Approximately 40% of US adults aged 18 to 44 were found to have insulin resistance in a 2021 study1. Maybe you have heard of insulin resistance. Or even better, you have came across it in a few of my posts. Insulin resistance is thought to precede Type II Diabetes by 10-15 years1. The more we understand about insulin resistance, the better we can prevent diabetes and other associated health conditions. Now is as good of a time as ever to dive into this topic.
What is it?
Insulin resistance occurs when your body does not respond to insulin as it should. Insulin is a hormone made by the pancreas that is released when glucose (sugar) is released. Insulin decreases blood glucose by helping glucose molecules enter muscle, fat, and liver tissue for stored energy. Insulin resistance leads to inappropriate glucose storage and corresponding increased insulin production. Ultimately, this results in decreased insulin sensitivity and increased blood glucose.
Risk Factors
Those with the following are at increased risk of developing insulin resistance:
- Abdominal obesity
- High body fat
- Physical inactivity
- Diet- including processed foods and nutrient imbalance (check out my post on macro and micronutrients for more info on this https://lrxwellness.com/macro-and-micro-nutrients/)
- Advanced age
- Certain medications (i.e. steroids, some antipsychotics and antidepressants)
- Certain genetic conditions
Health Conditions Associated with Insulin Resistance
- Prediabetes/diabetes
- Obesity
- Increased triglycerides (cholesterol)
- High blood pressure
- Systemic inflammation
- Cardiovascular disease
- Polycystic ovarian syndrome (PCOS)
- Metabolic syndrome
- Fatty liver disease (FLD)
Diagnosis
Unfortunately, insulin resistance is often a silent disease, meaning there are no symptoms. Symptoms may develop once it progresses to prediabetes or diabetes. This is why it is important to follow with a healthcare provider and get routine blood work including: fasting blood glucose, A1c, and/or a lipid profile.
The gold standard for diagnosing insulin resistance is the hyperinsulinemic-euglycemic glucose clamp technique. However, it is impractical so other methods have been adopted which include collecting and correlating fasting glucose and insulin concentrations.
In practice insulin resistance is typically inferred based on clinical presentation, metabolic syndrome being the strongest indicator. For more info on metabolic syndrome https://lrxwellness.com/a-silent-killer/
Prevention
- Physical activity
- Diet
- Eliminate processed foods
- Eat a well balanced diet
- Maintain a healthy weight
Treatment
Treatment is similar to prevention. Implement lifestyle modifications including:
- Increased physical activity
- Diet
- Eliminate processed foods
- Eat a well balanced diet
- Incorporate more low and less moderate-high glycemic index (GI) foods. Check out my prediabetes post for more info on this. https://lrxwellness.com/everything-you-need-to-know-about-prediabetes/
- Weight loss when indicated
When all else fails there are medications which may improve insulin resistance. However, lifestyle modifications are first line therapy.
In Conclusion
Insulin resistance is a common and likely underdiagnosed health condition. Its prevalence is increasing with obesity rates, sedentary lifestyle, and an aging population. Insulin resistance is associated with significant morbidity, burdening our healthcare system. All of which results in reduction in quality of life and health care received, as well as increased financial strain. The good news is: it is preventable! Adequate physical activity, a well balanced diet, and maintaining a healthy weight prevent insulin resistance. Preventing insulin resistance in turn prevents many other disease states and improves overall quality of life.
As always, please reach out with questions, comments, or for further discussion.
Lindsey, PharmD, BCPS
References
1Freeman AM, Acevedo LA, Pennings N. Insulin Resistance. [Updated 2023 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507839/
2Insulin resistance: What it is, causes, symptoms & treatment. Cleveland Clinic. (2021, December 16). https://my.clevelandclinic.org/health/diseases/22206-insulin-resistance
3U.S. Department of Health and Human Services. (2018, May). Insulin Resistance & Prediabetes. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance