Insulin Resistance: Symptoms, Causes, Normal Levels, Associated Diseases, Risk Factors and Treatments

We are talking about a hormone produced by the beta cells of the pancreas.

These cells disperse throughout the pancreas in small groups known as the islets of Langerhans .

The insulin produced is released into the bloodstream and travels throughout the body. Insulin is an essential hormone that has many actions within the body.

Most of the actions of insulin are directed at the metabolism (control) of carbohydrates (sugars and starches), lipids (fats) and proteins.

Insulin also regulates the functions of the body’s cells, including their growth. Insulin is critical to the body’s use of glucose for energy.

Insulin resistance (IR) is a condition in which the cells of the body become resistant to the effects of insulin. That is, the normal response to a given amount of insulin is reduced.

As a result, higher levels of insulin are needed for insulin to have its proper effects, and the pancreas compensates by trying to produce more insulin.

This resistance occurs in response to the body’s own insulin (endogenous) or when insulin is given by injection (exogenous).

With insulin resistance, the pancreas produces more and more insulin until the pancreas can no longer produce enough insulin for the body’s demands and then blood sugar rises.

Insulin resistance is a risk factor for the development of diabetes and heart disease.

What are the signs and symptoms of insulin resistance?

There are no specific signs and symptoms of insulin resistance.

What Causes Insulin Resistance?

There are several causes for insulin resistance and genetic factors (inherited component) are generally significant. Some medications can contribute to insulin resistance. Additionally, insulin resistance is often seen with the following conditions:

  • Metabolic syndrome is a group of conditions that involve excess weight (particularly around the waist), high blood pressure, and elevated levels of cholesterol and triglycerides in the blood.
  • Obesity.
  • The pregnancy.
  • Infection or serious illness.
  • Stress.
  • Inactivity and excess weight.
  • Use of steroids.

Other causes or factors that can make insulin resistance worse may include:

  • Taking certain medications.
  • Advanced age.
  • Sleep problems (especially sleep apnea).
  • Smoking cigarettes.

What is the relationship between insulin resistance and diabetes?

Type 2 diabetes mellitus (T2D) is the type of diabetes that appears later in life or with obesity at any age. Insulin resistance precedes the development of type 2 diabetes, sometimes by years.

In individuals who will eventually develop type 2 diabetes, blood glucose and insulin levels have been shown to be normal for many years, until at some point insulin resistance develops.

High insulin levels are often associated with central obesity, cholesterol abnormalities, and / or high blood pressure (hypertension). When these disease processes occur together, it is called metabolic syndrome.

One action of insulin is to cause cells in the body (particularly muscle and fat cells) to remove and use glucose from the blood.

This is one of the ways that insulin controls the level of glucose in the blood.

Insulin has this effect on cells by binding to insulin receptors on the surface of cells. Insulin can be thought of as “knocking on the doors” of muscle and fat cells. Cells hear the bang, open up, and allow glucose to be used.

With insulin resistance, the muscles do not hear the hit (they are resistant). Therefore, the pancreas is notified that it needs to produce more insulin, which increases the level of insulin in the blood and causes a stronger blow.

Cell resistance continues to increase over time. As long as the pancreas is able to produce enough insulin to overcome this resistance, blood glucose levels remain normal.

When the pancreas can no longer produce enough insulin, glucose levels in the blood begin to rise.

Initially, this happens after meals, when glucose levels are at their highest and more insulin is needed, but eventually also during fasting (for example, when waking up in the morning).

When blood sugar rises abnormally above certain levels, type 2 diabetes is present.

What are normal insulin levels?

The exact values ​​for normal or high insulin levels vary depending on the laboratory and the type of test performed. With insulin resistance, there is a high fasting insulin level and a normal to high fasting blood glucose level.

High or elevated insulin levels can also be seen with other medical conditions, including insulin-producing tumors (insulinomas), Cushing’s syndrome, and fructose or galactose intolerance.

What medical conditions are associated with insulin resistance?

While the metabolic syndrome links insulin resistance with abdominal obesity, high cholesterol, and high blood pressure; Several other medical conditions are specifically associated with insulin resistance.

Insulin resistance can contribute to the following conditions:

Type 2 diabetes: Overt diabetes can be the first sign of insulin resistance. Insulin resistance can be seen long before type 2 diabetes develops.

People who are reluctant or unable to see a healthcare professional often seek medical attention when they have already developed type 2 diabetes and insulin resistance.

Fatty liver: Fatty liver is strongly associated with insulin resistance. The accumulation of fat in the liver is a manifestation of the disorderly control of lipids that occurs with insulin resistance.

Fatty liver associated with insulin resistance can be mild or severe. The latest evidence suggests that fatty liver can even lead to liver cirrhosis and possibly liver cancer.

Arteriosclerosis : Arteriosclerosis (also known as atherosclerosis) is a process of progressive thickening and hardening of the walls of medium and large arteries.

Arteriosclerosis is responsible for:

  • Coronary artery disease (leading to angina and heart attack).
  • Heart attacks
  • Peripheral vascular disease.

Other risk factors for arteriosclerosis include:

  • High levels of “bad” cholesterol (LDL).
  • High blood pressure (hypertension).
  • Smoke.
  • Diabetes mellitus from any cause.
  • Family history of arteriosclerosis.

Skin lesions: Skin lesions include an increase in skin tags and a condition called Nigerian acanthosis (AN).

Acanthosis nigricans is a darkening and thickening of the skin, especially in folds such as the neck, under the arms, and in the groin.

This condition is directly related to insulin resistance, although the exact mechanism is unclear.

Acanthosis nigricans is a cosmetic condition strongly associated with insulin resistance in which the skin darkens and thickens in wrinkled areas (for example, the neck, armpits, and groin).

Skin lesions occur more frequently in patients with insulin resistance. A skin tag is a common and benign condition where some skin projects from the surrounding skin.

Skin tags vary significantly in appearance.

A skin tag can appear smooth or bumpy, flesh-colored or darker than the surrounding skin, and it can simply be lifted over the surrounding skin or attached by a stalk (peduncle) to hang from the skin.

Polycystic Ovarian Syndrome (PCOS): Polycystic ovary syndrome is a common hormonal problem that affects menstruating women.

It is associated with irregular or no periods (amenorrhea), obesity, and increased body hair in a male pattern of distribution (called hirsutism; for example, mustache, sideburns, beard, mid-chest, and central belly hair).

Hyperandrogenism : With PCOS, the ovaries can produce high levels of the hormone testosterone. This high level of testosterone can be seen with insulin resistance and may play a role in causing PCOS.

It is not clear why this association occurs, but it appears that insulin resistance somehow causes abnormal ovarian hormone production.

Growth abnormalities: High circulating insulin levels can affect growth. While the effects of insulin on glucose metabolism may be affected, its effects on other mechanisms may remain intact (or at least less affected).

Insulin is an anabolic hormone that promotes growth. Patients can actually grow larger with noticeable thickening of the features.

Children with open growth plates in their bones can grow faster than their peers.

However, neither children nor adults with insulin resistance become taller than predicted by their family growth pattern. In fact, most adults simply appear larger with thicker features.

The increased incidence of the skin tags mentioned above can also occur through this mechanism.

Who is at risk for insulin resistance?

A person is more likely to have or develop insulin resistance if he or she:

  • You are overweight with a body mass index (BMI) greater than 25 kg / m2. You can calculate your BMI by taking your weight (in kilograms) and dividing twice by your height (in meters).
  • You are a man with a waist over 40 inches or a woman with a waist over 35 inches.
  • You are over 40 years old.
  • You are of Latino, African American, Native American, or Asian American descent.
  • You have close family members who have type 2 diabetes, high blood pressure, or arteriosclerosis.
  • You have had gestational diabetes.
  • You have a history of high blood pressure, high blood triglycerides, low HDL cholesterol, arteriosclerosis (or other components of metabolic syndrome).
  • You have polycystic ovary syndrome (PCOS).
  • Shows acanthosis nigricans.

What specialties of doctors treat insulin resistance?

Insulin resistance can be treated by primary care professionals, including internists, family professionals, or pediatricians. Endocrinologists, specialists in hormonal disorders, also treat patients with insulin resistance.

Is there a test for insulin resistance?

A healthcare professional can identify people who are likely to have insulin resistance by taking a detailed history, performing a physical exam, and performing simple laboratory tests based on individual risk factors.

In general practice, fasting blood glucose and insulin levels are often adequate to determine whether there is insulin resistance and / or diabetes.

The exact level of insulin for diagnosis varies by analysis (by laboratory). However, a fasting insulin level above the upper quartile in a non-diabetic patient is considered abnormal.

Can Insulin Resistance Be Cured?

Control of insulin resistance is done through lifestyle changes (such as diet, exercise, and disease prevention) and medications.

Insulin resistance can be controlled in two ways. First, the need for insulin can be reduced. Second, it can increase the sensitivity of cells to the action of insulin.

Is there a special diet plan to treat insulin resistance?

The need for insulin can be reduced by altering the diet, particularly carbohydrates in the diet. Carbohydrates are absorbed into the body as they break down into their component sugars.

Some carbohydrates are broken down and absorbed faster than others; These refer to having a high glycemic index. These carbohydrates increase the level of glucose in the blood more quickly and require the secretion of more insulin to control the level of glucose in the blood.

Examples of carbohydrates with a high glycemic index that quickly raise blood glucose levels include:

  • Unrefined sugars (such as fruit juice and table sugar).
  • White bread.
  • Unrefined corn and potato products (such as muffins, mashed potatoes, donuts, corn chips, and French fries).

Examples of foods with a low glycemic index include:

  • Foods with higher fiber content (such as whole grain breads and brown rice).
  • Non-starchy vegetables (such as broccoli, green beans, asparagus, carrots, and greens). These are low in calories and total carbohydrates, and contain vitamins and fiber.

Since foods are rarely consumed in isolation, it can be argued that the glycemic index of each food is less important than the overall profile of the whole meal and associated beverages.

What foods help prevent type 2 diabetes?

Foods that are particularly helpful for people trying to prevent type 2 diabetes and maintain a healthy weight are similar to the low-glycemic foods described above:

  • Vegetables and fruits that provide fiber and vitamins.
  • Fat-free or low-fat dairy products to provide calcium and strengthen bones. Dairy products full of fat should be avoided as high-fat foods can worsen insulin resistance.
  • Whole grain products, which have a lower glycemic index than refined grains and are high in fiber.
  • Nuts that contain fiber, protein and healthy fats.
  • Fish, such as salmon, herring, mackerel, or sardines, is a source of “good” (heart-healthy) fats.
  • Lean meats or beans are an excellent source of protein.

Several studies have confirmed that weight loss, and even aerobic exercise without weight loss, increases the rate at which muscle cells extract glucose from the blood as a result of increased sensitivity.

Can exercise treat insulin resistance?

Diet and exercise have been shown to reduce the development of type 2 diabetes in multiple studies and can reduce insulin resistance.

What medications treat insulin resistance?

Metformin (Glucofage) is a drug used to treat type 2 diabetes. It has two actions that help control blood glucose levels.

Metformin prevents the liver from releasing glucose into the blood and increases the sensitivity of muscles and fat cells to insulin, allowing them to remove more glucose from the blood.

With these actions, metformin lowers blood insulin levels because lower blood sugar levels tell the pancreas to put out less insulin.

Metformin is a reasonably safe drug when used in the appropriate population. Although occasionally associated with gastrointestinal side effects, metformin is generally well tolerated.

While there are no FDA-approved drugs to prevent type 2 diabetes or to treat pre-type 2 diabetes (insulin resistance), the American Diabetes Association has recommended that metformin be the only drug considered for the prevention of diabetes. type 2 diabetes.

Can insulin resistance be prevented?

Insulin resistance cannot always be prevented, but there are ways to modify risk factors, such as maintaining a healthy weight and exercising regularly.

What is the prognosis for a person with insulin resistance?

Insulin resistance is associated with the development of type 2 diabetes unless steps are taken to reverse insulin resistance.

Losing weight, eating a healthy diet, not smoking, and exercising, as described above, can help reverse insulin resistance.

What new research has been done on insulin resistance?

Insulin resistance awareness has gained prominence, in its own right, as a contributor to metabolic syndrome. Timely intervention can delay the onset of overt type 2 diabetes.

Future studies should evaluate longer intervals than research to date to determine the duration of treatment to prevent the development of type 2 diabetes and related complications.

Lifestyle changes (in nutrition and physical activity) are clearly important in delaying the development of type 2 diabetes in people with insulin resistance and are the main recommendation for the prevention of diabetes in people with high risk.

Metformin is the only drug recommended by the guidelines for those patients at higher risk. Education about these changes should target all groups at risk for type 2 diabetes.

Childhood obesity is epidemic and on the rise in developed countries. Changes must be made in homes and school cafeterias to ensure healthier nutrition.