What Is Insulin Resistance?

Insulin resistance is the first stage along a continuum of insulin dysfunction. It begins with insulin resistance and, if left untreated, ends with uncontrolled diabetes. When you are in this initial phase, your body cannot effectively use insulin so it must make more to get the same job done.

Think about a car with a tank of gasoline. If you drive a very efficient car, you may get 22 to 25 miles out of every gallon of gasoline. If you drive an inefficient car, you might get 15 miles out of every gallon. Either way, the goal is to get to your destination, using more or less gas, depending on the efficiency of your vehicle.

It’s very similar with insulin. If your body is insulin-resistant, it requires more insulin to control your blood sugar. When we eat, glucose levels rise and insulin is released into your bloodstream. Your body continues to make as much insulin as it needs to keep your sugar controlled until it runs out of insulin.

Insulin is produced by the beta cells in your pancreas. Beta cells can tire out, so over time you lose more and more beta cells, and eventually you just can’t make insulin anymore. When you get to that stage, you are in the diabetes phase.


Is Insulin Resistance the Same as Pre-Diabetes?


Insulin resistance and pre-diabetes are two different stages along the same continuum, with pre-diabetes developing as the next stage of insulin dysfunction. If you’re just insulin-resistant, you may be making a whole lot of insulin to keep up with demand, but it’s still controlling your sugar. By the time you are prediabetic, you actually have blood sugar abnormalities.

Many times, a patient has been insulin-resistant for years before we know because we can’t always detect insulin resistance on blood work. We can detect pre-diabetes on blood work through blood sugar abnormalities, or a fasting blood glucose that’s over 100 but under 126, taken on more than one occasion. The Hemoglobin A1C test provides a 90-day overview of blood sugar performance. If that test is over 5.7 but under 6.4, you’re officially in the pre-diabetes phase.


Who’s Most at Risk for Developing Insulin Resistance?


The most common factor for developing insulin resistance is obesity or being overweight. As you gain excess fat, particularly in the abdominal area, your body starts to become insulin resistant.

Abdominal fat comes in two types: subcutaneous and visceral. Visceral fat is the kind you can’t see. It’s kind of sneaky. It collects around the organs inside your body, and it’s very inflammatory and particularly anti-insulinogenic. Even thin people can have a lot of visceral fat. The more body fat you have and the more overweight you are, particularly in the abdominal area, the less likely your insulin is to work effectively.

Other risk factors include family history or genetics. If any kind of pancreatic disease that’s killing off beta cells runs in your family, you’ll have trouble producing insulin. We also find insulin resistance in women with a history of polycystic ovary syndrome (PCOS) and gestational diabetes. Gestational diabetes sort of gives you a window into the future function of your insulin. If you’re diabetic when you’re pregnant, there’s a 1 in 2 risk that you’ll be diabetic later in life.


What are Signs of Insulin Resistance and Pre-Diabetes?


Diagnosing insulin resistance can be kind of tricky, because there are often no obvious signs or symptoms. Many times, we don’t find insulin resistance until somebody comes in for blood screening work and we see blood sugar abnormalities.

Fatigue may be a sign. When you can’t use your insulin appropriately to control your sugar, you can’t use that sugar for fuel. So, you end up feeling fatigued. But fatigue is so nonspecific, it can be a bunch of things.

By the time patients start showing sugar abnormalities, many signs appear such as recurring yeast infections and increased sugar cravings. The more insulin you have floating around in your bloodstream, the more you crave sugar because that insulin is sitting there waiting to take that sugar out of your bloodstream. That creates a negative snowball effect. If you have excess body weight that produces excess insulin, then excess insulin causes sugar cravings, that makes you want to eat more sugar, which then increases body weight. It can be a self-perpetuating problem.

While symptoms of tingling in the hands and fingers and blurry vision sometimes occur, they typically don’t appear until a patient shows sugar abnormalities. If you’re in the very early stages of insulin resistance, the only thing you may notice is some excess abdominal weight gain that you just can’t get rid of. That’s the most common thing I see.


Treat Early to Prevent Diabetes


If you are insulin resistant, or think you might be, get checked out as soon as possible. The earlier you treat it, the more likely you are to prevent diabetes down the line.


As a direct primary care physician, I can spend the time with you to properly diagnose insulin resistance and pre-diabetes, and together we can craft a treatment plan for incorporating lifestyle changes focused on dietary needs and getting more exercise to improve your insulin function. Visit Olp Family Medicine of Carmel or call 317-343-0611 to learn more.

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