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Insulin Resistance. Symptoms, Effects, and Treatment

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  • Insulin Resistance. Symptoms, Effects, and Treatment


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    A living organism consists of a huge number of cells that interact with each other. The coordinated work of all cells and the сentral nervous system is important (cells-neurons give commands to other cells of our body).

    Only effective transmission of information and strict performance of each cell's function can provide the body with a healthy and full existence.

    The human hormonal system is an information system that regulates the processes of the entire body: metabolism, digestion, sleep, and цake phases, feelings of hunger and satiety, good mood or depressive mood, and so on.


    Health directly depends on how well hormones transmit information to cells. For example, the hormone "insulin" should normally be responsible for the timely reduction of blood glucose levels.


    But sometimes this doesn't happen. So, why cells lose their sensitivity to insulin and how the pathological process of insulin resistance develops – let's talk about it today.

    In the beginning, let's look at the key concepts of insulin and blood glucose.

    Insulin is a hormone of peptide nature, formed in the beta cells of the islets of Langerhans of the pancreas. [1] Insulin has a multi-faceted effect on metabolism in almost all tissues.

    The main effect of insulin is to reduce the concentration of glucose in the blood. Insulin has both an anabolic effect (increases the synthesis of fats and proteins) and an anti-catabolic effect (suppresses the activity of enzymes that break down glycogen and fats).

    Glucose (grape sugar) is a monosaccharide, the final product of decomposition of most disaccharides and polysaccharides. [2] After a meal, the blood glucose level increases, and the pancreas releases insulin into the bloodstream, which interacts with the body's cells to deliver glucose via receptors.






    Main functions of insulin


    Positive:
    • Suppresses hunger, reduces appetite
    • Promotes the process of protein synthesis in the body
    • Promotes the penetration of the necessary substances into the cells (transports amino acids (BCAAs) to muscle cells)
    • Prevents the formation of ketone bodies*
    • Prevents the breakdown of muscles
    • Stimulates the liver and muscles to store glucose in the form of glycogen**


    Negative:
    • Slows down the process of splitting adipose tissue
    • High levels of insulin reduce the use of fat for energy
    • Increases the synthesis of free fatty acids in the liver (FFA)
    • Blocks the use of glycogen


    * ketone bodies are metabolic products formed in the liver. On a low-carb diet (keto), the content of ketone bodies in the body is increased, they are fuel for muscle tissue. During fasting, ketones are one of the main sources of energy for the brain.

    ** glycogen is an energy reserve (mainly in the liver and muscles), which can compensate for a sudden lack of glucose.




    Thus, the hormone insulin in normal amounts is one of the most important elements of the human body. But it happens that the pancreas produces insulin, but the cells in the body become resistant to it and can not use it effectively. This is how insulin resistance develops.

    Insulin resistance (IR) is a decrease in the response of insulin-sensitive cells to insulin when there is enough of it in the blood, leading to its chronic increased release in the body.

    IR is at the heart of the metabolic syndrome and, in most cases, remains unrecognized until it occurs. If a person with insulin resistance does not change their lifestyle, then they increase the risk of developing prediabetes and type 2 diabetes.

    IR creates unfavorable conditions, and the pancreas produces more and more insulin.

    It should be noted that IR can be physiological: puberty, pregnancy, bacterial infection, night sleep, high-carb diet. Excessive calorie intake, decreased activity, stress, poor sleep, etc. enhance IR.


    That is, IR helps a person survive in unfavorable environmental conditions. Physiological insulin resistance can turn into pathological, under the influence of a number of factors: genetic characteristics, medication intake, and, which is especially important for the modern world, as a result of an unbalanced diet, often accompanied by an excess of calories, and a sedentary lifestyle.

    Now let's take a closer look at symptoms, causes, consequences, and possible ways to deal with pathological IR. [3,4]

    It is important to diagnose serious metabolic disorders in time and understand that the decision concerning ways of treatment is made strictly individually in each case, only after consulting a specialist.






    Risk factors affecting the development of IR:
    • Overweight, obese (men with a waist circumference of more than 40 inches (102 cm); women - more than 34 inches (88 cm)
    • Age 40 or more
    • Burdened heredity (relatives with type 2 diabetes, hypertension, atherosclerosis)
    • A history of hypertension, high triglycerides, low levels of high-density lipoproteins, and atherosclerosis
    • Gestational diabetes mellitus (diabetes that occurs during pregnancy)
    • Polycystic ovary syndrome
    • Bad habits: smoking, alcohol, unhealthy diet



    Symptoms of insulin resistance:
    • High blood sugar
    • Abdominal obesity (belly fat)
    • Inability to lose weight or gain weight
    • Elevated triglyceride levels in the blood
    • Increased blood pressure
    • Increased feeling of hunger and thirst
    • Depression, insomnia
    • Inability to concentrate, drowsiness (especially after eating)
    • Tingling sensation in the extremities, frequent numbness, cramps of the calf muscles
    • Cracked heels
    • Short-term visual impairment (fog, blurring)
    • Dizzinesses
    • Pigmentation and rashes (red dots on the body, papillomas, keratomas)
    • A large number of fine lines; flabbiness and roughness on the skin
    • Dark circles and bags under the eyes
    • Hair in the chin area (in women); thinned eyebrows
    • Dark spots and roughness ("black acanthosis") - on the elbows, knees, fists, and armpits (typical for severe IR)




    Possible consequences of high insulin levels



    Atherosclerosis

    Excess insulin causes the accumulation of cholesterol plaques, narrowing of the arteries, and reduces blood flow, i.e. contributes to the formation of blood clots.



    Hypertension

    Food consumption increases the activity of the sympathetic nervous system: the heart, blood vessels, and kidneys. After a meal, insulin secretion increases, stimulating the consumption and exchange of glucose in the cells.


    The mechanism of food regulation of the activity of the sympathetic nervous system allows you to save calories during fasting, and with excessive energy intake from food, it helps to burn calories.


    Its effect is aimed at stabilizing the body's energy balance (maintaining weight). Thus, with insulin resistance, hyperactivation of the nervous system leads to the appearance of arterial hypertension, which is a kind of undesirable side effect of the mechanisms aimed at maintaining the body in balance.




    Cancer growth

    Since insulin is a growth hormone, it can also lead to the proliferation of cancers.



    Chronic inflammation

    Because of high insulin, arachidonic acid* is formed, which in turn turns into prostaglandin E2 – a substance that is the direct cause of pain at the biochemical level.

    Hyperinsulinemia also causes low levels of adiponectin**, which also increases inflammation. Inflammation that occurs as a result of a disease (for example, joints with arthrosis) is further accompanied and potentiated by pain. This is how a vicious circle develops: inflammation - pain - inflammation.


    *arachidonic acid – omega-6-unsaturated fatty acid, can be independently synthesized from the essential linoleic acid.

    **adiponectin, a hormone synthesized by white adipose tissue, is involved in the regulation of glucose levels and the breakdown of fatty acids.






    Consequences of insulin resistance


    Metabolic syndrome (MS)

    MS is manifested by an increase in visceral fat mass, a decrease in the sensitivity of peripheral tissues to insulin, and hyperinsulinemia, which disrupt carbohydrate, lipid, and purine metabolism, and also cause arterial hypertension. MS is a harbinger of type 2 diabetes.



    Prediabetes

    Blood glucose levels are higher than normal, but not high enough to make a diagnosis of type 2 diabetes.



    Type 2 diabetes mellitus (DM)

    Insulin-dependent diabetes, which is characterized by too high blood glucose levels, which over time leads to damage to nerves and blood vessels, leading to heart disease, stroke, blindness, kidney failure, and even amputation of the lower limbs.



    Laboratory diagnostics of insulin resistance

    It often happens that the sugar level remains at a normal level, but the insulin is high. Therefore, it is important to conduct a comprehensive survey, which includes:
    • Glucose tolerance test – diagnostics of glucose tolerance disorders
    • C-peptide – corresponds to the level of insulin produced in the body
    • Glycated hemoglobin – the average blood sugar content over a long period (up to three months)
    • Leptin – a hormone of adipose tissue, suppresses appetite, increases the sensitivity of liver cells and muscle tissue to the action of insulin. The content of leptin in the blood increases with increasing obesity, leptin resistance develops
    • Indicators of fat metabolism (lipid profile)
    • The current and most common method for assessing insulin resistance is to determine the basal ratio of glucose and insulin levels. [5] the study is conducted strictly on an empty stomach, after an 8-12-hour period of night fasting.




    Indicators are defined:


    Plasma glucose - mmol/l

    Insulin – immunoreactive insulin fasting state (mked/ml)

    The calculated index of insulin resistance HOMA - IR. The norm is less than 2.7. HOMA-IR index = (Glucose x Insulin) /22.5

    CARO insulin resistance index. The norm in a healthy person is not less than 0.33. CARO index = Glucose/Insulin

    Particular attention should be paid to the increase in fasting plasma levels of free fatty acids (FFA), as the earliest indication of a future violation of glucose tolerance.

    Based on all the data obtained, the specialist makes appropriate recommendations.






    Free fatty acids and insulin resistance


    FFA is the main "fuel" resource of the body. They are formed during lipolysis (splitting) of triglycerides (fats) accumulated in adipose tissue cells, as well as in lipoproteins (a complex of proteins and fats formed mainly in the liver and intestines).

    The level of FFA in the blood is subject to daily fluctuations, i.e. it increases and decreases, meeting the needs of our body.


    After each meal, the level of glucose in the blood increases; the hormone insulin suppresses lipolysis, which contributes to the formation of FFA, which means that their level in the blood plasma will decrease.


    The opposite situation occurs, for example, at night, when from the point of view of physiology, a person should rest from food and the level of glucose in plasma is lowered.

    Chronic increase and disruption of FFA metabolism are caused by poor nutrition (excess carbohydrates), lack of physical activity, and constant stress. If the body is healthy and all systems work smoothly, then the level of FFA is precisely balanced.

    Obese people have a large amount of adipose (adipose) tissue, which means that excessive amounts of FFA enter the bloodstream.

    If their further depot will be skeletal muscle tissue – this will lead to insulin resistance, if the liver – to dyslipidemia (abnormally elevated levels of lipids and/or lipoproteins in the human blood).






    Treatment of insulin resistance


    The most important thing in the fight against IR is the normalization of weight (reducing the level of adipose tissue). You can achieve weight loss both through nutrition and through an active lifestyle.



    Insulin Resistance Diet

    The rise of insulin during meals and its decrease after – this is good because it allows you to effectively control the level of sugar in the blood, ensuring the natural flow of important physiological processes.

    If you keep track of the number of meals, for example, eat three times a day, and strictly observe the intervals between meals, then the processes of fat accumulation and burning balance each other.

    Nutrition for insulin resistance is very important, it can both harm and significantly improve the situation. Eating unhealthy foods makes it extremely difficult for the body to cope with the existing problem.


    A ketogenic diet normalizes the production of insulin, reduces the concentration of sugar in the blood, cleanses, and strengthens blood vessels.


    Stress, poor sleep, and smoking are also factors that contribute to increased insulin (a non-food trigger of IR). [1,7]

    To increase insulin sensitivity, it is imperative to get rid of extra pounds. [3,4] but "fasting diets" do not benefit even completely healthy people. Let's take a closer look at what foods should be included in the diet, and which ones should be forgotten.

    First of all, it is necessary to follow the principles of a balanced diet — the diet should contain a sufficient amount of proteins, fats, trace elements, vitamins.

    Food should be cooked, baked, steamed, or grilled without oil.

    For a stable feeling of satiety throughout the day, it makes sense to avoid sudden spikes in blood sugar.

    A number of products, without bringing us absolutely no vitamin and mineral component, create an extra load on the digestive organs and also force our pancreas to work in an enhanced mode. Such foods need to be completely eliminated from your diet.





    The products listed below should be excluded
    • Сarbohydrates: flour, starch, sugar, honey, sweet syrups (fructose, agave, etc.).
    • Liquid calories: packaged juices, carbonated/energy drinks, and special attention to alcohol. There are studies that prove its harmful effect on the body, in particular on IR. Drink water (tea, black coffee).
    • All industrial confectionery products: cakes, candies, cakes, ice cream, etc.
    • All semi-finished products containing a large number of extra additives (flavor enhancers, colorants, stabilizers, preservatives): sausages, smoked meat, dumplings.
    • Fast food and fast food restaurant products.
    • All modern snacks: chips, crackers, popcorn.


    The diet should be built for the most part from simple and affordable products, unprocessed by industrial production.

    Any snack causes a jump in insulin, which means that the process of fat burning is blocked, but your appetite is growing. In the end - overeating - excess calories - the increase in weight. There are some studies confirming that the increase in insulin levels is caused by carbohydrate foods. A


    Unfortunately, in the modern world, you can hear from everywhere that you need to have a snack. Fitness marathons and inexperienced trainers promote 5-6 meals a day, which necessarily includes a "healthy snack".


    Office workers constantly chew something with tea/coffee, explaining that they can't afford a full meal due to workload, and a piece of cake or a slice of chocolate is the only thing that brings joy. TV screens are constantly streaming ads for "liquid calories," crispy chips and crackers, and sweet, supposedly nutritious bars.

    And how can you watch a movie without popcorn?

    It looks like this is another business income for the food industry. Our children are especially vulnerable because they believe everything if at home they are not convinced otherwise. It is worth paying special attention to the food culture in the family.


    Yes, for children, due to their rapid growth and development, more frequent meals are acceptable than for an adult, but it is important which ones. Definitely not sweet soda and chips. Remember, the most important thing is energy balance.


    And you need to choose a diet that will become your way of life, and not a temporary necessity.

    Only in this case, success is guaranteed: extra pounds will go away, the body will improve its health and gratefully respond with the absence of "sores". Nutrition must take into account all the features of your unique body, give a boost of vivacity, and provide nutrients.






    Insulin resistance and physical activity

    Any type of physical activity allows insulin to work more effectively, while the combination of aerobic and strength training provides the most pronounced effect. [5,6,2]


    During training, the body actively uses energy (glucose) from muscle glycogen, and after training, the muscles need to replenish their glycogen reserves. Insulin sensitivity increases.


    Aerobic training can dramatically increase insulin sensitivity by increasing glucose uptake by cells. The more intense the training, the higher sensitivity to insulin.

    To sum up: any disease is easier to prevent than to treat the consequences. Be attentive to your health, follow the keto diet, maintain physical activity, check up on time, and do not hesitate to seek help from specialists.




    Recommended for you:

    How the Keto Diet Can Help Reverse Diabetes

    Keto diet for diabetics. The only way to reverse diabetes naturally

    Why and How A Low-Carb Diet Cures Diabetes

    Type 2 Diabetes - A Disease That Shouldn't Exist





    References:

    1. Buxton O. M., Pavlova M. et al., Sleep restriction for 1 week reduces insulin sensitivity in healthy men, Diabetes. 2010 Sep;59(9)

    2. Black L. E., Swan P. D. et al., Effects of intensity and volume on insulin sensitivity during acute bouts of resistance training, J Strength Cond Res. 2010 Apr;24(4)

    3. Davis N. J., Tomuta N. et al., Comparative study of the effects of a 1-year dietary intervention of a low-carbohydrate diet versus a low-fat diet on weight and glycemic control in type 2 diabetes, Diabetes Care. 2009 Jul;32(7)

    4. F. M. Sacks, V. J. Carey et al., Effects of High vs Low Glycemic Index of Dietary Carbohydrate on Cardiovascular Disease Risk Factors and Insulin Sensitivity, The OmniCarb Randomized Clinical Trial, JAMA. 2014;312(23)

    5. Holloszy J. O., Exercise-induced increase in muscle insulin sensitivity, J Appl Physiol (1985). 2005 Jul;99(1)

    6. Dubé J. J., Allison K. F. et al., Exercise dose and insulin sensitivity: relevance for diabetes prevention, Med Sci Sports Exerc. 2012 May;44(5):793-9

    7. Haj Mouhamed D., Ezzaher A. et al., Effect of cigarette smoking on insulin resistance risk, Ann Cardiol Angeiol (Paris). 2016 Feb;65(1)
    Last edited by Barbara Radcliffe; 10-02-2020, 06:55 AM.

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