased LDL-cholesterol levels, there is a good chance that you have at least some degree of insulin resistance.

 

Ways to Overcome Insulin Resistance

Any type of physical activity has the potential to make your insulin work better…you knew I was going to say that. 🙂  Movement is integrated into who we are as human beings. We are designed to move.  When we live in a way that is inconsistent with our design, things start to go haywire.

female weight lifterAerobic endurance type activities can be helpful, but if you can begin to do some resistance exercise movements – otherwise known as weight training or weight lifting – not only will you benefit near term, but the added muscle will continue to benefit you well into the future.

Combining both endurance and resistance exercise activity has been shown to be the best approach in a number of research studies that have looked at these different forms of exercise. Combining aerobic activities — such as brisk walking, swimming, and riding a bicycle — with resistance training, is a good prescription for reversing insulin resistance. Do not neglect the weight lifting part of the prescription! The more muscle you have the more sugar burning capacity you have. Build muscle to reverse insulin resistance, stop prediabetes and avoid diabetes.

recumbent stationary bikeIf you have not exercised in a while, make sure you get checked over by your doctor first. Discuss your desire to improve your blood sugar levels and insulin sensitivity through exercise. For many people, the best way to begin is with a low intensity activity like simply walking. If you have a foot problem that keeps you from walking, see a podiatrist and get that addressed, but in the meantime start moving your feet and legs on a stationary bike. Recumbent stationary exercise bikes are great if you have a low-back problem.

I would not advise starting weightlifting right away. Start slowly with just endurance physical activity, you can then pick up the pace of your endurance activity (increasing intensity). After you are comfortable with this, then you can start to do the same approach with your weight lifting. In other words, start with a low weight, and moderate repetitions, then gradually increase the weight and adjust the number of repetitions as needed depending on your desired intensity level and weightlifting goals.

exercise bands for resistance weightliftingExercise resistance bands are a good way to start to get used to some resistance activity at home. Resistance exercise movement (with weights or rubber resistance bands) will benefit you the most if you build up to a weight or resistance that you can lift with good form at least 8 times, but not more than 12 times in each set. Plan to do one to three sets of 8–12 repetitions per exercise.  A full discussion of weight lifting methods is beyond the scope of this particular post, but I will get to it in a future post.

 

How Does Exercise Help Insulin Resistance

During exercise, your body burns the stored up form of sugar in your muscles and liver called glycogen. After exercise, your muscles replenish their glycogen storage with glucose sugar from the food you eat. The more glycogen you burn off during exercise, the longer your body’s insulin sensitivity will be improved because your muscles know they “need a refill.”

This increased insulin sensitivity from an episode of exercise movement activity does not last forever. To improve insulin sensitivity on a continuing basis, you should plan on moving –whether it be endurance/aerobic or resistance/weights – at a somewhat moderate level of intensity at least every other day. On the days when you are not moving as ambitiously and intensely, just do some more casual movement “in low gear” like going for a stroll.

In addition to the direct effect of exercise movement to burn off sugar and to build sugar burning muscle, there’s also an indirect benefit. This benefit involves the reduced body fat that comes about from exercise physical activity.

You especially benefit from losing the body fat at your gut commonly referred to as abdominal or visceral fat. This fat tissue is not a passive storage area for all the excess food calories you have eaten over the years. This fat tissue is actively involved in your metabolism, and therefore your overall health. Abdominal fat actually puts out biological chemicals that cause inflammation throughout your body. This inflammation from fat is believed to play a role in the development of insulin resistance, the onset of prediabetes, metabolic syndrome and eventual type 2 diabetes. Losing excess body fat is a well known way to improve insulin sensitivity. Even if you do not lose body fat, there is some preliminary research suggesting that exercise can change less healthy white body fat into brown fat which is better for your metabolism, including insulin resistance.

 

Your Diet (a.k.a. Food) Can Reverse Insulin Resistance

Eating in a way that avoids marked increases in blood glucose levels after meals can decrease insulin resistance and improve your insulin sensitivity. You can prevent such elevations by choosing foods with higher fiber content and lower glycemic index and glycemic load such as vegetables.

glucometer blood sugar testHow high your blood sugar level is after you eat is mainly a reflection of the amount of carbohydrates you have eaten. Diabetics on insulin understand this all too well since they often have to adjust their insulin dose based on how many carbohydrates they have eaten at a meal. Exercising just before meals can also help to lower your blood glucose sugar levels after you are done eating since insulin sensitivity is heightened right after exercise. Likewise, eating carbohydrates within 90 minutes after exercise is also beneficial for the same reason.

So, how should you eat? It depends, there is not a one size fits all recommendation that can be made, and to make matters even more confusing, there are a number of research studies that support both low-carbohydrate and low-fat eating to improve insulin resistance. Nevertheless, there are some guidelines you should consider.

There are several variables to be considered when looking at the different approaches to food in relationship to insulin resistance and blood sugar levels. Your personal degree of insulin resistance and body weight status are two such variables. One study suggested that one’s degree of insulin resistance may determine whether you can be successful on low-carbohydrate versus low-fat.(1)  Yet another study suggests that if one eats a high complex carb/low fat diet, but includes omega-3 fatty acids, like those found in fish oil, that will do the trick. (2)  ?I’m having a hard time with that one…?

And other studies support various levels of a low-carbohydrate approach. (3, 4)

To dig into these studies and try to parse them out is not only beyond the scope of this article, it is simply beyond me.  I don’t have enough hair left for me to risk pulling it all out  trying to mentally reconcile this apparently conflicting data.  At Nutrientology we generally take the low-carbohydrate approach simply because it makes the most basic intuitive common sense…I know Nutrientology readers are not only smart , but also remember to consider plain old common sense.  This was the approach used by type 1 diabetics back in a simpler time prior to the discovery of insulin, before everyone got so smart. This stuff does not have to be that complex.

As I said above insulin dependent diabetics understand the relationship of carbs to insulin secretion. My take on the literature is that we run into problems when we eat both high carbohydrate and high fat, especially when the carbohydrates are in the form of starches or processed foods, as opposed to those found in vegetables.  And the fats are artificial and processed such as found in vegetable oils. When you think low-carb, think low processed foods. Think real food…real plants and animals…food from the farmer’s market…food without a label.

Reducing the blood sugar challenge to the body after a meal should be encouraged. Better yet, limit the amount of carbohydrates (starches) in your diet in the first place. If you have insulin resistance you should not be eating a significant amount of non-vegetable and non-fruit carbohydrates. Eat real carbs, not from a package, and eat them after exercise when your muscles are ready to use them. That way they do not get turned into fat and get shipped off to your belly to join the ruckus, and start pumping out inflammatory compounds. You want carbs to be stored in your muscles as glycogen, not in your belly as fat.

For more information on how to food can be used to improve insulin sensitivity grab a book at the Nutrientology Store and get some more learnin’ done.

 

Supplements That Appear to Support Insulin Sensitivity

There are a handful of diet supplements that have shown some benefit in countering insulin resistance although many of these studies have been done in animals or in “test tubes.”

Some of these diet supplements include:

  • green tea extract
  • chromium
  • cinnamon
  • alpha lipoic acid
  • cyanidin-3-glucoside (I know, that’s a mouthful. Hang with me)

 

Green Tea Extract

A recent study of green tea extract using animals suggests that green tea extract (EGCG) may provide support to people with insulin resistance. I have previously posted about green tea and its ability to apparently inhibit the digestion of certain macronutrients including fat and protein.

Although the research was done using mice, there’s enough positive data to make a case for proceeding with human studies. The results of the “mice study” suggest that green tea, or its polyphenol rich extract, such as EGCG, may have the ability to reduce the glycemic effect of high starch foods. This apparently happens through green tea’s property of inhibiting the enzyme alpha-amylase, the enzyme that breaks down starch.

pure encapsulations green tea extract supplementAn EGCG containing green tea extract supplement appears to slow the digestion of starches resulting in a slower rise in blood sugar after a meal. This may benefit some people and be a means toward healthier blood sugar levels, especially for people with diabetes and prediabetes-metabolic syndrome.

An EGCG supplement is available at the Nutrientology Store.

 

Chromium

Chromium is a mineral that is available as a supplement. Some medical research has suggested that chromium may be supportive of insulin sensitivity and better blood sugar levels, but this is not clear.

pure encapsulations chromium supplementChromium can be considered, but at a low dose. The first rule is “do no harm.” Chromium has shown some benefits in blood sugar management for some people, but there can be problems involved in taking too much. The response to taking a chromium supplement for blood sugar levels appears to be individualized. Err on the side of caution and take too little rather than too much. Look for the benefit without unnecessary risk. (5)

A low dose chromium supplement is available at the Nutrientology Store.

 

Cinnamon

Cinnamon has been shown to decrease blood sugar levels and improve insulin sensitivity in people who were both of normal weight and overweight.

pure encapsulations cinnamon supplementCinnamon research has focused on its potential as a preventative supplement and possible treatment for insulin resistance, metabolic syndrome and type 2 diabetes. Extensive “test tube” evidence has shown that cinnamon may improve insulin resistance by helping the body overcome impairments in insulin signaling in muscle tissue. In fat tissue, it has been shown that cinnamon increases the expression of  something that regulates metabolism known as PPAR.

Without getting too technical, PPAR stands for “Peroxisome Proliferator-Activated Receptor.” It is an important regulator of your metabolism. Some anti-diabetes drugs work by influencing PPAR.  Alright things are really starting to get geeky, I’ll wrap this article up shortly…

Like green tea,  cinnamon also appears to inhibit starch digestion enzymes among other things favorable to having a healthier blood sugar level such as:

  • stimulating glucose uptake by cells by stimulating the movement of a cell membrane glucose transporter out to the cell membrane where it can do its thing and “open the door” to let glucose sugar into the cell and out of the bloodstream.
  • stimulating metabolism to burn glucose sugar and make glycogen for storage
  • inhibiting the formation of sugar from protein by a process known as gluconeogenesis
  • stimulating insulin release from the pancreas
  • increasing insulin receptor activity on the cell membrane so the receptors will be ready to engage insulin and open the door to let blood sugar into the cells of the body. (6)

Studies have also shown that cinnamon has potent anti-inflammatory properties. However, numerous human clinical trials with cinnamon have been conducted with varying findings. While some studies have showed no beneficial effect, others have suggested cinnamon may also influence:

  • cholesterol levels
  • systolic blood pressure

The only measurement consistently improved by using cinnamon is fasting glucose blood sugar levels. (7)

 

Alpha lipoic acid

Alpha-lipoic acid is a natural antioxidant made by the body. During metabolism, potentially harmful “free radicals” are formed. Antioxidants attack “free radicals” and neutralize their harmful effect.

pure encapsulations alpha lipoic acid supplementSince alpha lipoic acid (ALA) is such a potent and interesting anti-oxidant that plays a role in metabolism helping to turn glucose sugar into energy, several studies have looked at the potential for this nutrient to improve insulin resistance. One such study recruited and looked at184 patients with type 2 diabetes and insulin resistance. They were given ALA, omega 3 fatty acids, vitamin E or placebo. All three supplements were shown to effect insulin resistance.  Unfortunately their impact on insulin resistance was calculated indirectly based on the participants’ BMI and waist circumference. (8)

Another study looked at the degree of insulin resistance of fat cells treated with alpha lipoic acid.  This was a test tube study that used fat cells and alpha lipoic acid. They found that ALA seemed to protect fat cells from insulin resistance. (9)

And one more…this study examined the idea that diabetes can be improved by getting the body to make more alpha lipoic acid. The proponents of this theory think it may work by “firing up” the enzyme in the body that makes ALA so that it makes more. This enzyme is called LASY (lipoic acid synthase).  (10)   It appears LASY may be deficient in diabetics.

As an aside, alpha lipoic acid supplementation has shown promise in helping the symptoms of diabetic nerve damage known as diabetic peripheral neuropathy. I have written about this in my Special Report on the The 5 Top Supplements for Diabetic Peripheral Neuropathy.

 

Cyanidin-3-glucoside    

Cyanidin-3-glucoside is actually a pigment compound found in many red berries including grapes, blackberries, blueberries, cherries, cranberries and others.   This plant compound, technically known as an anthocyanin appears to support insulin sensitivity. Anthocyanins are a type of plant flavonoid polyphenol compound that have shown favorable human biologic activity.

Once again more “test tube” and rodent studies suggest that:

Dietary polyphenols could be included in the preventive/therapeutic armory against pathological conditions associated with insulin resistance.  Source

nutraMetrix isotonix opc-3 supplement

Great anthocyanin containing supplement – OPC-3.

Like green tea and cinnamon, it appears that anthocyanins can affect the activity of PPARs – peroxisome proliferator-activated receptors. PPARs affect how you burn fat and carbohydrate for energy.

Limited animal and test tube studies have been done looking at the effect of cyanidin-3-glucoside containing berries on triglycerides, fasting insulin, insulin resistance, and blood sugar. Berries appear to favorably affect these health markers.

Given that cyanidin-3-glucoside is an anti-inflammatory, one group of researchers looked at cyanidin 3-glucoside’s ability to lessen obesity-associated inflammation and irregular metabolism with associated insulin resistance and fatty liver in mice with “diabesity” (obese diabetic mice).  They found anti-diabetic effects apparently due to the berry supplement’s property of reducing inflammation by controlling inflammation producing pathways. (11)

You can check out an anthocyanin containing berry supplement at the Nutrientology Store.

 

Other Factors That Affect insulin Resistance and Your Blood Sugar Levels

You can also lower your insulin resistance by getting enough sleep, moderating your stress levels (exercise can help with this too.) 🙂

So go relax and get some rest.  You deserve it having made it through this rather technical article.  Tomorrow think about how you are going to use some of this information in your daily life to maintain a healthier body weight and blood sugar level to stop prediabetes and prevent diabetes with all its miserable complications including foot and leg problems that could keep you from leading a functional and independent life into your senior years.  Your family will thank you for it.

If you are a member of a healthcare field, or otherwise have a special knowledge in the area of nutritional supplements, exercise-movement or food, and you would like to share your knowledge with the Nutrientology family, go here. We’d love to hear from you.

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About Robert Creighton

Dr. Creighton is a podiatrist and foot surgeon with over 26 years in podiatric practice treating thousands of patients afflicted with the physiological, physical, and psychological side effects and complications of diabetes and pre-diabetes metabolic syndrome. He believes these disorders present a pressing public health concern that need to be more actively addressed in a multidisciplinary way. Dr. Creighton graduated from what is now the Temple University School of Podiatric Medicine after receiving his undergraduate degree in Biology. He is certified by the American Board of Foot and Ankle Surgery, a member of the American Public Health Association, an American College of Sports Medicine certified personal trainer and a Member of the American Nutrition Association.

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5 Responses to What is Insulin Resistance | Pre-diabetes

  1. Link Webpage August 2, 2013 at 8:26 PM #

    This is the kind of information that are meant to be shared across the internet. Disgrace on Google for not positioning this input up higher! Come on over and discuss with my website . Thank you =)

  2. Robert Creighton September 24, 2013 at 6:42 PM #

    Great question. I always say Nutrientology readers are smart. The general short answer is that insulin is a hormone, and hormones work properly only within very specific ranges. When they are too low, or too high, they cannot do their job, nor can they “play well” with other hormones. A more involved answer is beyond the context of the comment section, but insulin is a very powerful regulator of growth, development and repair in the body. I have discussed this role in the context of diabetic nueropathy here – http://nutrientology.com/health/conditions-and-diseases/nutritional-metabolic-disorders/stopping-pre-diabetes-nerve-damage/. In the context of prediabetes excess insulin over time can “down regulate” or decrease the number of insulin receptors making one even more resistant to its actions. Insulin also has a significant influence on blood pressure and circulation health. Excess insulin can make your kidneys increase blood pressure, for example. Excess insulin corrupts metabolism keeping one in a fat storing mode which leads to obesity. There are innumerable other effects of hyperinsulinemia. If you want to stop prediabetes, you need to talk to a doctor who has knowledge about how to bring your insulin levels down. Lowering complex carbohydrate intake is a start.

  3. France August 17, 2014 at 7:12 PM #

    This is really fascinating, You’re an excessively professional blogger. I have joined your feed and stay up for looking for extra of your excellent post. Additionally, I have shared your website in my social networks

  4. Robert Creighton October 4, 2014 at 11:03 AM #

    Thank you for your kind comments.
    Be well and best regards, Nutrientology.

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