Insulin Resistance

This month I thought I would write about insulin resistance. It has been in the news a great deal lately, but there are a lot of misconceptions. Here at Palmetto Endocrinology, we keep abreast of all the latest information coming available and will always try to help you to make an informed decision.

What Is Insulin Resistance?

Insulin resistance is when cells in your muscles, fat, and liver don’t respond well to insulin and can’t use glucose from your blood for energy. To make up for it, your pancreas makes more insulin. Over time, your blood sugar levels go up. Insulin resistance syndrome includes a group of problems like obesity, high blood pressure, high cholesterol, and type 2 diabetes. It could affect as many as 1 in 3 Americans. You might also hear it called metabolic syndrome.

Symptoms of Insulin Resistance

You can't tell that you have insulin resistance by how you feel. You'll need to get a blood test that checks your blood sugar levels.

Likewise, you won’t know if you have most of the other conditions that are part of insulin resistance syndrome (high blood pressure, low "good" cholesterol levels, and high triglycerides) without seeing your doctor.

Some signs of insulin resistance include:

• A waistline over 40 inches in men and 35 inches in women · Blood pressure readings of 130/80 or higher
• A fasting glucose level over 100 mg/dL
• A fasting triglyceride level over 150 mg/dL
• A HDL cholesterol level under 40 mg/dL in men and 50 mg/dL in women 
• Skin tags · Patches of dark, velvety skin called acanthosis nigricans

Risk Factors and Causes of Insulin Resistance

Things that can make this condition more likely include:

• Obesity, especially belly fat
• Inactive lifestyle
• Diet high in carbohydrates
• Gestational diabetes
• Health conditions like nonalcoholic fatty liver disease and polycystic ovary syndrome
• A family history of diabetes
• Smoking
• Ethnicity -- it’s more likely if your ancestry is African, Latino, or Native American
• Age -- it’s more likely after 45 · Hormonal disorders like Cushing’s syndrome and acromegaly · Medications like steroids, antipsychotics, and HIV medications · Sleep problems like sleep apnea

Diagnosis and Tests for Insulin Resistance

Your doctor will use these things to diagnose insulin resistance:

• Questions. They’ll want to know about your family's medical history.
• Physical exam. They’ll weigh you and check your blood pressure.
• Blood tests. You might get:
  • Fasting plasma glucose test. This test measures your blood sugar after you haven’t eaten for at least 8 hours.
  • Oral glucose tolerance test. First, you'll take the fasting glucose test. Then you'll drink a sugary solution. Two hours after that, you'll take another blood test.
  • Hemoglobin A1c test. This blood test shows your average blood sugar level for the past 2 to 3 months. Doctors use it to diagnose prediabetes or diabetes. If you have diabetes, it helps show whether it's under control. You may need to take the test again to confirm the results.

How Insulin Resistance Progresses to 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, though, your pancreas won’t be able to keep up. If you don’t make changes in the way you eat and exercise, your blood sugar levels will rise until you have prediabetes.

Your endocrinologist will look for these blood test results:

• Fasting plasma glucose test: 100-125
• Oral glucose tolerance test: 140-199 after the second test
• A1c results of 5.7% to 6.4%

If you aren’t able to manage prediabetes, you’ll be diagnosed with type 2 diabetes when your test levels reach:

• Fasting plasma glucose test: 126 or higher
• Oral glucose tolerance test: 200 or higher after the second test
• A1c results of 6.5% or above

Insulin Resistance Treatment and Prevention

You can take steps to reverse insulin resistance and prevent type 2 diabetes:

• Exercise. Go for at least 30 minutes a day of moderate activity (like brisk walking) 5 or more days a week. If you're not active now, work up to that.
• Get to a healthy weight. If you're not sure what you should weigh or how to reach a weight loss goal, ask your doctor. You may also want to talk with a nutritionist and a certified personal trainer.
• Eat a healthy diet. Think fruits, vegetables, whole grains, nuts, beans, fish, legumes, and other lean protein.
• Take medications. Your doctor may prescribe a medication to help keep your blood sugar in check.

Complications of Insulin Resistance

If metabolic syndrome goes untreated, it could lead to:

• Severe high blood sugar
• Severe low blood sugar
• Heart attack
• Stroke
• Kidney disease
• Eye problems
• Cancer
• Alzheimer’s disease

Well, there you have it. If you have any of the above symptoms, please make an appointment with us. We are here to help.

Author

Joseph Mathews, MD, FACP, FACE, ECNU, CCD Joseph W. Mathews M.D., a board certified Endocrinologist and Medical Director of Palmetto Endocrinology, was born and raised in South Carolina. He earned his Bachelor of Science in Biology from the College of Charleston, Cum Laude. He then achieved his M.D. at the Medical University of South Carolina where he also completed his residency in Internal Medicine and a Fellowship in Endocrinology, Diabetes, and Metabolism. Dr. Mathews is also a Fellow of both the American College of Endocrinology and the American College of Physicians, holds an Endocrine Certification in Neck Ultrasound (ECNU) and is a Certified Clinical Densitometrist (CCD). He has extensive experience performing ultrasound guided fine needle aspiration biopsies. His practice includes a range of specializations including prescribing and fitting patients with insulin pumps. Dr. Mathews' practice has drawn patients from out of state to benefit from his expertise in thyroid disorders, diabetes, cortisol problems and their Endocrine disorders.