Drowsiness after a meal, problems with weight loss, headaches, hunger pangs, excessive craving for sweets, constant fatigue are just some of the symptoms that may indicate the presence of an increasingly common disorder, which is insulin resistance. What is insulin resistance? Who is exposed to it and what is its treatment?
What is insulin resistance?
Insulin resistance in itself is not a disease, but a metabolic disorder that if untreated can predispose to the development of many diseases. It is a state of impaired response of tissues (especially liver, muscles and adipose tissue) to insulin, despite its normal or increased blood concentration. This hormone is secreted by the pancreas and is responsible for regulating blood glucose levels. Since with insulin resistance, target cells do not respond to insulin signals, blood glucose levels are not lowered. Consequently, the pancreas additionally secretes larger amounts of insulin, which over time leads to hypertrophy and death of the organ's beta cells. In addition, the excess of circulating insulin influences the development of adipose tissue, which results in even greater insulin resistance. This situation resembles a vicious circle that leads to the development of hyperglycemia and diabetes. It has been shown that reduced insulin sensitivity can appear more than 10 years before the onset of type 2 diabetes and that it is the strongest factor in the development of this disease. In the early stages of insulin resistance, glucose levels remain within the reference norm range. Over time, a pre-diabetic state develops, then when approximately 80-90% of the pancreatic islets are destroyed, diabetes develops.
Insulin resistance may be genetic or acquired. It is estimated that in Poland it is very common, in the age group of 35-79 years it occurs in about 40% of people.
The most common symptoms that may indicate insulin resistance
Up to a certain point, insulin resistance may develop and not give any characteristic symptoms. Over time, however, disturbing and bothersome symptoms appear. Those occurring most frequently include:
- unintentional weight gain,
- drowsiness after meals,
- mental sluggishness,
- worsening of mood,
- trouble concentrating,
- irritability,
- feeling constantly tired,
- hunger pangs,
- frequent cravings for sweets,
- difficulty losing weight.
Causes of insulin resistance
There are many causes of insulin resistance and not all are fully understood at present. One of the most important is overweight and obesity, especially abdominal type. It is defined as waist circumference over 80 cm in case of women and 94 cm in case of men. In the prevention of insulin resistance it is therefore very important to keep body weight within normal range and to prevent overweight and obesity. In addition, excessive calorie intake, frequent consumption of products with a high glycemic index, which cause increased insulin production, inflammation in the body and genetic factors may lead to the development of insulin resistance.
Insulin resistance-diagnosis
Insulin resistance is difficult to diagnose and may present many years before full-blown diabetes. The normoglycemic hyperinsulinemic clamp is considered the "gold standard" method for the diagnosis of insulin resistance, but for practical reasons it is not used as a primary screening test. Currently, diagnosis is based mainly on fasting glucose and insulin determination and OGTT- oral glucose load test. It involves analysis of fasting glucose and insulin and the first and second hour after administration of 75g of glucose. High levels of insulin in the blood that do not adequately lower glucose may indicate the presence of insulin resistance. Endocrinology consultation is necessary to select the appropriate test, make a diagnosis, and obtain guidance for further management.
Treatment of insulin resistance
The treatment of insulin resistance requires lifestyle changes. First and foremost, a well-chosen diet is considered as the basis of treatment, in addition to regular physical activity, as well as stress reduction and attention to sleep. These factors seem to be the best way to overcome this disorder. People with insulin resistance who are overweight or obese are advised to reduce their body weight gradually. Loss of excess body weight is associated with increased insulin sensitivity and inhibition of progression of pre-diabetes to diabetes. Diet should take into account the individual choice of energy intake depending on age, gender, body weight, lifestyle, among others. In addition, the diet with insulin resistance should be based primarily on products with a low glycemic index. Such products stimulate insulin secretion the least. It is not a simple diet - it requires, among other things, taking into account how the glycemic index of given products changes during thermal processing or depending on factors such as their degree of chopping or ripeness (e.g. fruit). It is also important to consider how meals are composed and their total glycemic load. The focus should be on changing eating habits rather than on quick and often unsustainable results. It is important to analyze your current habits in detail, recognize mistakes, and gradually make changes. It is very important to be systematic and consistent. In some cases drug treatment in the form of metformin is also required.
Why is untreated insulin resistance dangerous?
Long-term persistence of insulin resistance and continuous increase of insulin production leads to wear and tear of pancreatic islets and development of diabetes. An additional problem is the increase of insulin resistance along with worsening obesity, which stimulate each other to increase by a vicious circle mechanism. Untreated insulin resistance leads to many complications. Its direct consequence is the formation of metabolic syndrome, which includes both disorders of carbohydrate metabolism, obesity, hypertension and disorders of lipid metabolism. These problems promote the development of atherosclerosis and an increased risk of heart attack and stroke. Insulin resistance may lead to fatty liver, polycystic ovary syndrome and decreased testosterone production in men.
Therefore, it is worth to observe one's mood and react quickly enough to avoid dangerous complications caused by untreated insulin resistance.
Source:
- Brown AE, Walker M. :Genetics of Insulin Resistance and the Metabolic Syndrome. Curr Cardiol Rep. 2016;18(8):75.
- Napiórkowska L., Franek E.: Insulinooporność a stan przedcukrzycowy. Post N Med 2017; 30(02): 84-88.
- Suliburska J., Kuśnierek J.: Czynniki żywieniowe i pozażywieniowe w rozwoju insulinooporności. Forum Zaburzeń Metabolicznych 2010, 1 ( 3):177–183.
