Insulin resistance: Are you headed for diabetes?
How to know if you have insulin resistance and understanding the lesser known causes of blood sugar dysregulation
Two items before I dig in:
I didn’t intend for this newsletter to go out the day after Halloween, but I kind of like the timing. We’re headed into the tricky holiday seasons where there are endless opportunities for treats and other eating occasions that can make it more difficult to prioritize or sustain healthy habits.
Sorry about the newsletter title. I don’t want to be alarmist, but I use a headline analyzer, and this one was apparently the most attention grabbing. So, my apologies for being dramatic, but I really hope you’ll read today’s message.
Today, I’m talking about insulin resistance and some of the factors contributing to pre/diabetes that aren’t commonly discussed.
Lately, I’ve felt like a broken record explaining to clients the term “insulin resistance” as we review lab results and discuss factors contributing to their symptoms and diagnoses (i.e. brain fog, low energy, changes in body shape and composition, prediabetes, PCOS, etc.).
As you might imagine, I believe that when people know what’s going on in their bodies, they’re more likely to change their behaviors (and hopefully, their habits). I also feel confident there’s research showing that people knowing more doesn’t always lead to sustained behavior changes, but let’s take a hopeful lens today.
In today’s newsletter, I’ll explain insulin resistance and the factors that cause it, how to know if you might have it, and what to test (and continue to monitor!) to know understand your blood sugar and insulin metabolism.
*To save some of you time: If you already know that diabetes and prediabetes are a problem, and you understand the term “insulin resistance,” then skip to the “What causes insulin resistance” section. I want you to understand that our risk of developing insulin resistance (and possibly diabetes) isn’t just about eating a lot of ultra processed foods. In fact, I bet you aren’t yet aware of a couple of the contributors to insulin resistance.
Diabetes and prediabetes in the U.S.
In 2021, the Centers for Disease Control (CDC) estimated that over 11% of the entire US population had diabetes and nearly 15% of adults. About 38% of US adults had prediabetes (based on fasting glucose or A1c). That means that about 2 out of every 5 people have prediabetes… and many of us don’t even know it.
What is insulin and why do we need it?
Insulin is a hormone (messenger) that we need to live. Insulin tells cells (e.g. liver and muscle cells) to take sugar out of the bloodstream and into the cells. Think of insulin like a knock on the door of the cell to ask it to let sugar in.
We eat food, and insulin is released by the pancreas in response to the presence of food in the digestive tract. Insulin helps us regulate blood sugar levels in order to:
Make energy: insulin helps sugar get into the cells and tissues (e.g. muscle) to make energy for the body.
Store fat: when we have made enough energy to meet our needs, our bodies will store fat from excess calories.
What is insulin resistance?
Insulin resistance is a term you’ve probably heard in relation to prediabetes and diabetes. When our bodies have chronically high blood sugars, our cells can become “resistant” to insulin’s message—the message trying to get sugar out of the blood steam and into the cell for energy production or fat storage.
When our cells and tissues start “resisting” insulin’s messages to lower blood sugar it leaves sugar circulating in the blood, and the pancreas releases more and more insulin to try to get its message across (“get this sugar out of the bloodstream!”). As you’ve probably already figured out, this is the process that can eventually lead to type 2 diabetes.
I kind of think of high blood sugar and insulin resistance like the fable The Boy Who Cried Wolf. Eventually, after a lot of false alarms, the people in the town stop believing the boy, which becomes a real problem when an actual wolf shows up. As sugar stays high in the bloodstream due to overeating and other factors below, the body stops listening to insulin knocking at the door of liver cells, muscles cells, and other tissues. The cells “resist” insulin’s message. To complete the fable analogy, the cells stop believing we actually need more energy (sugar).
What causes insulin resistance?
Let’s start with the lesser known factors:
Inadequate sleep: When we don’t sleep at least 7 hours a night, we increase our likelihood of having insulin resistance. No matter how “perfect” our diet might be, if we don’t sleep enough, it’s harder to regulate our blood sugar.
Endocrine-disrupting chemicals (EDCs): Exposure to BPA in plastics contribute to increased risk of insulin resistance. And I hate to rain on the “BPA-free” parade, but those replacement compounds probably aren’t any safer. [I know, I’m no fun at parties. I try to warn people: don’t ask me a question you don’t really want the answer to.] The growing body of evidence on EDCs suggests that our blood sugar control isn’t just about what we eat, it’s also about what we’re exposed to. Please, please, try to avoid heating food in plastic (e.g. those “microwave-safe plastic steamer bags”).
Medications: Prescriptions like steroids (for inflammation) or statins (for high cholesterol) can affect blood sugar and contribute to insulin resistance.
Genetic predisposition: Our likelihood of developing diabetes can be higher (or lower) based on our genetics. Not everything related to insulin resistance and diabetes is within our control. However, our lifestyle can still lower our risk irrespective of our genetics. What we do still matters!
Chronic inflammation: Inflammation creates an internal environment that can increase insulin resistance.
Higher amounts of abdominal fat (“visceral fat” or “belly fat”): can lead to and worsen insulin resistance.
Low activity: being physically active is one of the most powerful and effective ways to improve insulin sensitivity (decrease insulin resistance). Essentially, by being active your muscles are demanding sugar from the bloodstream.
High intake of simple carbs (sugars) and ultra processed foods (UPFs): In a UK study of adults, individuals who had the highest intake of UPFs had a 44% higher risk of developing diabetes.
Do you have insulin resistance?
Symptoms and signs:
Erratic or unpredictable energy (obviously, this can also be caused by many things that aren’t insulin resistance)
Cravings for sugar
Insatiable hunger
Infections (e.g. skin or vaginal)
Difficulty healing cuts or sores
Skin tags and skin darkening around the armpits and neck
Belly fat
Increased thirst and urination
Fat around the abdomen: measure your waist circumference (around your belly button). If it’s higher than 40 inches in men or 35 inches in women, then that can suggest increased risk for insulin resistance.
Labs to test for insulin resistance and blood sugar regulation:
Fasting glucose (goal range 70-85): as part of your comprehensive metabolic panel.
Fasting insulin (goal <5, which is not what you’ll see on the lab reference range): Insulin rises in response to the presence of food. If you haven’t eaten recently, it shouldn’t be high.
HbA1c or “A1c” (goal <5.3%): A1c is a longer-term look at blood sugar control over the previous 3 months. While a fasting glucose is the level of your sugar at the moment you had your blood drawn, an A1c measures how high your blood sugar has been over a longer period of time.
Cholesterol: I particularly pay attention to triglyceride levels (too high) and HDL levels (too low).
Thank you if you made it this far! Did you learn anything new? I would love to hear from you. Comment below or hit reply to this email. As always, thank you for subscribing to Nuanced Nutrition.
