What is insulin resistance?  Insulin resistance occurs when excess glucose in the blood reduces the ability of the cells to absorb and use blood sugar for energy.  This can lead to development of prediabetes and eventually Type 2 diabetes.

When you have insulin resistance, your pancreas makes extra insulin to make up for it. For a while, this will work and your blood sugar levels will stay normal.  Over time, your pancreas will not be able to keep up.  If you don’t make lifestyle changes, which includes how you eat and exercise, your blood sugar levels will rise until you have prediabetes.  In prediabetes, when the cells cannot absorb the glucose, your glucose levels often build up in the blood.  The glucose or blood sugar levels are higher than usual, but not high enough to indicate diabetes.  In a person with prediabetes, the pancreas works hard to release enough insulin to overcome the body’s resistance and keep blood sugar levels down.  Over time, the pancreas’ ability to release insulin begins to decrease, which leads to the development of type 2 diabetes.

Insulin is essential for regulating the amount of glucose that circulates in the bloodstream. It induces the cells to absorb glucose.  Insulin usually helps the body maintain a good balance of energy, never allowing the level of blood glucose to spike for too long.

Insulin resistance can also lead to the other health issues, such as Acanthosis .  This is a skin condition that can develop in people with insulin resistance.  It involves dark patches forming on the groin, armpits, and most commonly around the neck.  Polycystic ovary syndrome can worsen the symptoms, which can include irregular menstrual cycles, infertility and periods that cause pain.

The following are risk factors for insulin resistance, prediabetes, and diabetes:

• A family history of diabetes
• Race (American Indian, African American, Asian American)
• Being overweight or having obesity, especially when the extra weight is around the midsection
• A sedentary lifestyle or with little to no exercise
• Smoking
• Poor sleeping habits
• High blood pressure, which has linked to an increased risk of insulin resistance
• Hormones
• Steroid Use
• Non-alcoholic fatty liver disease
• Gestational diabetes
• Polycystic ovary syndrome

Certain risk factors for prediabetes and diabetes are also risk factors for heart disease and other cardiovascular and cerebrovascular health concerns, such stroke and heart disease.

A number of tests can help diagnose prediabetes and diabetes, which include but not limited to Hemoglobin A1C test, which measures a person’s average blood sugar level over the previous 3 months.  Fasting blood glucose test checks glucose levels after a person refrains from eating or drinking for 8 or more hours.  Random glucose test involves a medical professional checking blood glucose levels at some point during the day.  

Doctors usually request more than one of these tests to ensure an accurate diagnosis.  If blood sugar levels consistently fall outside of a normal range, it might indicate that the body is becoming resistant to insulin.  During a doctor visit, your doctor will ask you questions about your symptoms, your personal and family medical history, evaluate your weight, and take your blood pressure. Diagnosing insulin resistance requires a blood test. This might be done through a small finger prick or by having a small needle inserted into a vein to take a sample of blood. You will often be required to fast (avoid eating or drinking anything except water) 8 hours before the test. The blood sample will be sent to a lab for testing. It will test your fasting blood sugar. Anything more than 100 mg/dL is an indication of insulin resistance. Your doctor also may have the lab test your cholesterol levels (from the same blood sample). People with insulin resistance often have high cholesterol.

The American Academy of Family Physicians (AAFP) recommends blood glucose screening of all pregnant women for gestational diabetes after the 24th week of pregnancy. Also, the AAFP recommends blood glucose screening for adults age 40 to 70 years who are overweight or obese and may be at risk of heart disease.

You cannot prevent or avoid risk factors such as race, age, and a family medical history. You can take steps to reduce your insulin resistance by losing weight (even 10% can make a difference), exercising regularly, and eating a healthy diet. Choose healthy carbohydrates. For example, eat whole grain bread instead of white bread, drink water instead of soda, and reduce your intake of sugary foods.

If you have or have had gestational diabetes, insulin resistance typically goes away after you give birth. However, you are at greater risk of being diagnosed with type 2 diabetes later in life. That should be a warning to change your diet and lifestyle early, so that you can delay it for as long as possible.

Diet, weight loss, and exercise can improve insulin resistance. However, most people need medicine, as well. Your doctor will prescribe a medicine that works best for your health and lifestyle needs. If your insulin resistance leads to uncontrolled type 2 diabetes, you may need insulin (given through a pump or daily injection).  Living with insulin resistance requires lifestyle changes, as well as regular use of prescription medicine. You will have to be more careful in making meal and snack choices, reading labels, and maintaining a lower weight. You also will have to commit to regular exercise and take your medicines as prescribed.

If you would like to make an appointment with our dietitian, nurse educator or anyone of our Health Education Technicians, please give us a call at the Awatii Wellness Center 701-627-7931.