By Hope Warshaw, MMSc, RD, CDE
With the increasing conversation about pre-diabetes and type 2 diabetes, you’ve likely heard the terms “insulin resistance” and its “opposite insulin sensitivity.” Another term that’s entered our lexicon with the epidemics of obesity and type 2 diabetes is “metabolic syndrome,” a group of symptoms, which, at its core, is insulin resistance. Think of metabolic syndrome, pre-diabetes and type 2 diabetes as a continuum.
The following are simple explanations of insulin resistance and metabolic syndrome along with actions to put them in reverse or at least slow their progression over time.
Insulin resistance defined
Insulin resistance most often occurs in people who are overweight. It’s particularly common in people who carry excess weight around their middle – their waistline. An apple-shaped figure is often associated with insulin resistance. The medical term is “central adiposity.”
As excess weight accumulates, especially in people who are at risk of type 2 diabetes, insulin resistance causes the body to become resistant to the insulin currently produced and secreted from the pancreatic beta cells. Over five to ten years, and if actions aren’t taken to reverse it, the pancreatic beta cells can no longer keep up with the body’s demand for insulin. Simplistically it’s said that the pancreatic beta cells get “pooped out”. It is then that blood glucose rises above a healthy level and towards the ranges high enough for the diagnosis of pre-diabetes or type 2 diabetes.
While this insulin resistance in the fat and muscle slowly causes the pancreas to work overtime to keep blood glucose within normal levels, other health issues stemming from insulin resistance are set in motion. Together these related medical conditions can result in what’s known as metabolic syndrome.
The National Institutes of Heart, Lung, and Blood of the National Institute of Health (NIH) and other heart organizations define metabolic syndrome as a group of five metabolic risk factors (below). To be diagnosed with metabolic syndrome, a person must have at least three of the five risk factors. Insulin resistance is not a risk factor, but it is at the center of this metabolic syndrome storm. It’s interesting to note that blood glucose rising above normal levels is typically the last of these metabolic risk factors to occur.
• Large waistline (for men: greater than 40”; for women: greater than 35”)
• High triglyceride level (greater than 150 mg/dl)*
• Low HDL cholesterol level (less than 40 mg/dl for men; 50 mg/dl for women)*
• High blood pressure (greater than 140 over 90)*
• High fasting blood glucose (greater than 100)*
*Or a medication to treat this problem is prescribed to lower or control the risk factor.
Root of insulin resistance
Excess pounds in the form of fat cells (adipose tissue) – again, especially those around the waist – set off a series of events, which are part of the body’s inflammatory response. These fat cells secrete cytokines (substances produced by cells), which move into the blood stream. This causes slow, steady and constant (or chronic) inflammation, which experts believe initiates the problems with insulin resistance described above.
A growing body of research now confirms that excess weight is not simply excess baggage. Far from it! Extra pounds are changing the way the body is functioning on a day-to-day basis. Over time, all of these changes combined have many damaging effects throughout the body!
Insulin resistance reversed
Insulin resistance can be reversed. Research shows, the earlier you take action along this continuum to reverse the effects of insulin resistance, the better. Even after the diagnosis of pre-diabetes or in the early years of type 2 diabetes, actions help decrease insulin resistance and increase insulin sensitivity.
The key actions are losing weight, becoming physically active, and keeping as much of that lost weight off as possible for as many years as possible (not an easy job!). Research, including the famed “Diabetes Prevention Program” (DPP), has shown over and over that losing as few as five to seven percent of starting weight, ~10 to 20 pounds, can help the body regain some insulin sensitivity. Again, the sooner you take action, the better!
Minimal weight loss improves insulin sensitivity – making the body’s cells more sensitive to the insulin still made in the pancreas. Becoming physically active in addition to weight loss and on its own, also improves insulin sensitivity. These actions can lower blood glucose (dramatically sometimes) and can often reverse other health conditions associated with insulin resistance and metabolic syndrome (see above).
To lose weight, follow the eating plan used in the DPP – low fat, calorie controlled. Basically, it’s healthy eating, which mimics the recommendations from the Dietary Guidelines 2010 and MyPlate.gov – sufficient fruits, vegetables, whole grains, legumes and low fat dairy foods. Lighten up on meat, fats and oils.
Next, get physically active. Start slowly and work up to 30 minutes of activity most days. Most people find walking to be the easiest and most time efficient exercise. The DPP participant’s had a goal of 150 minutes of exercise a week – that’s 30 minutes 5 times a week.
Because eating healthfully, exercising and dropping pounds for good is tough to do, consider seeking out the support you need. Perhaps it’s as simple as a neighbor or spouse who’s willing to partner and set realistic goals with you. Perhaps you’ll need the support of a weight control program either in person or online. There are many choices today.
What’s most important for your long-term health is that you take action NOW! Small steps can eek out big rewards!
Hope Warshaw, MMSc, RD, CDE has been a dietitian and diabetes educator for more than thirty years. She has owned her Hope Warshaw Associates, LLC, for over twenty years. Her work today spans from corporate consulting to writing consumer articles and authoring numerous best-selling books. She counsels people with diabetes and those with weight concerns. Hope is most well known for her expertise in the areas of diabetes nutrition management and healthy restaurant eating. For more information, visit her blog at www.hopewarshaw.com
The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.
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